THE CLINICAL USE OF ONDANSETRON

Objective: To establish guidelines for use of ondansetron. Data source s: MEDELINE computer search (to July 1993) and information from the ma nufacturer. Data extraction: We circulated a position paper based on o ur literature review for comment by clinicians and directors of pharma cy in major teaching hospitals in New South Wales who had an interest in ondansetron. Data synthesis: Ondansetron is effective in the contro l of nausea and vomiting occurring 24-48 hours after highly emetogenic chemotherapy and after radiotherapy. There are no data to support its use in delayed emesis. Combination with dexamethasone may improve eme tic control. The most commonly reported adverse effects are headache a nd constipation. Optimal dose, frequency of dosing and route of admini stration have not been established. The cost for each inpatient treate d successfully is about 3% more than conventional antiemetic therapy. Conclusions: Ondansetron shows clinical benefit in the management of a cute nausea and vomiting in patients receiving highly emetogenic chemo therapy, those who have responded poorly to other antiemetics after mo derately emetogenic chemotherapy, those who have intolerable side effe cts with conventional antiemetic agents and those receiving radiothera py to the upper abdomen. It is also marketed far the prevention and tr eatment of postoperative nausea and vomiting.