Volume 199 - Issue 11
An audit of the use of ondansetron in general medical patients
Authors: Penelope J Cotton and Samer Q Noaman
Med J Aust 2013; 199 (11): 748-750. || doi: 10.5694/mja13.10815
Published online: 16 December 2013
Published online: 16 December 2013
To the Editor: Ondansetron is a 5-HT3 receptor antagonist and an effective antiemetic in the treatment of acute chemotherapy- or radiotherapy-induced nausea and vomiting1 and postoperative nausea and vomiting.2 However, there is no evidence to support the superiority
of ondansetron in the empirical management of undifferentiated nausea and vomiting,1 although this appears to have become common practice. Trials comparing ondansetron and other antiemetics (such as ...
To the Editor: Ondansetron is a 5-HT3 receptor antagonist and an effective antiemetic in the treatment of acute chemotherapy- or radiotherapy-induced nausea and vomiting1 and postoperative nausea and vomiting.2 However, there is no evidence to support the superiority of ondansetron in the empirical management of undifferentiated nausea and vomiting,1 although this appears to have become common practice. Trials comparing ondansetron and other antiemetics (such as metoclopramide or promethazine) in the management of undifferentiated nausea have failed to show a significant difference in efficacy.3,4 Clinical guidelines for managing nausea and vomiting have been shown to increase compliance with consensus guidelines and reduce costs to health services associated with antiemetic prescribing.5
We conducted a retrospective audit of antiemetic prescribing for patients admitted to general medical units at Ballarat Base Hospital from 1 January 2012 until 30 March 2012. A total of 514 eligible patients were identified, and of those, 208 general medical patients (40%) were prescribed an antiemetic. Of these 208, 92 (44%) were prescribed ondansetron. Of those prescribed ondansetron, 23 (25%) were prescribed ondansetron only and 69 (75%) were prescribed ondansetron in addition to other antiemetics. In total, 18% of eligible general medical patients were prescribed ondansetron, but only one patient had a documented indication that met the recommended guidelines for the use of ondansetron.
A total of 104 doses of ondansetron were administered to patients identified during the study. Substituting each of these doses with metoclopramide would be associated with significant relative cost savings to the health service.
This audit suggests that ondansetron is being used to manage undifferentiated nausea and vomiting in general medical patients outside of recommended guidelines.
We urge practitioners to consider the implications of their antiemetic prescribing habits.
Competing interests
No relevant disclosures.
Acknowledgements
We would like to acknowledge the support of Ballarat Health Services in completing this audit, including the health information services staff for assistance in data extraction, and Kate Hamilton, Director of Oncology, for her guidance and support.
References
- Currow DC, Noble PD, Stuart-Harris RC. The clinical use of ondansetron. New South Wales Therapeutic Assessment Group. Med J Aust 1995; 162: 145-149. BABJHECJ
- Chen JJ, Frame DG, White TJ. Efficacy of ondansetron and prochlorperazine for the prevention of postoperative nausea and vomiting after total hip replacement or total knee replacement procedures: a randomized, double-blind, comparative trial. Arch Intern Med 1998; 158: 2124-2128. i1142872
- Barrett TW, DiPersio DM, Jenkins CA, et al. A randomized, placebo-controlled trial of ondansetron, metoclopramide and promethazine in adults. Am J Emerg Med 2011; 29: 247-255. i1142874
- Braude D, Crandall C. Ondansetron versus promethazine to treat acute undifferentiated nausea in the emergency department: a randomized, double-blind, noninferiority trial. Acad Emerg Med 2008; 15: 209-215. i1142876
- Busch AF, Pearce MJ, Allen B, Begg EJ. Compliance with guidelines results in appropriate ondansetron prescribing at Christchurch Hospital. N Z Med J 1996; 109: 142-144. i1142880