Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your medical history, especially of:. Ondansetron may cause a condition that affects the heart rhythm QT prolongation. The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation.
Before using ondansetron, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions:. Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. Talk to your doctor about using ondansetron safely. This drug may make you dizzy or drowsy or blur your vision.
Alcohol or marijuana cannabis can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely.
Limit alcoholic beverages. Talk to your doctor if you are using marijuana cannabis. Infants younger than 5 months may be more sensitive to the effects of this drug, especially diarrhea. Older adults may be more sensitive to the side effects of this drug, especially QT prolongation see also How To Use section.
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Many drugs besides ondansetron may affect the heart rhythm QT prolongation , including dofetilide, pimozide, procainamide, amiodarone, quinidine, sotalol, macrolide antibiotics such as erythromycin , among others.
Therefore, before using ondansetron, report all medications you are currently using to your doctor or pharmacist. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call Otherwise, call a poison control center right away.
US residents can call their local poison control center at Canada residents can call a provincial poison control center.
Symptoms of overdose may include: change in vision, severe dizziness, irregular heartbeat. Consult your doctor for more details. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of ondansetron injection in the elderly. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur.
In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below.
The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur.
Using alcohol or tobacco with certain medicines may also cause interactions to occur. Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
The presence of other medical problems may affect the use of this medicine. Show all parts of this monograph Drug action Indications and dose Important safety information Contra-indications Cautions Interactions Side-effects Pregnancy Breast feeding Hepatic impairment Directions for administration Prescribing and dispensing information Patient and carer advice Medicinal forms Drug action Ondansetron is a specific 5HT 3 -receptor antagonist which blocks 5HT 3 receptors in the gastro-intestinal tract and in the CNS.
Individual interactants: Ondansetron. Common or very common Constipation ; feeling hot ; headache ; sensation abnormal. Uncommon Arrhythmias ; chest pain ; hiccups ; hypotension ; movement disorders ; oculogyric crisis ; seizure. Rare or very rare Dizziness ; QT interval prolongation ; vision disorders. Present in milk in animal studies—avoid. Manufacturer advises caution in moderate to severe impairment decreased clearance. The two drugs are from the same therapeutic class, and would not be expected to be prescribed together.
Serotonergic actions of the two drugs might also increase the risk for additive serotonergic side effects. Guaifenesin; Hydrocodone: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering hydrocodone with serotonin-receptor antagonists. Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering hydrocodone with serotonin-receptor antagonists.
Halogenated Anesthetics: Major If ondansetron and halogenated anesthetics must be coadministered, ECG monitoring is recommended. Haloperidol: Major If ondansetron and haloperidol must be coadministered, ECG monitoring is recommended. QT prolongation and TdP have been observed during haloperidol treatment. Excessive doses particularly in the overdose setting or IV administration of haloperidol may be associated with a higher risk of QT prolongation.
Halothane: Major If ondansetron and halogenated anesthetics must be coadministered, ECG monitoring is recommended. Homatropine; Hydrocodone: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering hydrocodone with serotonin-receptor antagonists. Hydrocodone: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering hydrocodone with serotonin-receptor antagonists.
Hydrocodone; Ibuprofen: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering hydrocodone with serotonin-receptor antagonists. Hydrocodone; Phenylephrine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering hydrocodone with serotonin-receptor antagonists.
Hydrocodone; Potassium Guaiacolsulfonate: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering hydrocodone with serotonin-receptor antagonists. Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering hydrocodone with serotonin-receptor antagonists.
Hydrocodone; Pseudoephedrine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering hydrocodone with serotonin-receptor antagonists. Hydrocortisone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Hydromorphone: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering hydromorphone with serotonin-receptor antagonists.
Hydroxychloroquine: Major Avoid coadministration of ondansetron and hydroxychloroquine due to an increased risk of QT prolongation. Hydroxychloroquine prolongs the QT interval. Postmarketing data indicate that hydroxyzine causes QT prolongation and TdP. Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: Major Because of the potential risk and severity of serotonin syndrome, use caution when administering ondansetron with other drugs that have serotonergic properties such as methylene blue.
Ibuprofen; Oxycodone: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering oxycodone with serotonin-receptor antagonists.
Ibutilide: Major Ondansetron has been associated with QT prolongation and post-marketing reports of torsade de pointes TdP. Iloperidone: Major Iloperidone has been associated with QT prolongation; however, torsade de pointes TdP has not been reported. According to the manufacturer, since iloperidone may prolong the QT interval, it should be avoided in combination with other agents also known to have this effect, such as ondansetron.
If coadministration is unavoidable, obtain an ECG and serum electrolytes prior to the start of treatment, after treatment initiation, and periodically during treatment. Inotuzumab has been associated with QT interval prolongation. Ipecac: Major Ipecac has been shown to be effective in producing emesis in patients who have ingested antiemetics, provided ipecac is given promptly usually within 1 hour of antiemetic consumption.
If ipecac is administered after the antiemetic therapy has begun to exert therapeutic effects, ipecac may be less effective. The duration of the antiemetics action may need to be taken into account when selecting the appropriate clinical path for treating patients for overdosage. Patients on chronic or longer-acting antiemetic therapy, such as the 5HT-3 receptor antagonists, may be unresponsive to ipecac or other methods which induce vomiting.
Ipratropium; Albuterol: Minor Ondansetron has been associated with QT prolongation and post-marketing reports of torsade de pointes TdP. Caution and close monitoring are advised if these drugs are used together. Isocarboxazid: Moderate Because of the potential risk and severity of serotonin syndrome, use caution when administering ondansetron with other drugs that have serotonergic properties such as monoamine oxidase inhibitors MAOIs.
Serotonin syndrome has been described following the concomitant use of 5-HT3 receptor antagonists and other serotonergic drugs.
Monitor for the emergence of serotonin syndrome. Isoflurane: Major If ondansetron and halogenated anesthetics must be coadministered, ECG monitoring is recommended. Isoniazid, INH; Pyrazinamide, PZA; Rifampin: Minor Rifampin may reduce the efficacy of ondansetron by decreasing its systemic exposure; however, based on available data, no ondansetron dosage adjustment is recommended.
The proposed mechanism is rifampin-related induction of ondansetron metabolism through cytochrome P 3A4. These changes in ondansetron exposure with CYP3A4 inducers are not thought to be clinically relevant. Isoniazid, INH; Rifampin: Minor Rifampin may reduce the efficacy of ondansetron by decreasing its systemic exposure; however, based on available data, no ondansetron dosage adjustment is recommended. Itraconazole: Major Caution is advised when administering itraconazole with drugs that are known to prolong that QT interval and are metabolized by CYP3A4, such as ondansetron.
Both ondansetron and itraconazole are associated with QT prolongation; coadministration may increase this risk. In addition, coadministration of itraconazole a potent CYP3A4 inhibitor with ondansetron a CYP3A4 substrate may result in elevated ondansetron plasma concentrations and an increased risk for adverse events, including QT prolongation. If itraconazole therapy is stopped, it may be prudent to continue close monitoring for up to 2 weeks after discontinuing itraconazole. Once discontinued, the plasma concentration of itraconazole decreases to almost undetectable concentrations within 7 to 14 days.
The decline in plasma concentrations may be even more gradual in patients with hepatic cirrhosis or who are receiving concurrent CYP3A4 inhibitors. Ivosidenib: Major Avoid coadministration of ivosidenib with ondansetron due to an increased risk of QT prolongation. If concomitant use is unavoidable, monitor ECGs for QTc prolongation and monitor electrolytes; correct any electrolyte abnormalities as clinically appropriate.
An interruption of therapy and dose reduction of ivosidenib may be necessary if QT prolongation occurs. Prolongation of the QTc interval and ventricular arrhythmias have been reported in patients treated with ivosidenib.
Ixabepilone: Minor Ixabepilone is a weak inhibitor of P-glycoprotein Pgp. Ondansetron is a Pgp substrate, and concomitant use of ixabepilone with a Pgp substrate may cause an increase in ondansetron concentrations. Use caution if ixabepilone is coadministered with a Pgp substrate. Ketoconazole: Major Caution is advised when administering ketoconazole with drugs that are known to prolong that QT interval and are metabolized by CYP3A4, such as ondansetron.
Both ondansetron and ketoconazole are associated with QT prolongation; coadministration may increase this risk. In addition, coadministration of ketoconazole a potent CYP3A4 inhibitor with ondansetron a CYP3A4 substrate may result in elevated ondansetron plasma concentrations and an increased risk for adverse events, including QT prolongation.
Lapatinib: Major Monitor ECGs for QT prolongation and monitor electrolytes if coadministration of lapatinib with ondansetron is necessary; correct electrolyte abnormalities prior to treatment. Lapatinib has been associated with concentration-dependent QT prolongation; ventricular arrhythmias and torsade de pointes TdP have been reported in postmarketing experience with lapatinib. Ondansetron has also been associated with a dose-related increase in the QT interval and postmarketing reports of TdP.
Lasmiditan: Moderate Serotonin syndrome may occur during coadministration of lasmiditan and serotonin-receptor antagonists. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome, particularly after a dose increase or the addition of other serotonergic medications to an existing regimen.
Discontinue all serotonergic agents if serotonin syndrome occurs and implement appropriate medical management. Ledipasvir; Sofosbuvir: Moderate Caution and close monitoring of ondansetron-associated adverse reactions is advised with concomitant administration of ledipasvir. Ondansetron is a substrate of the drug transporter P-glycoprotein P-gp ; ledipasvir is a P-gp inhibitor. Taking these drugs together may increase ondansetron plasma concentrations.
Lefamulin: Major Avoid coadministration of lefamulin with ondansetron as concurrent use may increase the risk of QT prolongation. If coadministration cannot be avoided, monitor ECG during treatment. Lefamulin has a concentration dependent QTc prolongation effect.
The pharmacodynamic interaction potential to prolong the QT interval of the electrocardiogram between lefamulin and other drugs that effect cardiac conduction is unknown. Lenvatinib: Major Avoid coadministration of lenvatinib with ondansetron due to the risk of QT prolongation.
Prolongation of the QT interval has been reported with lenvatinib therapy. Levalbuterol: Minor Ondansetron has been associated with QT prolongation and post-marketing reports of torsade de pointes TdP. Levofloxacin has been associated with a risk of QT prolongation and TdP. Although extremely rare, TdP has been reported during postmarketing surveillance of levofloxacin.
Levomethadyl: Contraindicated Rarely and predominantly reported with intravenous ondansetron, transient ECG changes including QT prolongation have occurred. Levorphanol: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering levorphanol with serotonin-receptor antagonists.
Linezolid: Major Because of the potential risk and severity of serotonin syndrome, use caution when administering ondansetron with other drugs that have serotonergic properties such as linezolid.
Lithium: Major Ondansetron and lithium are associated with QT prolongation. Coadministration may increase the risk of QT prolongation; therefore, ondansetron and lithium should be coadministered with caution and close monitoring. Because of the potential risk and severity of serotonin syndrome, use caution when administering ondansetron with other drugs that have serotonergic properties such as lithium.
Moderate Moderate to significant dietary sodium changes, or changes in sodium and fluid intake, may affect lithium excretion. Systemic sodium chloride administration may result in increased lithium excretion and therefore, decreased serum lithium concentrations.
In addition, high fluid intake may increase lithium excretion. For patients receiving sodium-containing intravenous fluids, symptom control and lithium concentrations should be carefully monitored. It is recommended that patients taking lithium maintain consistent dietary sodium consumption and adequate fluid intake during the initial stabilization period and throughout lithium treatment. Supplemental oral sodium and fluid should be only be administered under careful medical supervision.
Lofexidine prolongs the QT interval. In addition, there are postmarketing reports of TdP. Long-acting beta-agonists: Moderate Ondansetron has been associated with QT prolongation and post-marketing reports of torsade de pointes TdP. Potassium levels should be within the normal range prior to and during therapy with ondansetron. At high doses, loperamide has been associated with serious cardiac toxicities, including syncope, ventricular tachycardia, QT prolongation, torsade de pointes TdP , and cardiac arrest.
Ondansetron has also been associated with an increased risk of QT prolongation and TdP. Risk for QT prolongation increases with increased dosage, and a 32 mg IV dose of ondansetron must no longer be used for the prevention of chemotherapy-induced nausea and vomiting.
Lopinavir; Ritonavir: Major Avoid coadministration of lopinavir with ondansetron due to the potential for additive QT prolongation. If use together is necessary, obtain a baseline ECG to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances.
Lopinavir is associated with QT prolongation. Moderate Caution and close monitoring are advised if these drugs are administered together. Lumacaftor; Ivacaftor: Minor Lumacaftor; ivacaftor may reduce the efficacy of ondansetron by decreasing its systemic exposure; however, based on available data, no ondansetron dosage adjustment is recommended.
Lumacaftor is a strong CYP3A inducer. Macimorelin: Major Avoid concurrent administration of macimorelin with drugs that prolong the QT interval, such as ondansetron. Use of these drugs together may increase the risk of developing torsade de pointes-type ventricular tachycardia.
Sufficient washout time of drugs that are known to prolong the QT interval prior to administration of macimorelin is recommended. Treatment with macimorelin has been associated with an increase in the corrected QT QTc interval.
Maprotiline: Major Due to a possible risk for QT prolongation and torsade de pointes TdP , ondansetron and maprotiline should be used together cautiously. There is evidence that the use of halofantrine after mefloquine causes a significant lengthening of the QTc interval. Mefloquine alone has not been reported to cause QT prolongation. However, due to the lack of clinical data, mefloquine should be used with caution in patients receiving drugs that prolong the QT interval.
Meperidine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering meperidine with serotonin-receptor antagonists. Meperidine; Promethazine: Major If ondansetron and promethazine must be coadministered, ECG monitoring is recommended.
Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering meperidine with serotonin-receptor antagonists. Mesoridazine: Contraindicated Rarely and predominantly reported with intravenous ondansetron, transient ECG changes including QT prolongation have occurred. Most cases involve patients being treated for pain with large, multiple daily doses of methadone, although cases have been reported in patients receiving doses commonly used for maintenance treatment of opioid addiction.
Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: Major Because of the potential risk and severity of serotonin syndrome, use caution when administering ondansetron with other drugs that have serotonergic properties such as methylene blue. Methylene Blue: Major Because of the potential risk and severity of serotonin syndrome, use caution when administering ondansetron with other drugs that have serotonergic properties such as methylene blue.
Methylprednisolone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Midostaurin: Major The concomitant use of midostaurin and ondansetron may lead to additive QT interval prolongation.
If these drugs are used together, perform electrocardiogram monitoring. In clinical trials, QT prolongation has been reported in patients who received midostaurin as single-agent therapy or in combination with cytarabine and daunorubicin.
Ondansetron has been associated with QT prolongation and torsade de pointes. Mifepristone: Major Due to a possible risk for QT prolongation and torsade de pointes TdP , mifepristone and ondansetron should be used together cautiously. Mifepristone has been associated with dose-dependent prolongation of the QT interval. There is no experience with high exposure or concomitant use with other QT prolonging drugs.
To minimize the risk of QT prolongation, the lowest effective dose should always be used. Ondansetron has been associated with QT prolongation and postmarketing reports of TdP. Exposure of drugs partially metabolized by CYP2D6, such as ondansetron may be increased when co-administered with mirabegron.
Therefore, appropriate monitoring and dose adjustment may be necessary. Mirtazapine: Major Concomitant use of mirtazapine and ondansetron may increase the risk of serotonin syndrome, QT prolongation, and torsade de pointes. Cases of QT prolongation, TdP, ventricular tachycardia, and sudden death have been reported during use of mirtazapine, primarily after overdose or in patients with risk factors for QT prolongation e. In addition, both mirtazapine and ondansetron have central serotonin-enhancing effects; therefore, serotonin syndrome is possible.
Mitotane: Minor Use caution if mitotane and ondansetron are used concomitantly, and monitor for decreased efficacy of ondansetron and a possible change in dosage requirements. Mitotane is a strong CYP3A4 inducer and ondansetron is a CYP3A4 substrate; coadministration may result in decreased plasma concentrations of ondansetron. Mometasone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Monoamine oxidase inhibitors: Moderate Because of the potential risk and severity of serotonin syndrome, use caution when administering ondansetron with other drugs that have serotonergic properties such as monoamine oxidase inhibitors MAOIs.
Morphine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering morphine with serotonin-receptor antagonist. Morphine; Naltrexone: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering morphine with serotonin-receptor antagonist.
Moxifloxacin: Major Concurrent use of ondansetron and moxifloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes TdP.
Nilotinib: Major Avoid coadministration of nilotinib with ondansetron due to an increased risk for QT prolongation and torsade de pointes TdP. Systemic exposure of ondansetron may also be increased resulting in an increase in ondansetron-related adverse reactions.
Nilotinib is a moderate CYP3A4 inhibitor; sudden death and QT interval prolongation have occurred in patients who received nilotinib therapy. Norfloxacin: Major Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when administering ondansetron with norfloxacin.
Arrhythmias, sinus bradycardia, and conduction disturbances have occurred during octreotide therapy. Since bradycardia is a risk factor for development of TdP, the potential occurrence of bradycardia during octreotide administration could theoretically increase the risk of TdP in patients receiving drugs that prolong the QT interval.
Ofloxacin: Major Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when administering ondansetron with ofloxacin. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval. Major Taking these drugs together may result in serotonin syndrome. Oliceridine: Moderate If concomitant use of oliceridine and serotonin-receptor antagonists is warranted, monitor patients for the emergence of serotonin syndrome.
Olodaterol: Moderate Ondansetron has been associated with QT prolongation and post-marketing reports of torsade de pointes TdP. Omeprazole; Amoxicillin; Rifabutin: Minor Monitor for altered response to ondansetron during coadministration of rifabutin. Rifabutin may increase the clearance and decrease blood concentrations of ondansetron.
However, no dosage adjustment for ondansetron is recommended during coadministration. Plasma concentrations and efficacy of ondansetron may be reduced if these drugs are administered concurrently.
Osilodrostat is associated with dose-dependent QT prolongation. Ondansetron has been associated with a dose-related increase in the QT interval and postmarketing reports of torsade de pointes. Osimertinib: Major Avoid coadministration of ondansetron with osimertinib if possible due to the risk of QT prolongation and torsade de pointes TdP.
If concomitant use is unavoidable, periodically monitor ECGs for QT prolongation and monitor electrolytes; an interruption of osimertinib therapy with dose reduction or discontinuation of therapy may be necessary if QT prolongation occurs. Concentration-dependent QTc prolongation occurred during clinical trials of osimertinib. Oxaliplatin: Major Monitor electrolytes and ECGs for QT prolongation if coadministration of ondansetron with oxaliplatin is necessary; correct electrolyte abnormalities prior to administration of oxaliplatin.
QT prolongation and ventricular arrhythmias including fatal TdP have also been reported with oxaliplatin use in postmarketing experience. Oxybutynin: Moderate The plasma concentrations of oxybutynin may be elevated when administered concurrently with cobicistat. Clinical monitoring for adverse effects, such as increased anticholinergic activity, is recommended during coadministration.
Oxycodone: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering oxycodone with serotonin-receptor antagonists.
Oxymorphone: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering oxymorphone with serotonin-receptor antagonists. Ozanimod: Major In general, do not initiate ozanimod in patients taking ondansetron due to the risk of additive bradycardia, QT prolongation, and torsade de pointes TdP. Additionally, there is a potential for hypertensive crisis. If concomitant use is necessary, monitor ECGs and for hypertension.
An active metabolite of ozanimod inhibits MAO-B, which may increase the potential for hypertensive crisis. Ozanimod may also result in a transient decrease in heart rate and atrioventricular conduction delays. Ozanimod has not been studied in patients taking concurrent QT prolonging drugs; however, QT prolonging drugs have been associated with TdP in patients with bradycardia.
Ondansetron is a serotonergic drug that has been associated with a dose-related increase in the QT interval and postmarketing reports of TdP. Paliperidone: Major Avoid coadministration of paliperidone and ondansetron if possible due to the potential for QT prolongation. If ondansetron and paliperidone must be coadministered, ECG monitoring is recommended and close monitoring is recommended in patients with known risk factors for cardiac disease or arrhythmias.
Paliperidone has been associated with QT prolongation; TdP and ventricular fibrillation have been reported in the setting of overdose. According to the manufacturer of paliperidone, the drug should be avoided in combination with other agents also known to have this effect. Panobinostat: Major The co-administration of panobinostat with antiemetic agents such as ondansetron may increase the risk of QT prolongation.
If concomitant use cannot be avoided, obtain electrocardiograms frequently and closely monitor patients for signs and symptoms of ondansetron toxicity, including QT prolongation and cardiac arrhythmias. Paroxetine: Major Because of the potential risk and severity of serotonin syndrome, use caution when administering ondansetron with other drugs that have serotonergic properties such as paroxetine.
In addition, because ondansetron is a CYP2D6 substrate and has a possible risk of QT prolongation and torsade de pointes, concurrent use of a potent CYP2D6 inhibitor such as paroxetine may increase the risk of such events. Pasireotide: Major If ondansetron and pasireotide must be coadministered, ECG monitoring is recommended, as coadministration may have additive effects on the prolongation of the QT interval. QT prolongation has occurred with pasireotide at therapeutic and supra-therapeutic doses.
Pazopanib: Major Coadministration of pazopanib and ondansetron is not advised. Pazopanib has been reported to prolong the QT interval. Pentamidine: Major Due to a possible risk for QT prolongation and torsade de pointes TdP , ondansetron and pentamidine should be used together cautiously. Phenytoin: Minor Phenytoin may reduce the efficacy of ondansetron by decreasing its systemic exposure; however, based on available data, no ondansetron dosage adjustment is recommended. Phenytoin is a strong CYP3A inducer.
Pimavanserin: Major Pimavanserin should be avoided in combination with ondansetron. Pimavanserin may cause QT prolongation.
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