Liquid medicine detail aid

What is Zofran?

Zofran 8mg/5ml oral solution is a liquid medicine designed to help patients going through chemotherapy or radiotherapy.

• These treatments have been linked to nausea and vomiting in patients across all ages.[1]
• Patients may experience these symptoms during the therapy, or afterwards, known as “post-operative nausea and vomiting” or PONV.
• Nausea and vomiting can make an already distressing time even more uncomfortable.

Dosage of Zofran

To prevent nausea and vomiting, patients are given a 5ml (8mg) dose up to two hours before their treatment. They’ll then take a further 5ml dose every 12 hours for up to five days.

• This can help to protect against delayed or prolonged vomiting.
• In patients with extreme sickness, a dose of up to 15ml (24mg) is recommended up to two hours before therapy.
• This can be combined with 12mg X, an anti-inflammatory medication, for maximum effectiveness.

Who can Zofran help?

Zofran has been formulated to help cancer patients undergoing chemotherapy and radiotherapy.

• In clinical trials, the drug has been effective across all age groups from age 2 to 65+[2], and it is also safe for children from ≥6 months.

In its liquid form, Zofran is especially helpful for vulnerable patients.

• Vulnerable patients may include children, the elderly, and those with learning difficulties.
• These patients may have difficulty swallowing, known as “dysphagia”.
• Our liquid solution offers a palatable alternative with a subtle strawberry flavour.

How does Zofran help cancer patients?

Zofran has been specially formulated to help cancer patients who experience nausea and vomiting during treatment.

• Up to 80% of patients in chemotherapy can experience nausea.[3]
• Between 50 and 80% of patients undergoing radiotherapy may also experience nausea.[4]

Zofran belongs to a class of medicines known as “serotonin 5-HT3 receptor antagonists”.

• Serotonin occurs naturally in the body and is known as a “neurotransmitter”.
• It is responsible for stabilising mood, memory and learning.
• Serotonin is also linked to vomiting and nausea.¹
• Zofran works by blocking the production of serotonin, which lessens nausea and vomiting symptoms.

The liquid formula is particularly helpful for cancer patients who may have difficulty swallowing.

Why is Zofran better than traditional tablets?

Previously, Zofran was available in a film-coated tablet or dissolving tablet only. The liquid version is the first of its kind to be licensed, as manufactured by X company.

Cancer patients undergoing chemotherapy or radiotherapy may have trouble swallowing.

• Up to 68% of care home residents may struggle to swallow.[5]
• Up to 8 in 10 children undergoing chemotherapy may struggle with oral mucositis, which causes swelling and may make swallowing difficult.[6]
• Those with conditions such as comorbid cerebral palsy or motor impairments (inability to move the limbs) may also struggle to swallow.[7]

If patients cannot swallow tablets, they may not take their medications properly. This can lead to serious consequences from underdose and overdose to death.

• Some patients may resort to chewing or crushing, which could cause the medicine to be absorbed too quickly.[8]
• This may result in adverse drug reactions (ADRs).
• Patients with difficulty swallowing are three times more likely to suffer from medication errors.⁸
• Crushing medications can cause tube blockages in up to 45% of patients.[9]

Zofran liquid solution is palatable with a mild strawberry flavour – ideal for everybody from young children to the elderly. Available in a syringe format, it assures the correct dosage every time, without the side effects of crushing or chewing tablets.

Are there any side effects of Zofran?

As with all medications, there are some reported side effects of Zofran. The most commonly reported side effects were:

• Headaches
• Dizziness (when taken through an IV)
• Hiccups
• Constipation
• Warmth or flushing.

In rarer cases, there were reports of seizures, movement disorders, blurred vision, irregular heartbeats and low blood pressure.

Patients with the following conditions should not take Zofran:

• Hypersensitivity to 5HT receptor antagonists.
• Children being treated with hepatotoxic chemotherapeutic agents.
• Use of serotonergic drugs such as SSRIs and SNRIs (anti-depressants) or opiate/opioid medicines.
• Hereditary fructose intolerance (Zofran contains the sweeter sorbitol which may have mild laxative effects).

As with all medications, patients should consult their doctor before taking Zofran.

Should Zofran be taken in pill or liquid form?

Zofran is available as a film-coated tablet, a dissolving tablet or in liquid form. In liquid form, it can be taken orally, rectally or through an IV drip.

Generally, patients taking the liquid form can enjoy benefits such as:

• Faster absorption rates.[10]
• A more palatable strawberry flavour.
• An easy-swallow solution if dysphagia is a problem.

However, some patients may feel more comfortable taking tablets:

• Some patients may struggle to use a syringe without the help of a medical professional.[11]
• Liquid solutions contain sorbitol, which may have mild laxative effects.[12]
• It may be more difficult to store liquid solutions.¹¹

Ultimately, it comes down to individual preference, but a liquid solution is palatable, ideal for all ages, and lessens the risks associated with crushing or chewing tablets.

What lifestyle changes can I make to help me through my cancer treatment?

On top of anti-sickness drugs such as Zofran, you can also prevent nausea during cancer treatment with a few lifestyle changes. These include:

• Avoiding your favourite food – you may develop a negative association with this food if you vomit.[13]
• Trying peppermint or ginger – take this in tea, or ground up in food such as ground ginger in curry dishes.[14]
• Drinking plenty of liquids – clear, sweet liquids are best such as fizzy drinks or ice-cold water.¹⁴
• Eating little and often – smaller, light meals may help to settle your stomach.[15]
• Complementary therapies – meditation, acupuncture and aromatherapy may help to calm your nerves before a treatment.¹⁵

References

1. Minami M, Endo T, Hirafuji M. [Role of serotonin in emesis]. Nihon Yakurigaku Zasshi. 1996 Nov;108(5):233-42. Japanese. doi: 10.1254/fpj.108.233. PMID: 8974084.
2. Sinha PK, Tripathi M, Ambesh SP. Efficacy of Zofran in prophylaxis of postoperative nausea and vomiting in patients following infratentorial surgery: a placebo-controlled prospective double-blind study. J Neurosurg Anesthesiol. 1999 Jan;11(1):6-10. doi: 10.1097/00008506-199901000-00002. PMID: 9890379.
3. National Cancer Institute. (2022). Nausea and Vomiting Related to Cancer Treatment. [Online]. Cancer.gov. Last Updated: 23 June 2022. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-hp-pdq [Accessed 20 September 2022].
4. Habibi M, Namimoghadam A, Korouni R, Fashiri P, Borzoueisileh S, Elahimanesh F, Amiri F, Moradi G. Radiation-induced nausea and vomiting: Is ABO blood group as important as radiation and patient-related factors? An observational study. Medicine (Baltimore). 2016 Aug;95(31): e4334. doi: 10.1097/MD.0000000000004334. PMID: 27495037; PMCID: PMC4979791.
5. Kelly J, Wright D. Administering medication to adult patients with dysphagia. Nurs Stand. 2009 Mar 25-31;23(29):62-8. doi: 10.7748/ns2009.03.23.29.62.c6928. PMID: 19385403.
6. Miller MM, Donald DV, Hagemann TM. Prevention and treatment of oral mucositis in children with cancer. J Pediatr Pharmacol Ther. 2012 Oct;17(4):340-50. doi: 10.5863/1551-6776-17.4.340. PMID: 23413048; PMCID: PMC3567887.
7. Robertson J, Chadwick D, Baines S, Emerson E, Hatton C. Prevalence of Dysphagia in People with Intellectual Disability: A Systematic Review. Intellect Dev Disabil. 2017 Dec;55(6):377-391. doi: 10.1352/1934-9556-55.6.377. PMID: 29194030.
8. X company Pharma. (2012). Medicines Management Medicines management and older people – a guide for healthcare professionals. [Online]. X company Pharma. Available at: https://www.X companypharma.com/sites/default/files/2773_medication_management_final_copy.pdf [Accessed 20 September 2022].
9. Fisher, C. & Blalock, B. (2014). Clogged Feeding Tubes: A Clinician’s Thorn. Nutrition Issues in Gastroenterology. 127(1), p.17. [Online]. Available at: https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-March-14.pdf [Accessed 20 September 2022].
10. Medicare Europe. (2021). Liquid Extracts Vs. Capsules/Tablets. [Online]. Medicare Europe. Available at: https://medicare-europe.co.uk/science-clinical-data/liquids-vs-pills.html [Accessed 20 September 2022].
11. Pharma Approach. (2020). Advantages and Disadvantages of Liquid Dosage Forms. [Online]. Pharma Approach. Last Updated: 09 November 2020. Available at: https://www.pharmapproach.com/advantages-and-disadvantages-of-liquid-dosage-forms/ [Accessed 20 September 2022].
12. Panoff, L. (2020). What Is Sorbitol? Benefits, Uses, Side Effects, and More. [Online]. Healthline. Last Updated: 25 September 2020. Available at: https://www.healthline.com/nutrition/what-is-sorbitol [Accessed 20 September 2022].
13. Gerszberg, D. (2022). 8 Tips for Managing Chemotherapy-Induced Nausea. [Online]. Columbia Surgery. Available at: https://columbiasurgery.org/news/2015/04/29/8-tips-managing-chemotherapy-induced-nausea [Accessed 20 September 2022].
14. Cancer Research UK. (2022). Other ways of controlling sickness. [Online]. Cancer Research UK. Available at: https://www.cancerresearchuk.org/about-cancer/coping/physically/sickness/treatment/other-ways-of-con [Accessed 20 September 2022].
15. Mayo Clinic Staff. (2022). Chemotherapy nausea and vomiting: Prevention is best defense. [Online]. Mayo Clinic. Available at: https://www.mayoclinic.org/tests-procedures/chemotherapy/in-depth/cancer/art-20047517 [Accessed 20 September 2022].

[1] https://pubmed.ncbi.nlm.nih.gov/8974084/

[2] https://pubmed.ncbi.nlm.nih.gov/9890379/

[3] https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-hp-pdq

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979791/

[5] https://pubmed.ncbi.nlm.nih.gov/19385403/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567887/

[7] https://pubmed.ncbi.nlm.nih.gov/29194030/

[8] https://www.X companypharma.com/sites/default/files/2773_medication_management_final_copy.pdf

[9] https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-March-14.pdf

[10] https://medicare-europe.co.uk/science-clinical-data/liquids-vs-pills.html

[11] https://www.pharmapproach.com/advantages-and-disadvantages-of-liquid-dosage-forms/

[12] https://www.healthline.com/nutrition/what-is-sorbitol

[13] https://columbiasurgery.org/news/2015/04/29/8-tips-managing-chemotherapy-induced-nausea

[14] https://www.cancerresearchuk.org/about-cancer/coping/physically/sickness/treatment/other-ways-of-controlling-sickness

[15] https://www.mayoclinic.org/tests-procedures/chemotherapy/in-depth/cancer/art-20047517