Reglan Vs. Zofran: Drug Comparison

Reglan^® (metoclopramide) is a prescription medication used to treat certain stomach and intestinal problems, including acid reflux and paralysis of the stomach, by improving stomach muscle movement and speeding up digestion. It helps relieve symptoms like nausea, vomiting, and feeling full quickly after eating. Typically taken 30 minutes before meals, Reglan is meant for short-term use, as prolonged treatment may increase the risk of side effects, including a serious condition called tardive dyskinesia, which causes involuntary muscle movements. Common side effects include drowsiness, fatigue, and restlessness.

Zofran^® is a brand-name medication that contains the active ingredient ondansetron. The information below is about ondansetron hydrochloride tablets. 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.”

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.

Prokinetic agent

5-HT₃ receptor antagonist

Reglan (metoclopramide) is indicated for the:

• Treatment for 4 to 12 weeks of symptomatic, documented gastroesophageal reflux in adults who fail to respond to conventional therapy

• Relief of symptoms in adults with acute and recurrent diabetic gastroparesis

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

• Typically taken orally up to four times daily

• Comes in 5 mg and 10 mg tablets

• 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

Most common adverse reactions (>10%) are:

• Restlessness

• Drowsiness

• Fatigue

• Weariness

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

• History of TD or dystonic reaction to metoclopramide

• When stimulation of gastrointestinal motility might be dangerous

• Pheochromocytoma, catecholamine-releasing paragangliomas

• Epilepsy

• Hypersensitivity to metoclopramide

• Drug interactions: Antipsychotics, CNS depressants, strong CYP2D6 inhibitors (e.g., quinidine, bupropion, fluoxetine, paroxetine), MAO inhibitors

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

• Concomitant use of apomorphine

• Tardive dyskinesia (TD), other extrapyramidal symptoms (EPS), and neuroleptic malignant syndrome (NMS): Avoid concomitant use of other drugs known to cause TD/EPS/NMS and avoid use in patients with Parkinson’s disease

• Depression and suicidal ideation/suicide: Avoid use

• 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

WARNING: TARDIVE DYSKINESIA

Reglan can cause tardive dyskinesia (TD), a serious movement disorder that is often irreversible. There is no known treatment for TD. The risk of developing TD increases with duration of treatment and total cumulative dosage.

Discontinue Reglan in patients who develop signs or symptoms of TD.

Avoid treatment with Reglan for longer than 12 weeks because of the risk of developing TD with longer-term use.

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

*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.