As a physician I believe everyone should have a medication for nausea in their medicine cabinet. After surgery, with a viral gastroenteritis, or if you get sick from a food borne illness you will need a medication to control nausea and vomiting (an antiemetic). There are huge differences in the costs of nausea medications so you need to know there are great new medications available as generics that are so much more affordable.
The oral nausea medication that changed the frontier when it was released, and is now available as a generic is ondansetron (Zofran is the brand name). It was the first selective serotonin blocking agent to be marketed. It is similar to granisetron, which made available as a generic in 1994. Ondansetron is an extremely safe and highly effective antiemetic that has greatly improved the ability to give chemotherapy. It is also used for nausea during pregnancy. Patients’ quality of life has been superior with ondansetron and granisetron than with older, traditional antiemetics.
The orally disintegrating tablet Zofran ODT, or ondansetron ODT, which does not require water to aid in swallowing, is also much more expensive than the regular tablets, so many people wonder if the ODT is better. No, not really. Following oral administration ondansetron tablets and orally disintegrating tablets (ODT) are bioequivalent (essentially the same). Yes, it may make sense that a dissolvable tablet on your tongue is easier to take if you can’t keep a pill down even for 20 minutes but you and your doctor need to decide if it’s worth the higher cost for the ODT.
There are two older nausea medications that deserve mention if you can’t tolerate ondansetron for some reason. Prochlorperazine (Compazine, which has been discontinued) is an antipsychotic medication used for the management of nausea and vomiting but it shares many of the actions and adverse effects of the antipsychotics.
Prochlorperazine has had many setbacks, and in 2008 a black box warning was added regarding an increased risk of death in elderly patients with dementia receiving these drugs for behavioral problems.
Another older nausea medication is trimethobenzamide (Tigan). Interestingly, the exact mechanism of action of trimethobenzamide is unknown, but it may be mediated through the chemoreceptor trigger zone (CTZ). Also strange is that this medication is expensive, because it’s been around forever.
Ondansetron and granisetron are typically considered Tier 1 medications by insurance companies, meaning you should only be responsible for your lowest copay. Regular ondansetron is often included in discount generic programs, and the 4mg tablet can be found for around $25 for 30 pills. Ondansetron ODT is slightly more expensive at around $30 for 30 pills. Granisetron 1mg tablets are significantly more, starting at around $500 for 30 pills.