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Carmustineetoposideand cisplatin do not affect the pharmacokinetics of ondansetron.

HepaticAspartate transaminaseASTand/or alanine transaminaseALTvalues exceeded twice the upper limit of normal in approximately 1to 2of 723 patients receiving ZOFRAN and cyclophosphamide-based chemotherapy in US clinical trialsThe increases were transient and did not appear to be related to dose or duration of therapyOn repeat exposuresimilar transient elevations in transaminase values occurred in some coursesbut symptomatic hepatic disease did not occurThe role of cancer chemotherapy in these biochemical changes is unclear.

Ondansetron is extensively metabolized in humanswith approximately 5of a radiolabeled dose recovered as the parent compound from the urineThe metabolites are observed in the urineThe primary metabolic pathway is hydroxylation on the indole ring followed by subsequent glucuronide or sulfate conjugation.

The development of serotonin syndrome has been reported with 5-HT 3 receptor antagonists aloneMost reports have been associated with concomitant use of serotonergic drugse.gselective serotonin reuptake inhibitorsSSRIsserotonin and norepinephrine reuptake inhibitorsSNRIsmonoamine oxidase inhibitorsmirtazapinefentanyllithiumtramadoland intravenous methylene blueSome of the reported cases were fatalSerotonin syndrome occurring with overdose of ZOFRAN alone has also been reportedThe majority of reports of serotonin syndrome related to 5-HT 3 receptor antagonist use occurred in a post-anesthesia care unit or an infusion center.

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october 2012 the prominent canadian physician gideon koren, md, who founded toronto hospital for sick children s motherisk published a report that raised questions about whether zofran is safe for use during pregnancy.