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Zuplenz
Zuplenz (ondansetron) is an antiemetic used to prevent nausea and vomiting caused by chemotherapy, radiation therapy, and surgery. It works by blocking the action of serotonin, a natural substance in the body that can trigger nausea and vomiting. Zuplenz comes in an orally soluble film form, which dissolves on the tongue without the need for water, making it particularly useful for patients who have difficulty swallowing pills or those who are experiencing nausea.
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Frequently Asked Questions
How long does it take for Zuplenz to start working?
Zuplenz starts working within 30 minutes of administration. It is typically given before chemotherapy, radiation, or surgery to prevent nausea and vomiting.
Can I take Zuplenz for nausea unrelated to chemotherapy or surgery?
While Zuplenz is commonly prescribed for nausea and vomiting caused by chemotherapy, radiation, or surgery, your doctor may prescribe it for other types of nausea if they deem it appropriate.
Can I drink water immediately after taking Zuplenz?
You don’t need to drink water with Zuplenz, as the film dissolves on the tongue. However, if desired, you can drink water after the film has completely dissolved.
What should I do if I miss a dose of Zuplenz?
If you miss a dose, take it as soon as you remember. If it is close to the time of your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Can Zuplenz cause drowsiness?
Yes, drowsiness is a possible side effect of Zuplenz. Be cautious when driving or operating heavy machinery until you know how it affects you.
Comprehensive Drug Guide
How Does Zuplenz Work?
Zuplenz works by blocking serotonin (5-HT3) receptors in the brain and gastrointestinal tract. Serotonin is involved in the signaling pathway that causes nausea and vomiting. By preventing serotonin from binding to these receptors, Zuplenz effectively reduces nausea and vomiting triggered by chemotherapy, radiation, and surgery.
Common Dosages
- 4 mg orally disintegrating film
- 8 mg orally disintegrating film
Typical Dosing
- For chemotherapy-induced nausea and vomiting (CINV): The typical dose is 8 mg taken 30 minutes before chemotherapy, followed by an additional 8 mg dose 8 hours later. Subsequent doses are given every 12 hours for 1-2 days after chemotherapy.
- For radiation-induced nausea and vomiting: The typical dose is 8 mg taken 1-2 hours before radiation therapy, followed by an additional dose every 8 hours as needed.
- For postoperative nausea and vomiting: The usual dose is 16 mg taken 1 hour before anesthesia.
Typical Dosing
FDA Approved Indications
- Nausea and vomiting caused by chemotherapy (both highly and moderately emetogenic chemotherapy)
- Nausea and vomiting caused by radiation therapy
- Postoperative nausea and vomiting following surgery
Who Shouldn't Take Zuplenz?
- Known hypersensitivity to ondansetron or any other 5-HT3 receptor antagonists.
- Congenital long QT syndrome, as Zuplenz may prolong the QT interval, increasing the risk of serious heart rhythm problems.
Advice From The Pharmacist
- Zuplenz comes as a thin film that dissolves on the tongue. Place the film on your tongue, allow it to dissolve completely, and swallow the saliva. No water is needed.
- Do not chew or swallow the film whole before it has dissolved.
- If you are taking Zuplenz for chemotherapy-related nausea, be sure to follow the prescribed dosing schedule to maximize its effectiveness.
- Avoid driving or operating machinery until you know how Zuplenz affects you, as it may cause drowsiness or dizziness in some patients.
Side Effects of Zuplenz
Common Side Effects
- Headache
- Fatigue
- Constipation
- Dizziness
Uncommon/Severe Side Effects
- QT prolongation (irregular heart rhythm)
- Severe allergic reactions (rash, hives, difficulty breathing)
- Serotonin syndrome when combined with other serotonergic medications
Risks and Warnings of Zuplenz
- QT Prolongation: Zuplenz may cause QT prolongation, which can lead to serious heart rhythm disturbances, especially in patients with pre-existing heart conditions or those taking medications that also affect the heart rhythm.
- Serotonin Syndrome: Although rare, Zuplenz may increase the risk of serotonin syndrome, particularly when used with other medications that affect serotonin levels (e.g., SSRIs, SNRIs). Symptoms include confusion, rapid heart rate, and muscle rigidity.
- Hypersensitivity Reactions: Severe allergic reactions to ondansetron, the active ingredient in Zuplenz, have been reported. Discontinue use if you experience rash, swelling, or difficulty breathing.
Interactions with Zuplenz
Common Drug Interactions
- SSRIs and SNRIs: Medications that affect serotonin levels, such as antidepressants (SSRIs or SNRIs), may increase the risk of serotonin syndrome when taken with Zuplenz.
- Drugs that prolong the QT interval: Combining Zuplenz with medications known to prolong the QT interval (such as antiarrhythmics, certain antipsychotics) can increase the risk of serious heart rhythm disturbances.
- Apomorphine: The combination of Zuplenz with apomorphine is contraindicated due to the risk of severe hypotension and loss of consciousness.
Alternatives to Zuplenz
- Zofran (ondansetron): The same active ingredient as Zuplenz, available in tablet, injectable, and orally disintegrating tablet forms.
- Granisetron (Kytril): Another 5-HT3 receptor antagonist used for nausea and vomiting caused by chemotherapy and surgery.
- Dolasetron (Anzemet): Another serotonin receptor antagonist for the prevention of nausea and vomiting.
- Aprepitant (Emend): A neurokinin-1 receptor antagonist often used in combination with ondansetron for preventing chemotherapy-induced nausea and vomiting.
