Why Zofran Is Prescribed for Kids With Nausea

A girl who cared by Grandma is taking pills in bed
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If your child was recently in the emergency room because he was vomiting and dehydrated, he may have been given a dose of Zofran (ondansetron). You may wonder why this drug that is used for nausea in cancer chemotherapy is used for children who have stomach flu. It has become very common in the emergency room setting for acute gastroenteritis (stomach flu).

The Difference Between Zofran and Phenergan

Phenergan (promethazine) is often used to control nausea and vomiting, but in 2006 the FDA recommended it not be used for children under age 2. This medication carries a risk of causing slowed or stopped breathing in babies and toddlers. In older children, Phenergan so often causes drowsiness that many pediatricians don't like to use it. Even if your child isn't vomiting, if he is too sleepy to drink when he has a stomach virus, then he or she will likely still become dehydrated.

Zofran has its own warning, though, at least for higher dosages that were once for nausea and vomiting associated with chemotherapy. This followed a study that found that a single 32-milligram dose might affect the heart's rhythm, leading to QT interval prolongation. This dose, however, is no longer available and is much higher than the 2 milligrams to 8 milligrams that children and teens typically are prescribed.

Use of Zofran for Stomach Flu

Although Zofran is only approved for preventing nausea and vomiting for patients about to undergo chemotherapy or surgery, many medications are given off-label for other conditions. In this case, there are many research studies that show that Zofran can be helpful for treating and preventing vomiting associated with acute gastroenteritis.

A 2011 Cochrane review of studies concluded that oral ondansetron helped children and adolescents cease vomiting and reduced the need for intravenous rehydration and hospital admission. A 2014 study said Zofran was given to half of the children with stomach flu who visited an emergency room in the U.S.

The study concluded that clinicians should focus on giving the drug to the children who were most at risk of dehydration, couldn't keep down oral fluids, and might need intravenous fluids.

When Zofran Is Given to Children

While many practitioners find Zofran helpful in the emergency room at preventing and treating vomiting from gastroenteritis, your pediatrician might not prescribe it on an outpatient basis. The current practice guidelines, including those from the American Academy of Pediatrics, don't recommend using medications to stop vomiting.

There are no research studies supporting that it works in this situation as all of the studies have been done in an emergency room setting. If further research supports it, maybe doctors will use it more for kids with the stomach flu.

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Article Sources
  • Cheng A. Emergency department use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children. Paediatrics & Child Health. 2011;16(3):177-179.
  • Fedorowicz Z, Jagannath VA, Carter B. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database of Systematic Reviews. July 2011. doi:10.1002/14651858.cd005506.pub5.
  • Freedman SB, Hall M, Shah SS, et al. Impact of Increasing Ondansetron Use on Clinical Outcomes in Children With Gastroenteritis. JAMA Pediatrics. 2014;168(4):321. doi:10.1001/jamapediatrics.2013.4906.