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Intravenous Administration of Ondansetron
Question# 999
We now have the ability to administer ondansetron IV. I looked through the medical directive and co.panion document to see how it should be administered but there were no directions. I have since asked quite a few ACPs and we are all under the same belief that diluting the 2ml of zofran in 8ml of NS and using a slow push is sufficient. One ACP did tell me the only way zofran could be given was if it was diluted in a 50ml NS bag and administering over 10-15 mins. I had not heard this before. What is base hospitals direction as I believe there is some confusion amongst paramedics.
Answer:
The 4mg dose of ondansetron prescribed by the ALS PCS can be safely administered by slow IV push in a single syringe over 2-5 minutes.
Dilution in a "mini-bag" of 50mL NS or D5W is also acceptable but not required for this dose.
In higher doses (currently not found in the ALS PCS) the risk of arrythmias precipitated by the QT prolonging effects of the drug are increased with faster administrations so the higher dosing ranges of Ondansetron must be administered by slow infusion.
Dilution in a "mini-bag" of 50mL NS or D5W is also acceptable but not required for this dose.
In higher doses (currently not found in the ALS PCS) the risk of arrythmias precipitated by the QT prolonging effects of the drug are increased with faster administrations so the higher dosing ranges of Ondansetron must be administered by slow infusion.