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نشرة الممارس الصحي نشرة معلومات المريض بالعربية نشرة معلومات المريض بالانجليزية صور الدواء بيانات الدواء
  SFDA PIL (Patient Information Leaflet (PIL) are under review by Saudi Food and Drug Authority)

Ondanion injection contains a medicine called ondansetron. This belongs to a group of medicines

called anti-emetics.

 

Ondanion injection is used for:

· preventing nausea and vomiting caused by chemotherapy (in adults and children) or radiotherapy for cancer (adults only)

· preventing nausea and vomiting after surgery.

 

Ask your doctor, nurse or pharmacist if you would like any further explanation about

these uses.


Do not have Ondanion injection if:

· you are taking apomorphine (used to treat Parkinson’s disease)

· you are allergic (hypersensitive) to ondansetron or any of the other ingredients in Ondanion injection (listed in Section 6), or to medicinal products from the same class (e.g. granisetron, dolasetron).

If you are not sure, talk to your doctor, nurse or pharmacist before having Ondanion injection.

 

Warnings and precautions

Check with your doctor, nurse or pharmacist before having Ondanion injection if:

· you have ever had heart problems (e.g. congestive heart failure which causes shortness of breath and swollen ankles)

· you have an uneven heart beat (arrhythmias)

· you are allergic to medicines similar to ondansetron, such as granisetron or palonosetron

· you have liver problems

· you have a blockage in your gut

· you have problems with the levels of salts in your blood, such as potassium, sodium and magnesium.

If you are not sure if any of the above apply to you, talk to your doctor, nurse or pharmacist

before having Ondanion injection.

 

Other medicines and Ondanion

Please tell your doctor, nurse or pharmacist if you are taking, or have recently taken, or might take any other medicines. This includes medicines that you buy without a prescription and herbal

medicines. This is because Ondanion can affect the way some medicines work. Also some other

medicines can affect the way Ondanion works.

 

In particular, tell your doctor, nurse or pharmacist if you are taking any of the following

medicines:

· carbamazepine or phenytoin used to treat epilepsy

· rifampicin used to treat infections such as tuberculosis (TB)

· antibiotics such as erythromycin or ketoconazole

· anti-arrhythmic medicines used to treat an uneven heart beat

· beta-blocker medicines used to treat certain heart or eye problems, anxiety or prevent migraines

· tramadol, a pain killer

· medicines that affect the heart (such as haloperidol or methadone)

· cancer medicines (especially anthracyclines and trastuzumab)

· SSRIs (selective serotonin reuptake inhibitors) used to treat depression and/or anxiety including fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram

· SNRIs (serotonin noradrenaline reuptake inhibitors) used to treat depression and/or anxiety including venlafaxine, duloxetine

 

If you are not sure if any of the above applies to you, talk to your doctor, nurse or pharmacist

before having Ondanion injection.

 

Ondanion injection should not be given in the same syringe or infusion (drip) as any other

medication.

 

Pregnancy and breast-feeding

It is not known if Ondanion is safe during pregnancy. If you are pregnant, think you are pregnant

or are planning to have a baby, ask your doctor or pharmacist for advice before having Ondanion

injection.

 

Do not breast-feed if you have Ondanion. This is because small amounts pass into the mother’s

milk. Ask your doctor or midwife for advice.

 

Important information about some of the ingredients of Ondanion injection

This medicine contains sodium citrate and sodium chloride. This means that Ondanion injection

contains 7.21 mg of sodium per 4 mg dose, which is less than 1 mmol sodium (23 mg) per dose i.e. essentially “sodium-free”.


Ondansetron Solution for Injection will usually be given to you by a nurse or doctor by slow injection or infusion (drip) into a vein (intravenously).

 

The dose you have been prescribed will depend on the treatment you are having.

 

To prevent nausea and vomiting from chemotherapy or radiotherapy in adults

 

On the day of chemotherapy or radiotherapy

· the usual adult dose is 8 mg given by a slow injection into your vein, just before your treatment, and another 8 mg twelve hours later. After chemotherapy, your medicine will usually be given by mouth as an 8 mg Ondansetron tablet or 10 ml (8 mg) Ondansetron syrup.

 

On the following days

· the usual adult dose is one 8 mg tablet or 10 ml (8 mg) syrup taken twice a day

· this may be given for up to 5 days.

 

If your chemotherapy or radiotherapy is likely to cause severe nausea and vomiting, you may be

given more than the usual dose of Ondanion. Your doctor will decide this.

 

 

To prevent nausea and vomiting from chemotherapy in children aged over 6 months and

adolescents

 

The doctor will decide the dose depending on the child’s size (body surface area) or weight. Look at the label for more information

 

On the day of chemotherapy

· the first dose is given by an injection into the vein, just before your child’s treatment. After chemotherapy, your child’s medicine will usually be given by mouth twelve hours later, as Ondansetron syrup or a Ondansetron tablet.

 

On the following days

· 2.5 ml (2 mg) syrup twice a day for small children and those weighing 10 kg or less

· one 4 mg tablet or 5 ml (4 mg) syrup twice a day for larger children and those weighing more than 10 kg

· two 4 mg tablets or 10 ml (8 mg) syrup twice a day for teenagers (or those with a large body surface area)

· these doses can be given for up to five days

 

To prevent and treat nausea and vomiting after an operation

 

Adult:

· The usual dose for adults is 4 mg given by a slow injection into your vein. For prevention, this will be given just before your operation.

 

Children:

· For children aged over 1 month and adolescents the doctor will decide the dose. The maximum dose is 4 mg given as a slow injection into the vein. For prevention, this will be given just before the operation.

 

Patients with moderate or severe liver problems

The total daily dose should not be more than 8 mg.

 

If you keep feeling or being sick

Ondanion injection should start to work soon after having the injection. If you continue to be sick or feel sick, tell your doctor or nurse.

 

If you have more Ondanion injection than you should

Your doctor or nurse will give you or your child Ondanion injection so it is unlikely that you or your child will receive too much. If you think you or your child have been given too much or have missed a dose, tell your doctor or nurse.


Like all medicines, Ondanion injection can cause side effects, although not everybody gets them.

 

Allergic reactions

If you have an allergic reaction, tell your doctor or a member of the medical staff straight

away. The signs may include:

· sudden wheezing and chest pain or chest tightness

· swelling of your eyelids, face, lips, mouth or tongue

· skin rash - red spots or lumps under your skin (hives) anywhere on your body

· collapse.

 

Other side effects include:

 

Very common (may affect more than 1 in 10 people)

· headache.

 

Common (may affect up to 1 in 10 people)

· a feeling of warmth or flushing

· constipation

· changes to liver function test results (if you have Ondanion injection with a medicine called cisplatin, otherwise this side effect is uncommon)

· irritation and redness at the site of injection.

 

Uncommon (may affect up to 1 in 100 people)

· hiccups

· low blood pressure, which can make you feel faint or dizzy

· uneven heart beat

· chest pain

· fits

· unusual body movements or shaking.

 

Rare (may affect up to 1 in 1,000 people)

· feeling dizzy or light headed

· blurred vision

· disturbance in heart rhythm (sometimes causing a sudden loss of consciousness)

 

Very rare (may affect up to 1 in 10,000 people)

· poor vision or temporary loss of eyesight, which usually comes back within 20 minutes.

 

 

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via The National Pharmacovigilance and Drug Safety Centre (NPC). By reporting side affects you can help provide more information on the safety of this medicine.


· Keep out of the reach and sight of children.

· Do not use Ondanion injection after the expiry date which is stated on the pack after ‘EXP’. The expiry date refers to the last day of that month.

· Unopened ampoules: Do not store above 30°C. Protect from light.

· After opening/dilution/reconstitution: Shelf life is 24 hours stored in a refrigerator (2-8°C).

· Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.


What Ondanion injection contains

· The active substance in 1 ml Solution for Injection and Infusion is 2 mg ondansetron as ondansetron hydrochloride dihydrate. Each 2 ml ampoule contains 4 mg Ondansetron as ondansetron hydrochloride dihydrate. Each 4 ml ampoule contains 8 mg Ondansetron as ondansetron hydrochloride dihydrate.

· The other ingredients are Sodium chloride; Citric acid monohydrate; Sodium citrate; Water for injections.


Ondanion 2 mg/ml Injection is a clear aqueous solution in Type I (Ph. Eur.) amber glass ampoule packaged in a cardboard box with a leaflet. Every ampoule contains 2 ml or 4 ml solution. They are marketed in packs of 5 ampoules.

SPIMACO

AlQassim pharmaceutical plant

Saudi Pharmaceutical Industries &

Medical Appliance Corporation

P.O. Box 2597 Al-Qassim First Industrial City,

King AbdulAzziz Road, BURAYDAH 51461,

Al-Qassim, Saudi Arabia.


March 2018.
  نشرة الدواء تحت مراجعة الهيئة العامة للغذاء والدواء (اقرأ هذه النشرة بعناية قبل البدء في استخدام هذا المنتج لأنه يحتوي على معلومات مهمة لك)

حقن اوندانيون تحتوي على دواء يسمى اوندانسيترون. هذا الدواء ينتمي إلى مجموعة من الأدوية تسمي مضادات القئ.

 

تستخدم حقن اوندانيون في:

• منع الغثيان والقيء الناجم عن العلاج الكيميائي (في البالغين والأطفال) أو العلاج الإشعاعي للسرطان (الكبار فقط).

• منع الغثيان والقيء بعد الجراحة.

 

اسأل طبيبك، أو الممرضة أو الصيدلي إذا كنت تريد أي توضيح إضافي حول هذه الاستخدامات

لا تستخدم حقن اوندانيون إذا:

• كنت تتناول ابومورفين (يستخدم لعلاج مرض شلل الرعاش).

• كانت لديك حساسية (فرط حساسية) من اوندانسيترون أو أي من المكونات الأخرى في حقن اوندانيون (المدرجة في الفقرة 6)، أو للمنتجات الطبية من نفس الفئة (مثل جرانيسيترون، دولاسيترون).

إذا لم تكن متأكداً، تحدث إلى طبيبك أو الممرضة أو الصيدلي قبل استخدام حقن اوندانيون.

 

التحذيرات والاحتياطات

تحقق مع طبيبك أو الممرضة أو الصيدلي قبل استخدام حقن اوندانيون إذا:

• كان لديك في أي وقت مضى مشاكل في القلب (مثل فشل القلب الاحتقاني الذي يسبب ضيق في التنفس وتورم الكاحلين)

• كانت لديك دقات قلب غير منتظمة (اضطراب ضربات القلب)

• كانت لديك حساسية من الأدوية المماثلة لاوندانسيترون، مثل جرانيسيترون أو بالونوسيترون

• كانت لديك مشاكل في الكبد

• كان لديك انسداد في الأمعاء

• كانت لديك مشاكل في مستويات الأملاح في الدم، مثل البوتاسيوم والصوديوم والماغنيسيوم.

إذا لم تكن متأكداً مما إذا كان أي من أعلاه ينطبق عليك، تحدث إلى طبيبك أو الممرضة أو الصيدلي قبل استخدام حقن اوندانيون.

 

اوندانيون والأدوية الأخرى

فضلا أخبر طبيبك أو الممرضة أو الصيدلي إذا كنت تتناول، أو تناولت مؤخرا، أو قد تتناول أي أدوية أخرى. وهذا يشمل الأدوية التي تشتريها دون وصفه طبية، والأعشاب الطبية. وهذا لأن اوندانيون من الممكن أن يؤثر على طريقة عمل بعض الأدوية. أيضا بعض الأدوية الأخري من الممكن أن تؤثر على الطريقة التي يعمل بها اوندانيون.

 

على وجه الخصوص، أخبر طبيبك، أو الممرضة أو الصيدلي إذا كنت تتناول أي من الأدوية التالية:

• كاربامازبين أو الفينيتوين المستخدم لعلاج الصرع

• الريفامبيسين والذي يستخدم لعلاج الالتهابات مثل الدرن (السل)

• المضادات الحيوية مثل الاريثروميسين أو الكيتوكونازول

• أدوية علاج اضطراب ضربات القلب المستخدمة لعلاج دقات القلب الغير المنتظمة

• أدوية مُحْصِرُ المُسْتَقْبِلاتِ البيتا المستخدمة لعلاج بعض مشاكل القلب أو العين، القلق أو منع الصداع النصفي

• ترامادول، قاتل الألم

• الأدوية التي تؤثر على القلب (مثل هالوبيريدول أو الميثادون)

• أدوية السرطان (وبخاصة أنثراسيكلينيس وتراستوزوماب)

• إس إس أرأي (مثبطات امتصاص السيروتونين) يستخدم لعلاج الاكتئاب أو القلق بما في ذلك فلوكستين، باروكسيتين، سيرترالين، فلوڨوكسامين، سيتالوبرام، اسيتالوبرام

• إس إن أر أي (مثبطات امتصاص السيروتونين والنورادرينالين) تستخدم لعلاج الاكتئاب أو القلق بما في ذلك ڨينلافاكسين، دولوكسيتين

 

إذا لم تكن متأكداً مما إذا كان أي من أعلاه ينطبق عليك، تحدث إلى طبيبك أو الممرضة أو الصيدلي قبل استخدام حقن اوندانيون.

 

لا يجب اعطاء حقن اوندانيون في نفس المحاقن أو التسريب (التنقيط) لأي دواء أخر.

 

الحمل والرضاعة الطبيعية

من غير المعروف إذا كان اوندانيون أمن خلال فترة الحمل. إذا كنتي حاملا، أو تعتقدين أنك حاملا أو تخططين لإنجاب طفل، اسألي طبيبك أو الصيدلي للحصول على المشورة قبل استخدام حقن اوندانيون.

 

لا تقومين بالرضاعة الطبيعية إذا كنتي تستخدمين اوندانيون. وهذا بسبب وصول كميات صغيرة إلى حليب الأم. اسألي طبيبك أو المولدة للحصول على المشورة.

 

معلومات هامة عن بعض مكونات حقن اوندانيون

هذا الدواء يحتوي على سترات الصوديوم وكلوريد الصوديوم. وهذا يعني أن حقن اوندانيون تحتوي على 7.21 ملجم صوديوم لكل جرعة 4 ملجم، وهو أقل من 1 ملي مول من الصوديوم (23 ملجم) لكل جرعة أي بشكل أساسي "خالي من الصوديوم".

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عادة ما يعطى لك محلول اوندانسيترون للحقن من قبل ممرضة أو طبيب عن طريق الحقن البطيء أو التسريب (بالتنقيط) في الوريد (عن طريق الوريد).

 

تتوقف الجرعة التي وصفت لك على العلاج الذي تحصل عليه.

 

لمنع الغثيان والقيء من العلاج الكيميائي أو العلاج الإشعاعي في البالغين

 

في يوم العلاج الكيميائي أو العلاج الإشعاعي

• الجرعة المعتادة للكبار هي 8 ملجم تعطي بالحقن البطيء في الوريد، وقبل العلاج الخاص بك مباشرة، و8 ملجم أخري بعد 12 ساعة. بعد العلاج الكيميائي، يعطي عادة الدواء عن طريق الفم كقرص اوندانسيترون 8 ملجم أو 10 مل (8 ملجم) شراب اوندانسيترون.

 

في الأيام التالية

• الجرعة المعتادة للكبار هي 8 ملجم قرص واحد أو شراب 10 مل (8 ملجم) تتناول مرتين في اليوم

• وقد يتم اعطاؤها لمدة تصل إلى 5 أيام.

 

إذا كان العلاج الكيميائي أو العلاج الإشعاعي الخاص بك من المرجح أن يسبب الغثيان والتقيؤ الحاد، قد يتم إعطاؤك جرعة اوندانيون أكثر من المعتادة. وسوف يقرر طبيبك ذلك.

 

لمنع الغثيان والقيء من العلاج الكيميائي في الأطفال الذين تتراوح أعمارهم أكثر من 6 أشهر والمراهقين

 

سوف يقرر الطبيب الجرعة حسب الوزن أو الحجم (مساحة سطح الجسم) للطفل. انظر لُصاقَةُ التَّوسيم لمزيد من المعلومات

 

في يوم العلاج الكيميائي

• تعطي الجرعة الأولى بالحقن في الوريد، قبل بدء العلاج الخاص بطفلك مباشرة. بعد العلاج الكيميائي، عادة ما يعطي الدواء لطفلك عن طريق الفم بعد 12 ساعة، كشراب اوندانسيترون أو اوندانسيترون أقراص.

 

في الأيام التالية

• 2.5 مل (2 ملجم) شراب مرتين يوميا للأطفال الصغار، والذين يزنون 10 كجم أو أقل

• قرص واحد 4 ملجم أو 5 مل (4 ملجم) شراب مرتين يوميا للأطفال الكبار والذين يزنون أكثر من 10 كجم

• قرصين من 4 ملجم أقراص أو 10 مل (8 ملجم) شراب مرتين يوميا للمراهقين (أو الذين لديهم مساحة كبيرة من الجسم)

• يمكن أن تعطي هذه الجرعات لمدة تصل إلى خمسة أيام

 

لمنع وعلاج الغثيان والقيء بعد العملية

 

الكبار:

• الجرعة المعتادة للبالغين 4 ملجم تعطي بالحقن البطيء في وريدك. للوقاية، سوف يعطي قبل العملية الخاصة بك مباشرة.

 

الأطفال:

• للأطفال الذين تزيد أعمارهم عن 1 شهر والمراهقين سوف يقرر الطبيب الجرعة. الجرعة القصوى هي 4 ملجم تعطي بالحقن البطيء في الوريد. للوقاية، سوف يعطي قبل العملية مباشرة.

 

المرضى الذين يعانون من مشاكل متوسطة أو حادة في الكبد

لا يجب أن تكون الجرعة اليومية الإجمالية أكثر من 8 ملجم.

 

إذا استمر الشعور أو اصبت بالإعياء

يجب أن يبدأ تأثير حقن اوندانيون قريبا بعد الحقن. إذا استمرت حالة الإعياء أو بدأت في الشعور بالإعياء، أخبر طبيبك أو الممرضة.

 

إذا استخدمت حقن اوندانيون أكثر مما يجب

سوف يعطي الطبيب أو الممرضة لك أو لطفلك حقن اوندانيون ولذلك فمن غير المرجح أن تأخذ أنت أو طفلك جرعة زائدة. إذا كنت تعتقد أنه قد تم اعطاؤك أو إعطاء طفلك جرعة زائدة أو تم نسيان اعطاؤك الجرعة، أخبر طبيبك أو الممرضة

مثل جميع الأدوية من الممكن أن تسبب حقن اوندانيون أعراضا جانبية، على الرغم من أن الجميع لا يحصل عليها.

 

الحساسية

إذا كان لديك رد فعل تحسسي، أخبر طبيبك أو أحد أعضاء الفريق الطبي على الفور. وقد تشمل الأعراض:

• صفير مفاجئ عند التنفس وألم في الصدر أو ضيق في الصدر

• تورم في الجفون، الوجه، الشفاه، والفم أو اللسان

• طفح جلدي-البقع الحمراء أو كتل تحت الجلد (الشري) في أي مكان في جسمك

• انهيار.

 

وتشمل الأعراض الجانبية الأخرى:

 

شائعة جداً (قد تؤثر على أكثر من 1 في كل 10 أشخاص)

• صداع.

 

شائعة (قد تؤثر على ما يصل إلى 1 في كل 10 أشخاص)

• شعور بالحرارة أو الاحمرار

• الإمساك

• تغير في نتائج اختبار وظائف الكبد (إذا كنت تستخدم حقن اوندانيون مع دواء يسمى سيسبلاتين، خلاف هذا يعتبر هذا العرض الجانبي غير شائع)

• تهيج واحمرار في موضع الحقن.

 

غير شائعة (قد تؤثر على ما يصل إلى 1 في كل 100 شخص)

• الفواق

• انخفاض ضغط الدم، والذي يمكن أن يجعلك تشعر بالاغماء أو بالدوار

• ضربات قلب غير متساوية

• ألم في الصدر

• نوبات

• حركات جسم غير عادية أو اهتزاز.

 

نادرة (قد تؤثر على ما يصل إلى 1 في كل 1,000 شخص)

• الشعور بالدوخة أو الدوار

• عدم وضوح الرؤية

• اضطراب في ضربات القلب (في بعض الأحيان تسبب فقدان مفاجئ للوعي)

 

نادرة جداً (قد تؤثر على ما يصل إلى 1 في كل 10,000 شخص)

• ضعف البصر أو فقدان مؤقت للبصر، الذي عادة ما يأتي مرة أخرى في غضون 20 دقيقة.

 

الإبلاغ عن الأعراض الجانبية

إذا ظهرت عليك أي أعراض جانبية، قم بالتحدث مع طبيبك أو الصيدلي أو الممرضة. ويشمل ذلك أي أعراض جانبية محتملة غير المُدرجة في هذه النشرة. يمكنك أيضا الإبلاغ عن الأعراض الجانبية مباشرة عبر المركز الوطني للتيقظ والسلامة الدوائية. يمكنك من خلال الإبلاغ عن الأعراض الجانبية أن تساعد في توفير المزيد من المعلومات حول سلامة هذا الدواء.

• يحفظ بعيدا عن متناول ونظر الأطفال.

• لا تستخدم حقن اوندانيون بعد تاريخ انتهاء الصلاحية المذكور علي العبوة. يشير تاريخ انتهاء الصلاحية إلى آخر يوم من ذلك الشهر.

• الأمبولات المغلقة: لا يحفظ في درجة حرارة أعلي من 30 درجة مئوية. يحمي من الضوء.

• بعد الفتح/التخفيف/إعادة التكوين: مدة الصلاحية هي 24 ساعة في الثلاجة (2-8°C).

• لا تتخلص من أي أدوية عن طريق مياه الصرف الصحي أو النفايات المنزلية. اسأل الصيدلي عن كيفية التخلص من الأدوية التي لم تعد تستخدمها. ومن شأن هذه التدابير أن تساعد على حماية البيئة.

• المادة الفعالة في 1 مل من محلول الحقن والتنقيط هي 2 ملجم اوندانسيترون على هيئة اوندانسيترون ثنائي هيدرات الهيدروكلوريد. يحتوي كل امبول 2 مل على 4 ملجم اوندانسيترون على هيئة اوندانسيترون ثنائي هيدرات الهيدروكلوريد. يحتوي كل امبول 4 مل على 8 ملجم اوندانسيترون على هيئة اوندانسيترون ثنائي هيدرات الهيدروكلوريد.

• المكونات الأخرى هي كلوريد الصوديوم؛ حامض الستريك احادي التموه؛ سترات الصوديوم؛ ماء للحقن

 

حقن اوندانيون2 ملجم/مل هي محلول مائي صافي في امبول من زجاج العنبر من النوع الأول (دستور الأدوية الأوروبي) معبأة في عبوة من الورق المقوى مع النشرة الداخلية.

كل امبول يحتوي على محلول 2 مل أو 4 مل. متاحة للتسويق في عبوات من 5 أمبولات.

الدوائية

مصنع الأدوية بالقصيم

الشركة السعودية للصناعات الدوائية والمستلزمات الطبية.

صندوق بريدي 2597 المنطقة الصناعية الأولي بالقصيم،

طريق الملك عبد العزيز، بريدة 51461،

القصيم، المملكة العربية السعودية

مارس 2018
 Read this leaflet carefully before you start using this product as it contains important information for you

Ondanion® 2mg/ml solution for injection and infusion.

Each ml of solution contains 2 mg of ondansetron as ondansetron hydrochloride dihydrate. Ondansetron 4 mg / 2 ml Solution for Injection: Each 2 ml ampoule contains 4 mg of ondansetron as ondansetron hydrochloride dihydrate. Excipient with known effect: Each 2 ml ampoule contains 7.21 mg of sodium as sodium chloride and sodium citrate. For the full list of excipients, see section 6.1. Ondansetron 8 mg / 4 ml Solution for Injection: Each 4 ml ampoule contains 8 mg of ondansetron as ondansetron hydrochloride dihydrate. Excipient with known effect: Each 4 ml ampoule contains 14.43 mg of sodium as sodium chloride and sodium citrate. For the full list of excipients, see section 6.1.

Solution for injection and infusion, ampoule. Clear aqueous solution. Osmolarity: 290mOsmol/L±5% pH: 3.3 – 4.0

Adults:

Ondanion is indicated for the management of nausea and vomiting induced by cytotoxic chemotherapy and radiotherapy. Ondanion is indicated for the prevention and treatment of postoperative nausea and vomiting (PONV).

Pediatric Population:

Ondanion is indicated for the management of chemotherapy-induced nausea and vomiting (CINV) in children aged ≥6 months, and for the prevention and treatment of PONV in children aged ≥1 month.

 


For intravenous injection or after dilution for intravenous infusion. 

Chemotherapy and Radiotherapy induced nausea and vomiting. 

Adults

The emetogenic potential of cancer treatment varies according to the doses and combinations of chemotherapy and radiotherapy regimens used. The route of administration and dose of Ondanion should be flexible in the range of 8-32 mg a day and selected as shown below. 

Emetogenic chemotherapy and radiotherapy: Ondansetron can be given either by rectal, oral (tablets or syrup), intravenous or intramuscular administration. 

For most patients receiving emetogenic chemotherapy or radiotherapy, Ondanion 8 mg should be administered as a slow intravenous injection (in not less than 30 seconds), immediately before treatment, followed by 8 mg orally twelve hourly. 

To protect against delayed or prolonged emesis after the first 24 hours, oral or rectal treatment with Ondanion should be continued for up to 5 days after a course of treatment. 

Highly emetogenic chemotherapy: For patients receiving highly emetogenic chemotherapy, e.g. high- dose cisplatin, Ondansetron can be given either by oral, rectal, intravenous or intramuscular administration. Ondanion has been shown to be equally effective in the following dose schedules over the first 24 hours of chemotherapy: 

  • A single dose of 8 mg by slow intravenous injection (in not less than 30 seconds) immediately before chemotherapy. 

  • A dose of 8 mg by slow intravenous injection (in not less than 30 seconds) immediately before chemotherapy, followed by two further intravenous injection (in not less than 30 seconds), or by a constant infusion of 1 mg/hour for up to 24 hours. 

  • A maximum initial intravenous dose of 16 mg diluted in 50-100 ml of saline or other compatible infusion fluid (see section 6.6) and infused over not less than 15 minutes immediately before chemotherapy. The initial dose of Ondanion may be followed by two additional 8 mg intravenous doses (in not less than 30 seconds) or intramuscular doses four hours apart. 

A single dose greater than 16 mg must not be given due to dose dependent increase of QT- prolongation risk (see sections 4.4, 4.8 and 5.1). 

The selection of dose regimen should be determined by the severity of the emetogenic challenge. The efficacy of Ondanion in highly emetogenic chemotherapy may be enhanced by the addition of a single intravenous dose of dexamethasone sodium phosphate, 20 mg administered prior to chemotherapy. 

To protect against delayed or prolonged emesis after the first 24 hours, oral or rectal treatment with Ondanion should be continued for up to 5 days after a course of treatment. 

Pediatric Population: 

CINV in children aged ≥ 6 months and adolescents 

The dose for CINV can be calculated based on body surface area (BSA) or weight – see below. In Pediatric clinical studies, ondansetron was given by IV infusion diluted in 25 to 50 ml of saline or other compatible infusion fluid and infused over not less than 15 minutes. 

Weight-based dosing results in higher total daily doses compared to BSA-based dosing (sections 4.4.and 5.1). 

Ondanion injection should be diluted in 5% dextrose or 0.9% sodium chloride or other compatible infusion fluid (see section 6.6) and infused intravenously over not less than 15 minutes. 

There are no data from controlled clinical trials on the use of Ondanion in the prevention of delayed or prolonged CINV. There are no data from controlled clinical trials on the use of Ondanion for radiotherapy-induced nausea and vomiting in children. 

Dosing by BSA: 

Ondanion should be administered immediately before chemotherapy as a single intravenous dose of 5 mg/m2. The single intravenous dose must not exceed 8 mg. 

Oral dosing can commence 12 hours later and may be continued for up to 5 days (Table 1). 

The total dose over 24 hours (given as divided doses) must not exceed adult dose of 32 mg. 

Table 1: BSA-based dosing for Chemotherapy - Children aged ≥6 months and adolescents 

BSA 

Day 1 (a,b) 

Days 2-6 (b) 

< 0.6 m2 

5 mg/m2 IV plus 

2 mg syrup after 12 hrs 

2 mg syrup every 12 hrs 

≥ 0.6 m2 to ≤ 1.2 m2 

5 mg/m2 IV plus 

4 mg syrup or tablet after 12 hrs 

4 mg syrup or tablet every 12 hrs 

> 1.2 m2 

5 mg/m2 or 8 mg IV plus 8 mg syrup or tablet after 12 hours 

8 mg syrup or tablet every 12 hours 

a The intravenous dose must not exceed 8 mg. 

b The total dose over 24 hours (given as divided doses) must not exceed adult dose of 32 mg 

Dosing by bodyweight: 

Weight-based dosing results in higher total daily doses compared to BSA-based dosing (sections 4.4. and 5.1). 

Ondanion should be administered immediately before chemotherapy as a single intravenous dose of 0.15 mg/kg. The single intravenous dose must not exceed 8 mg. Two further intravenous doses may be given in 4-hourly intervals. 

Oral dosing can commence 12 hours later and may be continued for up to 5 days (Table 2). 

The total dose over 24 hours (given as divided doses) must not exceed adult dose of 32 mg. 

Table 2: Weight-based dosing for Chemotherapy - Children aged ≥6 months and adolescents 

Weight 

Day 1 (a,b) 

Days 2-6 (b) 

≤ 10 kg 

Up to 3 doses of 0.15 mg/kg IV every 4 hrs 

2 mg syrup every 12 hrs 

> 10 kg 

Up to 3 doses of 0.15 mg/kg IV every 4 hrs 

4 mg syrup or tablet every 12 hrs 

a The intravenous dose must not exceed 8 mg. 

b The total dose over 24 hours (given as divided doses) must not exceed adult dose of 32 mg. 

Elderly

In patients 65 to 74 years of age, the dose schedule for adults can be followed. All intravenous doses should be diluted in 50-100 ml of saline or other compatible infusion fluid (see section 6.6) and infused over 15 minutes. 

In patients 75 years of age or older, the initial intravenous dose of Ondanion should not exceed 8 mg. All intravenous doses should be diluted in 50-100 ml of saline or other compatible infusion fluid (see section 6.6) and infused over 15 minutes. The initial dose of 8 mg may be followed by two further intravenous doses of 8 mg, infused over 15 minutes and given no less than four hours apart. (see section 5.2) 

Patients with Renal Impairment: 

No alteration of daily dosage or frequency of dosing, or route of administration are required. 

Patients with Hepatic Impairment: 

Clearance of Ondanion is significantly reduced and serum half-life significantly prolonged in subjects with moderate or severe impairment of hepatic function. In such patients a total daily dose of 8 mg should not be exceeded and therefore parenteral or oral administration is recommended. 

Patients with Poor Sparteine/Debrisoquine Metabolism: 

The elimination half-life of ondansetron is not altered in subjects classified as poor metabolizers of sparteine and debrisoquine. Consequently, in such patients repeat dosing will give drug exposure levels no different from those of the general population. No alteration of daily dosage or frequency of dosing is required. 

Post-Operative Nausea and Vomiting (PONV): 

Adults

For the prevention of PONV: Ondansetron can be administered orally or by intravenous or intramuscular injection. 

Ondanion may be administered as a single dose of 4 mg given by slow intravenous injection at induction of anesthesia. 

For treatment of established PONV: A single dose of 4 mg given by slow intravenous injection is recommended. 

Pediatric population: 

PONV in children aged ≥ 1 month and adolescents 

For prevention of PONV in pediatric patients having surgery performed under general anesthesia, a single dose of Ondanion may be administered by slow intravenous injection (not less than 30 seconds) at a dose of 0.1 mg/kg up to a maximum of 4 mg either prior to, at or after induction of anesthesia. 

For the treatment of PONV after surgery in pediatric patients having surgery performed under general anesthesia, a single dose of Ondanion may be administered by slow intravenous injection (not less than 30 seconds) at a dose of 0.1 mg/kg up to a maximum of 4 mg. 

There are no data on the use of Ondanion in the treatment of PONV in children below 2 years of age. 

Elderly: 

There is limited experience in the use of Ondanion in the prevention and treatment of PONV in the elderly, however Ondanion is well tolerated in patients over 65 years receiving chemotherapy. 

Patients with Renal Impairment: 

No alteration of daily dosage or frequency of dosing, or route of administration are required. 

Patients with Hepatic Impairment: 

Clearance of Ondanion is significantly reduced and serum half-life significantly prolonged in subjects with moderate or severe impairment of hepatic function. In such patients a total daily dose of 8 mg should not be exceeded and therefore parenteral or oral administration is recommended. 

Patients with poor Sparteine/Debrisoquine Metabolism: 

The elimination half-life of ondansetron is not altered in subjects classified as poor metabolizers of sparteine and debrisoquine. Consequently, in such patients repeat dosing will give drug exposure levels no different from those of the general population. No alteration of daily dosage or frequency of dosing are required. 

 


Concomitant use with apomorphine (see section 4.5). Hypersensitivity to ondansetron or to other selective 5-HT3-receptor antagonists (e.g.granisetron, dolasetron) or to any component of the preparation.

Hypersensitivity reactions have been reported in patients who have exhibited hypersensitivity to other selective 5HT3 receptor antagonists.

Respiratory events should be treated symptomatically and clinicians should pay particular attention to them as precursors of hypersensitivity reactions.

Ondansetron prolongs the QT interval in a dose-dependent manner (see section 5.1). In addition, post- marketing cases of Torsade de Pointes have been reported in patients using ondansetron. Avoid ondansetron in patients with congenital long QT syndrome. Ondansetron should be administered with caution to patients who have or may develop prolongation of QTc, including patients with electrolyte abnormalities, congestive heart failure, bradyarrhythmias or patients taking other medicinal products that lead to QT prolongation or electrolyte abnormalities.

Hypokalemia and hypomagnesaemia should be corrected prior to ondansetron administration.

There have been post-marketing reports describing patients with serotonin syndrome (including altered mental status, autonomic instability and neuromuscular abnormalities) following the concomitant use of ondansetron and other serotonergic drugs (including selective serotonin reuptake inhibitors (SSRI) and serotonin noradrenaline reuptake inhibitors (SNRIs)). If concomitant treatment with ondansetron and other serotonergic drugs is clinically warranted, appropriate observation of the patient is advised.

As ondansetron is known to increase large bowel transit time, patients with signs of sub-acute intestinal obstruction should be monitored following administration.

In patients with adenotonsillar surgery prevention of nausea and vomiting with ondansetron may mask occult bleeding. Therefore, such patients should be followed carefully after ondansetron.

Ondanion Injection contains less than 1 mmol sodium (23 mg) per dose, i.e. essentially “sodiumfree”.

Pediatric Population:

Pediatric patients receiving ondansetron with hepatotoxic chemotherapeutic agents should be monitored closely for impaired hepatic function.

CINV:

When calculating the dose on an mg/kg basis and administering three doses at 4-hour intervals, the total daily dose will be higher than if one single dose of 5 mg/m2 followed by an oral dose is given. The comparative efficacy of these two different dosing regimens has not been investigated in clinical trials. Cross-trial comparison indicates similar efficacy for both regimens (section 5.1).


There is no evidence that ondansetron either induces or inhibits the metabolism of other drugs commonly co-administered with it. Specific studies have shown that there are no interactions when ondansetron is administered with alcohol, temazepam, furosemide, alfentanil, tramadol, morphine, lidocaine, thiopental, or propofol.

Ondansetron is metabolized by multiple hepatic cytochrome P-450 enzymes: CYP3A4, CYP2D6 and CYP1A2. Due to the multiplicity of metabolic enzymes capable of metabolizing ondansetron, enzyme inhibition or reduced activity of one enzyme (e.g. CYP2D6 genetic deficiency) is normally compensated by other enzymes and should result in little or no significant change in overall ondansetron clearance or dose requirement.

Caution should be exercised when ondansetron is coadministered with drugs that prolong the QT interval and/or cause electrolyte abnormalities. (See section 4.4).

Use of ondansetron with QT prolonging drugs may result in additional QT prolongation. Concomitant use of ondansetron with cardiotoxic drugs (e.g. anthracyclines (such as doxorubicin, daunorubicin) or trastuzumab), antibiotics (such as erythromycin), antifungals (such as ketoconazole), antiarrhythmics (such as amiodarone) and beta blockers (such as atenolol or timolol) may increase the risk of arrhythmias. (See section 4.4).

Serotonergic Drugs (e.g. SSRIs and SNRIs): There have been post-marketing reports describing patients with serotonin syndrome (including altered mental status, autonomic instability and neuromuscular abnormalities) following the concomitant use of ondansetron and other serotonergic drugs (including SSRIs and SNRIs). (See section 4.4)

Apomorphine: Based on reports of profound hypotension and loss of consciousness when ondansetron was administered with apomorphine hydrochloride, concomitant use with apomorphine is contraindicated.

Phenytoin, Carbamazepine and Rifampicin: In patients treated with potent inducers of CYP3A4 (i.e. phenytoin, carbamazepine, and rifampicin), the oral clearance of ondansetron was increased and ondansetron blood concentrations were decreased.

Tramadol: Data from small studies indicate that ondansetron may reduce the analgesic effect of tramadol.


Pregnancy

The safety of ondansetron for use in human pregnancy has not been established. Evaluation of experimental animal studies does not indicate direct or indirect harmful effects with respect to the development of the embryo, or fetus, the course of gestation and peri- and post-natal development. However as animal studies are not always predictive of human response the use of ondansetron in pregnancy is not recommended.

Breast-feeding

Tests have shown that ondansetron passes into the milk of lactating animals. It is therefore recommended that mothers receiving Ondanion should not breast-feed their babies.

Fertility

There is no information on the effects of ondansetron on human fertility.


In psychomotor testing ondansetron does not impair performance nor cause sedation. No detrimental effects on such activities are predicted from the pharmacology of ondansetron.


Adverse events are listed below by system organ class and frequency. Frequencies are defined as: very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1000 to <1/100), rare (≥1/10,000 to <1/1000) and very rare (<1/10,000). Very common, common and uncommon events were generally determined from clinical trial data. The incidence in placebo was taken into account. Rare and very rare events were generally determined from post-marketing spontaneous data. 

The following frequencies are estimated at the standard recommended doses of ondansetron. The adverse event profiles in children and adolescents were comparable to that seen in adults. 

Immune system disorders 

Rare: 

Immediate hypersensitivity reactions sometimes severe, including anaphylaxis. 

Nervous system disorders 

Very common: 

Headache. 

Uncommon: 

Seizures, movement disorders (including extrapyramidal reactions such as dystonic reactions, oculogyric crisis and dyskinesia) (1). 

Rare: 

Dizziness predominantly during rapid IV administration. 

Eye disorders 

Rare: 

Transient visual disturbances (e.g. blurred vision) predominantly during IV administration. 

Very rare: 

Transient blindness predominantly during intravenous administration (2). 

Cardiac disorders 

Uncommon: 

Arrhythmias, chest pain with or without ST segment depression, bradycardia. 

Rare: 

QTc prolongation (including Torsade de Pointes). 

Vascular disorders 

Common: 

Sensation of warmth or flushing. 

Uncommon: 

Hypotension. 

Respiratory, thoracic and mediastinal disorders 

Uncommon: 

Hiccups. 

Gastrointestinal disorders 

Common: 

Constipation. 

Hepatobiliary disorders 

Uncommon: 

Asymptomatic increases in liver function tests (3). 

General disorders and administration site conditions 

Common: 

Local IV injection site reactions. 

1. Observed without definitive evidence of persistent clinical sequelae. 

2. The majority of the blindness cases reported resolved within 20 minutes. Most patients had received chemotherapeutic agents, which included cisplatin. Some cases of transient blindness were reported as cortical in origin. 

3. These events were observed commonly in patients receiving chemotherapy with cisplatin. 

Reporting of suspected adverse reactions 

Reporting suspected adverse reactions after AUTHORIZATION of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system.   

 

 

To report any side effect(s): 

 The National Pharmacovigilance and Drug Safety Centre (NPC) 

o Fax: +966-11-205-7662 

o Call NPC at +966-11-2038222, Exts: 2317-2356-2340. 

o Reporting Hotline:19999 

o E-mail: npc.drug@sfda.gov.sa 

o Website: www.sfda.gov.sa/npc 

 

 


Symptoms and Signs

There is limited experience of ondansetron overdose. In the majority of cases, symptoms were similar to those already reported in patients receiving recommended doses (see section 4.8). Manifestations that have been reported include visual disturbances, severe constipation, hypotension and a vasovagal episode with transient second-degree AV block. Ondansetron prolongs the QT interval in a dose-dependent fashion. ECG monitoring is recommended in cases of overdose.

Pediatric population

Pediatric cases consistent with serotonin syndrome have been reported after inadvertent oral overdoses of ondansetron (exceeded estimated ingestion of 4 mg/kg) in infants and children aged 12 months to 2 years.

Treatment

There is no specific antidote for ondansetron, therefore in all cases of suspected overdose, symptomatic and supportive therapy should be given as appropriate. Further management should be as clinically indicated or as recommended by the national poisons centre, where available. The use of ipecacuanha to treat overdose with ondansetron is not recommended, as patients are unlikely to respond due to the anti-emetic action of ondansetron itself.


Mechanism of Action 

Pharmacotherapeutic group: Antiemetics and antinauseants, Serotonin (5-HT3) antagonists 

ATC Code: A04AA01 

Ondansetron is a potent, highly selective 5HT3 receptor-antagonist. Its precise mode of action in the control of nausea and vomiting is not known. Chemotherapeutic agents and radiotherapy may cause release of 5HT in the small intestine initiating a vomiting reflex by activating vagal afferents via 5HT3 receptors. Ondansetron blocks the initiation of this reflex. Activation of vagal afferents may also cause a release of 5HT in the area postrema, located on the floor of the fourth ventricle, and this may also promote emesis through a central mechanism. Thus, the effect of ondansetron in the management of the nausea and vomiting induced by cytotoxic chemotherapy and radiotherapy is probably due to antagonism of 5HT3 receptors on neurons located both in the peripheral and central nervous system. 

The mechanisms of action in post-operative nausea and vomiting are not known but there may be common pathways with cytotoxic induced nausea and vomiting. 

Ondansetron does not alter plasma prolactin concentrations. 

The role of ondansetron in opiate-induced emesis is not yet established. 

QT Prolongation 

The effect of ondansetron on the QTc interval was evaluated in a double blind, randomized, placebo and positive (moxifloxacin) controlled, crossover study in 58 healthy adult men and women. 

Ondansetron doses included 8 mg and 32 mg infused intravenously over 15 minutes. At the highest tested dose of 32 mg, the maximum mean (upper limit of 90% CI) difference in QTcF from placebo after baseline-correction was 19.6 (21.5) msec. At the lower tested dose of 8 mg, the maximum mean (upper limit of 90% CI) difference in QTcF from placebo after baseline-correction was 5.8 (7.8) msec. 

In this study, there were no QTcF measurements greater than 480 msec and no QTcF prolongation was greater than 60 msec. No significant changes were seen in the measured electrocardiographic PR or QRS intervals. 

Pediatric population 

CINV 

The efficacy of ondansetron in the control of emesis and nausea induced by cancer chemotherapy was assessed in a double-blind randomized trial in 415 patients aged 1 to 18 years (S3AB3006). On the days of chemotherapy, patients received either ondansetron 5 mg/m2 intravenous and ondansetron 4 mg orally after 8 to 12 hours or ondansetron 0.45 mg/kg intravenous and placebo orally after 8 to 12 hours. Post-chemotherapy both groups received 4 mg ondansetron syrup twice daily for 3 days. Complete control of emesis on worst day of chemotherapy was 49% (5 mg/m2 intravenous and ondansetron 4 mg orally) and 41% (0.45 mg/kg intravenous and placebo orally). Post-chemotherapy both groups received 4 mg ondansetron syrup twice daily for 3 days. There was no difference in the overall incidence or nature of adverse events between the two treatment groups. 

A double-blind randomized placebo-controlled trial (S3AB4003) in 438 patients aged 1 to 17 years demonstrated complete control of emesis on worst day of chemotherapy in: 

  • 73% of patients when ondansetron was administered intravenously at a dose of 5 mg/m2 intravenous together with 2 to 4 mg dexamethasone orally 

  • 71% of patients when ondansetron was administered as syrup at a dose of 8 mg together with 2 to 4 mg dexamethasone orally on the days of chemotherapy. 

Post-chemotherapy both groups received 4 mg ondansetron syrup twice daily for 2 days. There was no difference in the overall incidence or nature of adverse events between the two treatment groups. 

The efficacy of ondansetron in 75 children aged 6 to 48 months was investigated in an open-label, non-comparative, single-arm study (S3A40320). All children received three 0.15 mg/kg doses of intravenous ondansetron, administered 30 minutes before the start of chemotherapy and then at 4 and 8 hours after the first dose. Complete control of emesis was achieved in 56% of patients. 

Another open-label, non-comparative, single-arm study (S3A239) investigated the efficacy of one intravenous dose of 0.15 mg/kg ondansetron followed by two oral ondansetron doses of 4 mg for children aged < 12 years and 8 mg for children aged ≥ 12 years (total no. of children n = 28). Complete control of emesis was achieved in 42% of patients. 

PONV 

The efficacy of a single dose of ondansetron in the prevention of post-operative nausea and vomiting was investigated in a randomized, double-blind, placebo-controlled study in 670 children aged 1 to 24 months (post-conceptual age ≥44 weeks, weight ≥ 3 kg). Included subjects were scheduled to undergo elective surgery under general anesthesia and had an ASA status ≤ III. A single dose of ondansetron 0.1 mg/kg was administered within five minutes following induction of anesthesia. The proportion of subjects who experienced at least one emetic episode during the 24-hour assessment period (ITT) was greater for patients on placebo than those receiving ondansetron (28% vs. 11%, p <0.0001). 

Four double-blind, placebo-controlled studies have been performed in 1469 male and female patients (2 to 12 years of age) undergoing general anesthesia. Patients were randomized to either single intravenous doses of ondansetron (0.1 mg/kg for Pediatric patients weighing 40 kg or less, 4 mg for Pediatric patients weighing more than 40 kg; number of patients = 735) or placebo (number of patients = 734). Study drug was administered over at least 30 seconds, immediately prior to or following anesthesia induction. Ondansetron was significantly more effective than placebo in preventing nausea and vomiting. The results of these studies are summarized in Table 3. 

Table 3: Prevention and treatment of PONV in Pediatric Patients – Treatment response over 24 hours 

Study 

Endpoint 

Ondansetron % 

Placebo % 

p value 

S3A380 

CR 

68 

39 

≤0.001 

S3GT09 

CR 

61 

35 

≤0.001 

S3A381 

CR 

53 

17 

≤0.001 

S3GT11 

no nausea 

64 

51 

0.004 

S3GT11 

no emesis 

60 

47 

0.004 

CR = no emetic episodes, rescue or withdrawal 

 


Following oral administration, ondansetron is passively and completely absorbed from the gastrointestinal tract and undergoes first pass metabolism. Peak plasma concentrations of about 30 ng/mL are attained approximately 1.5 hours after an 8 mg dose. For doses above 8 mg the increase in ondansetron systemic exposure with dose is greater than proportional; this may reflect some reduction in first pass metabolism at higher oral doses. Mean bioavailability in healthy male subjects, following the oral administration of a single 8 mg tablet, is approximately 55 to 60%. Bioavailability, following oral administration, is slightly enhanced by the presence of food but unaffected by antacids. Studies in healthy elderly volunteers have shown slight, but clinically insignificant, age-related increases in both oral bioavailability (65%) and half-life (5 hours) of ondansetron. 

The disposition of ondansetron following oral, intramuscular and intravenous dosing in adults is similar with a terminal half-life of about 3 hours and steady state volume of distribution of about 140 L. Equivalent systemic exposure is achieved after intramuscular and intravenous administration of ondansetron. 

A 4 mg intravenous infusion of ondansetron given over 5 minutes results in peak plasma concentrations of about 65 ng/ml. Following intramuscular administration of ondansetron, peak plasma concentrations of about 25 ng/ml are attained within 10 minutes of injection. 

Following administration of ondansetron suppository, plasma ondansetron concentrations become detectable between 15 and 60 minutes after dosing. Concentrations rise in an essentially linear fashion, until peak concentrations of 20-30 ng/ml are attained, typically 6 hours after dosing. Plasma concentrations then fall, but at a slower rate than observed following oral dosing due to continued absorption of ondansetron. The absolute bioavailability of ondansetron from the suppository is approximately 60% and is not affected by gender. The half-life of the elimination phase following suppository administration is determined by the rate of ondansetron absorption, not systemic clearance and is approximately 6 hours. Females show a small, clinically insignificant, increase in half-life in comparison with males. 

Ondansetron is not highly protein bound (70-76%). Ondansetron is cleared from the systemic circulation predominantly by hepatic metabolism through multiple enzymatic pathways. Less than 5% of the absorbed dose is excreted unchanged in the urine. The absence of the enzyme CYP2D6 (the debrisoquine polymorphism) has no effect on ondansetron's pharmacokinetics. The pharmacokinetic properties of ondansetron are unchanged on repeat dosing. 

Special Patient Populations 

Gender 

Gender differences were shown in the disposition of ondansetron, with females having a greater rate and extent of absorption following an oral dose and reduced systemic clearance and volume of distribution (adjusted for weight). 

Children and Adolescents (aged 1 month to 17 years) 

In Pediatric patients aged 1 to 4 months (n = 19) undergoing surgery, weight normalized clearance was approximately 30% slower than in patients aged 5 to 24 months (n = 22) but comparable to the patients aged 3 to 12 years. The half-life in the patient population aged 1 to 4 month was reported to average 6.7 hours compared to 2.9 hours for patients in the 5 to 24 month and 3 to 12 year age range. The differences in pharmacokinetic parameters in the 1 to 4 month patient population can be explained in part by the higher percentage of total body water in neonates and infants and a higher volume of distribution for water soluble drugs like ondansetron. 

In Pediatric patients aged 3 to 12 years undergoing elective surgery with general anesthesia, the absolute values for both the clearance and volume of distribution of ondansetron were reduced in comparison to values with adult patients. Both parameters increased in a linear fashion with weight and by 12 years of age, the values were approaching those of young adults. When clearance and volume of distribution values were normalized by body weight, the values for these parameters were similar between the different age group populations. Use of weight-based dosing compensates for age- related changes and is effective in normalizing systemic exposure in Pediatric patients. 

Population pharmacokinetic analysis was performed on 428 subjects (cancer patients, surgery patients and healthy volunteers) aged 1 month to 44 years following intravenous administration of ondansetron. Based on this analysis, systemic exposure (AUC) of ondansetron following oral or IV dosing in children and adolescents was comparable to adults, with the exception of infants aged 1 to 4 months. Volume was related to age and was lower in adults than in infants and children. Clearance was related to weight but not to age with the exception of infants aged 1 to 4 months. It is difficult to conclude whether there was an additional reduction in clearance related to age in infants 1 to 4 months or simply inherent variability due to the low number of subjects studied in this age group. Since patients less than 6 months of age will only receive a single dose in PONV a decreased clearance is not likely to be clinically relevant. 

Table 3. Pharmacokinetics in Pediatric Patients 1 Month to 18 Years of Age 

Study 

 

Patient Population 

(Intravenous dose) 

Age 

AUC 

 

(ng.h/L) 

CL 

 

(L/h/kg) 

Vdn 

 

(L/kg) 

T1/2 

 

(h) 

Geometric Mean 

Mean 

S3A403192 

Surgery  

(0.1 or 0.2mg/kg) 

1 to 4 months 

19 

360 

0.401 

3.5 

6.7 

S3A403192 

Surgery 

(0.1 or 0.2mg/kg) 

5 to 24 months 

22 

236 

0.581 

2.3 

2.9 

S3A40320 & S3A40319 

Pop PK 2,3 

Cancer/ Surgery (0.15mg/kg q4h/  

0.1 or 0.2mg/kg) 

 

1 to 48 months 

115 

257 

0.582 

3.65 

4.9 

S3KG024 

Surgery 

(2 mg or 4 mg) 

3 to 12 years 

 

21 

240 

0.439 

1.65 

2.9 

S3A-150 

Cancer 

(0.15 mg/kg q 4h) 

4 to 18 years 

21 

247 

0.599 

1.9 

2.8 

1  Ondansetron single intravenous dose: 0.1 or 0.2 mg/kg 

2Population PK Patients: 64% cancer patients and 36% surgery patients. 

3Population estimates shown; AUC based on dose of 0.15 mg/kg. 

4 Ondansetron single intravenous dose: 2 mg (3 to 7 years) or 4 mg (8 to 12 years) 

 

Elderly 

Early Phase I studies in healthy elderly volunteers showed a slight age-related decrease in clearance, and an increase in half-life of ondansetron. However, wide inter-subject variability resulted in considerable overlap in pharmacokinetic parameters between young (< 65 years of age) and elderly subjects (≥ 65 years of age) and there were no overall differences in safety or efficacy observed between young and elderly cancer patients enrolled in CINV clinical trials to support a different dosing recommendation for the elderly. 

Based on more recent ondansetron plasma concentrations and exposure-response modelling, a greater effect on QTcF is predicted in patients ≥ 75 years of age compared to young adults. Specific dosing information is provided for patients over 65 years of age and over 75 years of age for IV dosing (see section 4.2). 

Renal Impairment 

In patients with renal impairment (creatinine clearance 15-60 ml/min), both systemic clearance and volume of distribution are reduced following IV administration of ondansetron, resulting in a slight, but clinically insignificant, increase in elimination half-life (5.4 hours). A study in patients with severe renal impairment who required regular haemodialysis (studied between dialyses) showed ondansetron's pharmacokinetics to be essentially unchanged following intravenous administration. 

Hepatic Impairment 

Following oral, intravenous or intramuscular dosing in patients with severe hepatic impairment, ondansetron's systemic clearance is markedly reduced with prolonged elimination half-lives (15 to 32 hours) and an oral bioavailability approaching 100% due to reduced pre-systemic metabolism. The pharmacokinetics of ondansetron following administration as a suppository have not been evaluated in patients with hepatic impairment. 

 


Preclinical data revealed no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity and carcinogenic potential.

Ondansetron and its metabolites accumulate in the milk of rats; milk/plasma-ratio was 5.2.1.

A study in cloned human cardiac ion channels has shown ondansetron has the potential to affect cardiac repolarization via blockade of HERG potassium channels. The clinical relevance of this finding is uncertain.


Ondanion 

Solution for Injection 

Quantity per ampoule 

(2ml) 

Quantity per ampoule 

(4ml) 

Other Excipients 

Citric acid monohydrate 

1.000 

2.000 

Sodium citrate 

0.500 

1.000 

Sodium chloride 

18.000 

36.000 

Water for Injection 

Qs. to 2ml 

Qs. to 4ml 


Ondanion injection should not be administered in the same syringe or infusion as any other medication. Ondansetron injection should only be mixed with those infusion solutions that are mentioned in section 6.6.


Unopened: 24 Months/2 Years. After opening/reconstitution/dilution: 24 hours stored in a refrigerator (2-8°C).

Before opening: Do not store above 30°C.

Chemical and physical in-use stability has been demonstrated for 24 hours at 2-8°C.

From a microbiological point of view, unless the method of opening/reconstitution/dilution precludes the risk of microbial contamination, the product should be used immediately.

If not used immediately, in-use storage times and conditions are the responsibility of the user

For shelf life after opening/dilution/ reconstitution se section 6.3


Type I (Ph. Eur.) amber glass ampoule packaged in a cardboard box with a leaflet.

Pack size: 5 Ampoules per unit carton.


Ondanion Injection should not be autoclaved. 

For single use only. Any unused solution should be discarded. 

The solution is to be visually inspected prior to use (also after dilution). Only clear solutions practically free from particles should be used. 

 

Compatibility with intravenous fluids 

Ondanion injection should only be mixed with those infusion solutions which are recommended: 

  • Sodium Chloride Intravenous Infusion BP 0.9%w/v 

  • Glucose Intravenous Infusion BP 5%w/v 

  • Mannitol Intravenous Infusion BP 10%w/v 

  • Ringers Intravenous Infusion 

  • Potassium Chloride 0.3%w/v and Sodium Chloride 0.9%w/v Intravenous Infusion BP 

  • Potassium Chloride 0.3%w/v and Glucose 5%w/v Intravenous Infusion BP 

Should not be mixed with other pharmaceutical products. 

In keeping with good pharmaceutical practice dilutions of Ondanion injection in intravenous fluids should be prepared at the time of infusion or stored at 2-8°C for no more than 24 hours before the start of administration. 

Compatibility studies have been undertaken in polyvinyl chloride infusion bags and polyvinyl chloride administration sets. It is considered that adequate stability would also be conferred by the use of polyethylene infusion bags or Type 1 glass bottles. Dilutions of Ondanion in sodium chloride 0.9%w/v or in glucose 5%w/v have been demonstrated to be stable in polypropylene syringes. It is considered that Ondanion injection diluted with other compatible infusion fluids would be stable in polypropylene syringes. 

Compatibility with other drugs: Ondanion may be administered by intravenous infusion at 1 mg/hour, e.g. from an infusion bag or syringe pump. The following drugs may be administered via the Y-site of the Ondanion giving set for ondansetron concentrations of 16 to 160 micrograms/ml (e.g. 8 mg/500 ml and 8 mg/50 ml respectively); 

Cisplatin: Concentrations up to 0.48 mg/ml (e.g. 240 mg in 500 mL) administered over one to eight hours. 

5-Fluorouracil: Concentrations up to 0.8 mg/ml (e.g. 2.4 g in 3 litres or 400 mg in 500 ml) administered at a rate of at least 20 ml per hour (500 mL per 24 hours). Higher concentrations of 5-fluorouracil may cause precipitation of ondansetron. The 5-fluorouracil infusion may contain up to 0.045% w/v magnesium chloride in addition to other excipients shown to be compatible. 

Carboplatin: Concentrations in the range 0.18 mg/ml to 9.9 mg/ml (e.g. 90 mg in 500 ml to 990 mg in 100 mL), administered over ten minutes to one hour. 

Etoposide: Concentrations in the range 0.14 mg/ml to 0.25 mg/ml (e.g. 72 mg in 500 ml to 250 mg in 1 litre), administered over thirty minutes to one hour. 

Ceftazidime: Doses in the range 250 mg to 2000 mg reconstituted with Water for Injections BP as recommended by the manufacturer (e.g. 2.5 ml for 250 mg and 10 ml for 2 g ceftazidime) and given as an intravenous bolus injection over approximately five minutes. 

Cyclophosphamide: Doses in the range 100 mg to 1 g, reconstituted with Water for Injections BP, 5 ml per 100 mg cyclophosphamide, as recommended by the manufacturer and given as an intravenous bolus injection over approximately five minutes. 

Doxorubicin: Doses in the range 10-100 mg reconstituted with Water for Injections BP, 5 ml per 10 mg doxorubicin, as recommended by the manufacturer and given as an intravenous bolus injection over approximately 5 minutes. 

Dexamethasone: Dexamethasone sodium phosphate 20 mg may be administered as a slow intravenous injection over 2-5 minutes via the Y-site of an infusion set delivering 8 or 16 mg of ondansetron diluted in 50-100 ml of a compatible infusion fluid over approximately 15 minutes. Compatibility between dexamethasone sodium phosphate and ondansetron has been demonstrated supporting administration of these drugs through the same giving set resulting in concentrations in line of 32 microgram - 2.5 mg/ml for dexamethasone sodium phosphate and 8 microgram - 1 mg/ml for ondansetron.


SPIMACO AlQassim pharmaceutical plant Saudi Pharmaceutical Industries & Medical Appliance Corporation P.O. Box 2597 Al-Qassim First Industrial City, King AbdulAzziz Road, BURAYDAH 51461, Al-Qassim, Saudi Arabia.

October 2019.
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