Ondansetron Vs. Sertraline: Drug Comparison

Ondansetron is a medication used to prevent nausea and vomiting by blocking serotonin receptors in the brain and gut, which are involved in triggering the vomiting reflex. Its FDA-approved indications include the prevention of nausea and vomiting associated with chemotherapy, radiation therapy, and surgery. Off-label uses may include managing nausea in pregnancy (morning sickness) and gastroenteritis. Ondansetron is available in several forms, including oral tablets, orally disintegrating tablets, oral solution, and intravenous injections. Common side effects include headaches, constipation, and dizziness, while serious risks include a rare heart rhythm disorder (QT prolongation). Caution is advised in patients with heart conditions or those taking other medications that affect the QT interval.

Sertraline is the active ingredient in the brand-name medication Zoloft^®. The information below is about brand name Zoloft. According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

Zoloft (sertraline) is a selective serotonin reuptake inhibitor (SSRI) used to treat mood disorders by increasing available serotonin levels in the brain, which helps improve mood and reduce symptoms of anxiety and depression. Its FDA-approved indications include the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), and premenstrual dysphoric disorder (PMDD). Off-label uses may include the treatment of eating disorders and generalized anxiety disorder (GAD). Zoloft is available in tablet and oral solution forms, typically taken once daily. Common side effects include nausea, dizziness, insomnia, and sexual dysfunction, and it carries a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly during the initial treatment period.

5-HT3 receptor antagonist

Selective serotonin reuptake inhibitor (SSRI)

Ondansetron is indicated for the prevention of:

• Nausea and vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m²

• Nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy

• Nausea and vomiting associated with radiotherapy in patients receiving either total body irradiation, single high-dose fraction to the abdomen, or daily fractions to the abdomen

• Postoperative nausea and/or vomiting

Zoloft (sertraline hydrochloride) is indicated for the treatment of:

• Major depressive disorder (MDD)

• Obsessive-compulsive disorder (OCD)

• Panic disorder (PD)

• Posttraumatic stress disorder (PTSD)

• Social anxiety disorder (SAD)

• Premenstrual dysphoric disorder (PMDD)

• Typically taken orally—see the full prescribing information for the recommended dosage in adults and pediatric

• Comes in 4 mg, 8 mg, and 24 mg tablets

• Typically taken orally once daily

• Comes in 25 mg, 50 mg, and 100 mg tablets and 20 mg/mL oral solution

The most common adverse reactions in adults for the:

Prevention of chemotherapy-induced (≥ 5%) are:

• Headache

• Malaise/Fatigue

• Constipation

• Diarrhea

Prevention of radiation-induced nausea and vomiting (≥ 2%) are:

• Headache

• Constipation

• Diarrhea

Prevention of postoperative nausea and vomiting (≥ 9%) are:

• Headache

• Low levels of oxygen

Most common adverse reactions (≥5% and twice placebo) in pooled placebo-controlled MDD, OCD, PD, PTSD, SAD and PMDD clinical trials were:

• Nausea

• Diarrhea/Loose stool

• Tremor

• Indigestion

• Decreased appetite

• Excessive sweating

• Ejaculation failure

• Decreased libido

• Patients known to have hypersensitivity (e.g., anaphylaxis) to ondansetron or any components of the formulation

• Concomitant use of apomorphine

• Concomitant use of monoamine oxidase inhibitors (MAOIs), or use within 14 days of stopping MAOIs

• Concomitant use of pimozide

• Known hypersensitivity to sertraline or excipients

• Zoloft oral solution only: Concomitant use of disulfiram

• Drug interactions: protein-bound drugs, CYP2D6 substrates

• Hypersensitivity reactions, including anaphylaxis and bronchospasm

• QT interval prolongation and Torsade de pointes

• Serotonin syndrome

• Myocardial ischemia

• Masking of progressive ileus and/or gastric distension following abdominal surgery or chemotherapy-induced nausea and vomiting

• Serotonin syndrome

• Increased risk of bleeding

• Activation of mania/hypomania

• Seizures

• Angle closure glaucoma

• QTc prolongation

• Sexual dysfunction

• Pregnancy: Third trimester use may increase risk for persistent pulmonary hypertension and withdrawal in the neonate

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients.

Closely monitor for clinical worsening and emergence of suicidal thoughts and behaviors.

*This information is from the ondansetron hydrochloride label used by Aurobindo Pharma Limited. See the Full Prescribing Information for more complete information. This information may not be accurate for all medications that include the active ingredient ondansetron.

*This information is from the label for brand name Zoloft^®. See the Full Prescribing Information for more complete information. Sertraline, the active ingredient in Zoloft, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient sertraline.