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Ondansetron in Patients Requiring Anti-Emetics: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Last updated: August 4, 2020
Project Number: RC1297-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of oral ondansetron versus intravenous ondansetron?
  2. What is the comparative clinical effectiveness of ondansetron versus other anti-emetic agents for palliative patients?
  3. What is the comparative cost-effectiveness of ondansetron versus other anti-emetic agents for palliative patients?
  4. What are the evidence-based guidelines regarding the use of ondansetron for palliative patients?

Key Message

Evidence from one double-blind, randomized controlled trial suggested no difference in effectiveness between 4 mg or 8 mg orally disintegrating film tablets and 4 mg intravenous ondansetron in controlling the overall incidence of postoperative nausea and vomiting in women who underwent elective gynecological laparoscopic procedures. However, within the first six hours after surgery, the incidence of vomiting was statistically significantly lower with the 8 mg oral formulation than with the 4 mg intravenous ondansetron. There were no significant differences between any of the studied ondansetron formulations regarding incidence of postoperative nausea, analgesic consumption, time to oral intake, overall patient satisfaction, and side effects. A key source of uncertainty in the evidence was that it was based on one randomized controlled trial with an unclear level of statistical power to identify clinically meaningful differences in effects between treatment groups. Also, the study was conducted in women undergoing elective gynecological laparoscopic procedures at a single center in India, and the generalizability of the findings to patients requiring medication to control nausea and vomiting of different etiology is unknown.No relevant evidence was identified regarding the comparative clinical effectiveness or cost-effectiveness of ondansetron versus other anti-emetic agents for palliative patients. Similarly, no evidence-based guidelines for the use of ondansetron in palliative patients were identified.