CPS Statement – ED use of oral ondansetron for acute gastroenteritis related vomiting in infants and children

Ondansetron oral (weight based dosing) to be considered in:

  • 6months to `12 years
  • mild to moderate dehydration
  • or who have failed a trial of ORT
  • DOSING recommendations are for oral and a single dose:
    • 8-15kg: 2mg
    • 15-30kg: 4mg
    • >30kg: 6-8mg

Key facts for counselling:

  • works within 1-2h
  • oral rehydration should be started 15-30 minutes after the dose is given
  • Benefits:
    • reduced risk of further emesis, and reduced frequency of emesis
    • reduced risk of IV rehydration and admission
  • Adverse event:
    • the most significant adverse event is increased risk of diarrhea up to 48 h after administration of dose. Self-limited and lasts <48h.
    • Therefore, it is not recommended for those who have gastroenteritis with a predominant symptom of diarrhea.
  • the studies reviewed were mainly with oral but IV ondansetron studies appear to have the same conclusions
  • only studied for in hospital, not out of hospital setting.

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