Ondansetron is a highly effective anti-emetic that, since it has gone generic, is also quite inexpensive. There have been some reports of QT prolongation and cardiac arrhythmias especially with the high-dose 32mg IV dose for chemotherapy patients.
Is still safe in our ED population? A large systematic review was done in this month's Ann Emerg Med July 2014,p19-31.
Take Home Points:
1) No reports of arrhythmia associated with single dose administration identified
2) 80% of 60 unique reports were IV
3) 83% had significant PMH or already on a QT prolonging drug
Conclusion: Ondansetron doesn't warrant routine EKG or electrolyt screening in oral administration.High dose IV and High Risk patients do require more vigilance with EKG and electrolyte screening.
