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Sunday, February 22, 2015
The Dance With Ondansetron (Zofran)
Zofran is the brand name for a drug whose generic name is Ondansetron. It is a prescription drug often used for severe nausea and vomiting as often seen in viral illnesses of the stomach or "stomach flu". It may also be used in conjunction with cancer chemotherapies which can produce severe nausea and vomiting.
It is occasionally used to treat hyperemesis gravidarum or the severe abnormal exaggerated upper gastrointestinal response to the hormones of pregnancy. It is not indicated in the treatment of normal nausea and vomiting in pregnancy. There are some occasional other uses particularly in the field of addiction and withdrawal. The drug is available as an injectable and also in an orally disintegrating tablet.
In general, this is a good drug. It can help to prevent the admission of a patient to a hospital for overnight intravenous hydration by quelling the cyclic severe nausea and vomiting of certain viral illnesses. It can help to advance the settling of one's stomach sufficient to allow some fluids taken by mouth and this is a largely positive thing. It can help to make chemotherapy more tolerable for a patient who requires it. It can allow the patient to complete a recommended course rather than to electively abbreviate or terminate it.
However, there are a subgroup of people who need to be particularly careful prior to using this drug. Ondansetron is noted to have the capacity to lengthen the QT portion of an otherwise normal EKG. In a susceptible subgroup of patients, this can lead to arrhythmia and potential for sudden death. Certainly anyone who experiences a rapid heartbeat or any noted change in heartbeat while taking Ondansetron should return to the hospital emergency room.
As the parent of a child who died of a sudden arrhythmic disorder which had been unknown to his doctors and to us, why would I mention it ? Daniel did not use Ondansetron prior to his sudden passing. However, this may be of issue to those of you who have lost a child or family member and who have other children or family members who may have the same proclivity to arrhythmia, which may be as yet undiagnosed. Two of Daniel's brothers have in fact, used Ondansetron for a day or so following a stomach flu on two separate years. We did use the drug knowing that arrhythmia was a potential side effect, but the emergency room physicians ordering the drug made the decision that the benefits outweighed the risks at that particular juncturet of the treatment. Both young adults were well enough to be able to discontinue the drug after the initial 24 hours of use.
My reason for letting all of you know about Ondansetron is that even among the population of those who have lost a sibling to a sudden arrhythmic disorder that there can be an appropriate short term use for the drug. You should also know that a sibling of someone who has died of presumed Long QT Syndrome should not receive this drug in the longer term.
Make sure that any physician ordering drugs for your family or your children know that you have lost a family member to Long QT Syndrome, if in fact, you have.
As always, just as my thoughts and memories are always with Daniel, my thoughts are also with the other parents and families who suddenly and inexplicably lost a healthy child to a sudden arrhythmic death of which there is most often, no warning.