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5-HT3 Receptor Antagonists
Specific Drugs
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Ondansetron = Gold standard
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4 mg IV at the end of case
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NNT = 6 for prevention of vomiting & 7 for prevention of nausea
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Granisetron
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0.35-3 mg (5-20mcg/kg) IV
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As effective as ondansetron
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Palonosetron
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0.075 mg IV
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Effective for 24 hours & superior to ondansetron 4mg IV for PONV prevention
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Ramosetron
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0.3 mg IV
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Similar effectiveness to ondansetron
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When to Administer
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Ondansetron & Granisetron most effective when given at end of surgery
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Palonosetron is usually given at the start of surgery
Adverse Events
NNH listed is for Ondansetron
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Constipation (NNH = 23)
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↑ Liver Enzymes (NNH = 31)
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Headache (NNH = 36)
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↑ QTc: rare especially for 4mg Ondansetron IV dose
Adapted from Anesth Analg. August 2020 - Volume 131 - Issue 2 - p 411-448
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