Last update Sept. 3, 2022

Ondansetron

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Ondansetron is a 5-HT3 receptor antagonist with antiemetic activity. It is used in the control and prevention of nausea and vomiting. Administered intravenously, intramuscularly, orally or rectally in one or two doses per day.

Since the last update, we have not found published data on its excretion in breastmilk.

Its high volume of distribution and short half-life make it unlikely that it will be excreted in breast milk in significant quantities.

* A computer model based on pharmacokinetic data predicts a clinically insignificant exposure to the infant (theoretical dose 0.005 mg/kg) at a relative dose of 3%. (Job 2022)

No problems have been reported in infants of mothers treated with ondansetron. (Zhao 2020, Job 2022)

Administration of ondansetron after caesarean section does not affect a positive start to breastfeeing (Zhao 2020, Jelting 2017, Uerpairojkit 2017), or the health of the newborn. (Nallam 2017, Elkomy 2015)

Its use is safe in children between 1 and 24 months. (Khalil 2005).

Onsdansetron does not affect prolactin production. (Lisson 1994)

It is considered by experts and prestigious medical associations to be safe, probably compatible or of choice in breastfeeding. (Hale, LactMed, Reece-Stremtan 2017, Rowe 2016, Briggs 2015, Mahadevan 2006)

Alternatives

  • Metoclopramide ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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Other names

Ondansetron is also known as


Ondansetron in other languages or writings:

Groups

Ondansetron belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Ondansetron in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 60 %
Molecular weight 293 daltons
Protein Binding 75 %
VD 2.2 l/Kg
Tmax 1.5 hours
T½ 3 hours
Theoretical Dose *(0.005) mg/Kg/d
Relative Dose *(3) %
Ped.Relat.Dose *(1.6) %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on March 15, 2022 Full text (link to original source)
  3. Job KM, Dallmann A, Parry S, Saade G, Haas DM, Hughes B, Berens P, Chen JY, Fu C, Humphrey K, Hornik C, Balevic S, Zimmerman K, Watt K. Development of a Generic Physiologically-Based Pharmacokinetic Model for Lactation and Prediction of Maternal and Infant Exposure to Ondansetron via Breast Milk. Clin Pharmacol Ther. 2022 May;111(5):1111-1120. Abstract
  4. Zhao W, Ma L, Wang J, Shi X. Retrospective Comparison of the Safety and Effectiveness of Dexmedetomidine Versus Standard of Care Before and During Cesarean Delivery in a Maternity Unit in Zhengzhou, China. Med Sci Monit. 2020 Oct 24;26:e925709. Abstract Full text (link to original source)
  5. Jelting Y, Klein C, Harlander T, Eberhart L, Roewer N, Kranke P. Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions. Local Reg Anesth. 2017 Aug 9;10:83-90. Abstract Full text (link to original source)
  6. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med. 2017 Nov;12(9):500-506. Full text (link to original source) Full text (in our servers)
  7. Nallam SR, Cherukuru K, Sateesh G. Efficacy of Intravenous Ondansetron for Prevention of Postspinal Shivering during Lower Segment Cesarean Section: A Double-Blinded Randomized Trial. Anesth Essays Res. 2017 Apr-Jun;11(2):508-513. Abstract Full text (link to original source)
  8. Uerpairojkit K, Chesoh A, Budcharoentong D. Ondansetron for prophylaxis of spinal morphine induced nausea during early rooming in breastfeedinga randomized placebo controlled trial. J Med Assoc Thai. 2017;100:1283-9. Abstract Full text (link to original source) Full text (in our servers)
  9. Elkomy MH, Sultan P, Carvalho B, Peltz G, Wu M, Clavijo C, Galinkin JL, Drover DR. Ondansetron pharmacokinetics in pregnant women and neonates: towards a new treatment for neonatal abstinence syndrome. Clin Pharmacol Ther. 2015 Feb;97(2):167-76. Abstract
  10. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  11. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  12. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006 Jul;131(1):283-311. Review. Abstract Full text (link to original source) Full text (in our servers)
  13. Khalil SN, Roth AG, Cohen IT, Simhi E, Ansermino JM, Bolos ME, Coté CJ, Hannallah RS, Davis PJ, Brooks PB, Russo MW, Anschuetz GC, Blackburn LM. A double-blind comparison of intravenous ondansetron and placebo for preventing postoperative emesis in 1- to 24-month-old pediatric patients after surgery under general anesthesia. Anesth Analg. 2005 Aug;101(2):356-61, table of contents. Abstract
  14. Roila F, Del Favero A. Ondansetron clinical pharmacokinetics. Clin Pharmacokinet. 1995 Abstract
  15. Lissoni P, Cazzaniga M, Rovelli F, Mainini E, Tancini G, Barni S. Ondansetron does not stimulate prolactin release in breast cancer patients. Tumori. 1994 Abstract

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