Ondansetron is safe and effective for prehospital treatment of nausea and vomiting by paramedics

Prehosp Emerg Care. 2011 Jan-Mar;15(1):34-8. doi: 10.3109/10903127.2010.519822.

Abstract

OBJCTIVE: The objectives were to evaluate the safety and efficacy of ondansetron in the out-of-hospital treatment of undifferentiated nausea or vomiting.

Methods: Patients with severe nausea or intractable vomiting who were transported by paramedic-staffed ambulances in eight California counties were treated with intravenous (IV), intramuscular (IM), or oral dissolving tablet (ODT) administration of ondansetron. Data were collected prospectively for a six-month period using an online database. Prospectively defined outcome measures were 1) efficacy as measured by a quantitative visual analog nausea scale and 2) incidence of adverse effects. There were no control or placebo groups.

Results: Data was collected for 2072 patients, but one patient did not receive the medication. Therefore, Ondansetron was administered to 2,071 patients (3.7% of transported patients). Most patients were adult, with only 66 patients less than 18 years old. Of the 2,071 patients, 1,320 (64%) received IV administration, 77 (4%) received IM administration, and 674 (33%) received ODT administration of ondansetron. Intravenous administration resulted in the largest improvements in nausea scores (mean 4.4; 95% confidence interval [CI] 4.2, 4.5), followed by IM (mean 3.6; 95% CI 3.0, 4.3) and ODT (mean 3.3; 95% CI 3.1, 3.5). Overall, the mean decrease in nausea score was 4.0 (95% CI 3.9, 4.1; p < 0.001) on a 10-point scale. After medication administration, four patients had mild hypotension, one had hypertension, two had itching or rash, and one had a brief episode of supraventricular tachycardia that resolved spontaneously.

Conclusions: Ondansetron is safe and effective for out-of-hospital treatment of nausea and vomiting when administered by paramedics via the IV, IM, or oral route. When available to paramedics, ondansetron is used frequently.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Allied Health Personnel / statistics & numerical data*
  • Antiemetics / administration & dosage
  • Antiemetics / adverse effects
  • Antiemetics / therapeutic use*
  • California
  • Child
  • Child, Preschool
  • Confidence Intervals
  • Databases, Factual
  • Emergency Medical Services / methods*
  • Emergency Medical Services / statistics & numerical data
  • Female
  • Health Status Indicators
  • Humans
  • Infant
  • Infant, Newborn
  • Infusions, Intravenous
  • Injections, Intramuscular
  • Male
  • Middle Aged
  • Nausea / drug therapy*
  • Ondansetron / administration & dosage
  • Ondansetron / adverse effects
  • Ondansetron / therapeutic use*
  • Pain Measurement
  • Prospective Studies
  • Statistics, Nonparametric
  • Tablets
  • Vomiting / drug therapy*
  • Young Adult

Substances

  • Antiemetics
  • Tablets
  • Ondansetron