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
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- 1. 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.
- 2. 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.
- 3. 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.
- 4. 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.
- 5. 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.
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.
No relevant disclosures.