Use of ondansetron and other antiemetics in the management of toxic acetaminophen ingestions

Journal of Toxicology. Clinical Toxicology
E J Scharman

Abstract

Patients presenting with acetaminophen toxicity and vomiting are often treated with antiemetics so that orally administered N-acetylcysteine can be retained. The policy at the West Virginia Poison Center is to reserve ondansetron, an antiemetic with a higher cost than other antiemetics, as a second line agent for patients presenting within 8 hours of an acetaminophen ingestion. A retrospective study of cases between January 1993 and December 1995, in which the primary or secondary drug ingested was an adult-strength, acetaminophen-only formulation and the ingestion resulted in vomiting. Seventy-eight patients with laboratory-verified acetaminophen toxicity and vomiting were evaluated for the type of antiemetics used and the antiemetic's effectiveness. Of the 78 acetaminophen toxic patients with vomiting, 17/51 patients (33.3%) who received a nonondansetron antiemetic failed therapy and required IV ondansetron. Of the 24 patients who received ondansetron, 4 patients (16.7%) failed therapy. All four patients who failed ondansetron therapy had previously failed other antiemetic therapy. Although ondansetron had a lower failure rate than nonondansetron antiemetics, almost two-thirds of acetaminophen toxic patients with vomiting did...Continue Reading

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Citations

Dec 12, 2007·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Melissa A MillerJennifer L Donovan
Apr 22, 2009·Current Opinion in Pediatrics·Deborah A Levine
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May 12, 2010·Basic & Clinical Pharmacology & Toxicology·Sa'ed H ZyoudSamah W Al-Jabi

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