5-HT3 Receptor Antagonists 

 

Specific Drugs 

 

  • Ondansetron = Gold standard 

    • 4 mg IV at the end of case 

    • NNT = 6 for prevention of vomiting & 7 for prevention of nausea 

  • Granisetron 

    • 0.35-3 mg (5-20mcg/kg) IV  

    • As effective as ondansetron 

  • Palonosetron 

    • 0.075 mg IV 

    • Effective for 24 hours & superior to ondansetron 4mg IV for PONV prevention 

  • Ramosetron

    • 0.3 mg IV

    • Similar effectiveness to ondansetron

 

When to Administer 

 

  • Ondansetron & Granisetron most effective when given at end of surgery 

  • Palonosetron is usually given at the start of surgery 

 

Adverse Events

NNH listed is for Ondansetron 

  • Constipation (NNH = 23) 

  • ↑ Liver Enzymes (NNH = 31) 

  • Headache (NNH = 36) 

  • ↑ 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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