Why Zofran Is Prescribed for Kids With Nausea and Vomiting

Zofran (ondansetron) can be used in emergency situations to treat severe vomiting and diarrhea in children with acute gastroenteritis (stomach flu). It’s also a drug commonly used to prevent severe nausea and vomiting in people undergoing cancer chemotherapy or radiation therapy.

Zofran doesn’t treat stomach flu but can help prevent dehydration, which can become very serious very quickly in babies and younger children.

This article describes how Zofran is used in kids as well as the possible side effects, risks, and contraindications. It also lists some of the other medications that can be used to treat nausea and vomiting in children with stomach flu.

Uses of Zofran for Kids

Zofran is approved for the prevention of nausea and vomiting in people undergoing chemotherapy or radiation. It is also approved to prevent postoperative (post-surgical) nausea and vomiting.

Even so, Zofran is often prescribed off-label due to its potent antiemetic (anti-nausea) effects. This includes the treatment of severe vomiting in children with gastroenteritis. It is typically used in emergency room settings as the last resort when vomiting poses a risk of severe dehydration.

Dehydration is a dangerous loss of body fluid that can lead to complications like seizures, kidney failure, and shock if the fluid loss is severe. Because kids have smaller body sizes, dehydration and its complications can both develop rapidly.

Zofran can be also used to support oral rehydration therapy (ORT) in babies and children with severe diarrhea and vomiting. ORT involves drinking water with modest amounts of sugar and salts to replenish lost body fluids. Studies have shown that Zofran can help children keep oral fluids down rather than vomiting them up.

Outside of its approved uses, Zofran is only used in emergency situations when the benefits outweigh the potential risks.

Dosage for Kids

Zofran is available in an oral tablet, dissolvable tablet, oral solution, and an intravenous (IV) solution.

In emergency situations, intravenous Zofran solution is delivered either as a slow injection (in not less than 30 seconds) or an IV drip over 15 minutes. The dosage in milligrams varies by the weight of the child in kilograms (mg/kg).

The oral tablets or solution are prescribed based on the child's weight as follows:

Side Effects

As with all medications, Zofran may cause side effects. Because the drug is delivered in a hospital setting for a short amount of time, the side effects tend to be manageable.

Common side effects of Zofran include:

• Dizziness
• Fatigue
• Headache
• Weakness
• Constipation
• Diarrhea

Risks and Contraindications

While the benefits of Zofran in emergency situations usually outweigh the risks, it is nevertheless used with caution in children with severe diarrhea as it can sometimes make it worse. This is especially true in cases of severe stomach flu where other treatment options may need to be explored.

Zofran can also cause irregular heart rhythms and should never be used in children with a known heart condition. The same applies if a child is experiencing irregular heartbeats as a result of dehydration, which is not uncommon in severe cases.

Zofran has been studied in children as young as three months. Even so, clinical judgment and experience are needed to ensure that it is used appropriately, particularly in children under the age of two years.

Alternatives to Zofran

Zofran is not the only option for treating severe vomiting in children with stomach flu. In fact, other options may be recommended well before Zofran is even considered. These include:

• Antivert (meclizine)
• Dramamine (dimenhydrinate)
• Reglan (metoclopramide)
• Stemetil (prochlorperazine)

Antivert and Dramamine are available over the counter and by prescription. Reglan and Stemetil are available by prescription only (although there is a version of Stemetil called Buccastem M that is available over the counter).

Speak with your child's pediatrician before using any medication to treat your child's vomiting or diarrhea.