Ondansetron + other 5HT3 antagonists (Zofran®, various) – Nausea & vomiting associated with chemotherapy and other hospital-led treatments

NICE recommendations, summary of meeting discussions, links to additional supporting docs etc.

March 1998:

The hospital may prescribe treatment for up to 2 days after chemotherapy. After this time, ondansetron is no more effective than other anti-emetics. If nausea is a problem after this time, anti-emetics such as domperidone or metoclopramide should be used. There should be no need to renew prescriptions of ondansetron beyond that provided by the hospital.

November 2007: The TAG debated use of these anti-emetics for non-chemotherapy-induced nausea and vomiting, associated continued use beyond licensed period and subsequent transfer of prescribing to primary care.

The TAG noted examples of exceptional use terminal care situations e.g. end-stage renal failure and in patients suffering chronic pain and nausea secondary to use of opiates.

In general such off-label use will be the EXCEPTION RATHER THAN THE RULE and the need to continue use of ondansetron and related anti-emetics in primary care should be RARE.

November 2011: The TAG revisited this recommendation and agreed to maintain the current classification especially in view of the significant difference in cost of ondansetron between hospital and primary care.

September 2016:  The TAG agreed  to recommend that acute use of ondansetron (plain tablets only) for nausea and vomiting as a second line option in hyperemesis gravidarum be classified as Advice (GP prescribing following consultant initiation / recommendation). The TAG also agreed to recommend that acute use of ondansetron (plain tablets only) for nausea and vomiting for drug-induced nausea and vomiting in palliative care be classified as Advice (GP prescribing following consultant initiation / recommendation)

September 2016:  The NHS Norfolk & Waveney CCGs’ D&TCG noted and supported the TAG recommendations.