Ondansetron - Chris Aiken, MD

Ondansetron (Zofran)

Antiemetic (serotonin 5-HT3 antagonist)

OCD¹
Alcohol binge drinking²

Bulimia³

Features

Generic, Non-sedating, Medication, Weight-Free, Elderly-Safe, Sexual-free, Child-Approved, Tolerable, Non-controlled, Bipolar-Safe

Handout

Dosing

4 mg qd (some need 8 mg). Can give ODT ($6/mth at costplusdrugs.com). In bulimia it improved satiety at a dose of 24 mg/day (but I would start low, 4 mg/day, and titrate as needed).

Often insurance won’t cover full 30 days, and we can’t approve as it is not a psychiatric med, but out of pocket is cheap (costplusdrugs.com, goodrx).

Management

Use for real OCD, not obsessional anxiety that is due to GAD or depressive rumination. As an alternative, consider granesitron, but that one is more expensive and not as well studied.

TOLERABILITY: Constipation.

RISK: QTc prolongation.

EMR Text

OCD

Ondansetron use based on randomized controlled trials in OCD (Heidari M et al, Int Clin Psychopharmacol. 2014;29(6):344-350).

Ondansetron side effects reviewed with patient.

Alcohol

Ondansetron use based on randomized controlled trials in alcohol use disorder (Johnson B et al, Eur J Intern Med. 2024;127:50-62).

Ondansetron side effects reviewed with patient.

Binge eating

Ondansetron use based on a randomized controlled trial in bulimia where it reduced binge/purge frequency (Faris PL et al, Lancet 2000;355(9206):792-797).

Ondansetron side effects reviewed with patient.

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