Ondansetron (Zofran) alternatives: What can I take instead?

In this article:

• What can I take instead of ondansetron
• Top 5 ondansetron alternatives
• Natural alternatives
• How to switch

In this article

• What can I take instead of ondansetron
• Top 5 ondansetron alternatives
• Natural alternatives
• How to switch

Ondansetron (Zofran) is a prescription antiemetic medication approved by the U.S. Food and Drug Administration (FDA) to prevent nausea and vomiting. The brand-name Zofran is no longer available in the U.S., but the generic version, ondansetron, is commonly prescribed for patients undergoing cancer treatments such as chemotherapy or radiation, or those who have recently undergone surgery. It’s also prescribed off-label as an add-on therapy to reduce symptoms of some mental health conditions, such as obsessive-compulsive disorder (OCD) and schizophrenia.

Ondansetron is a powerful medication to prevent nausea and vomiting, but some patients are unable to take it due to its side effects or interactions with other medications. Some also find it’s not the most effective antiemetic for them. In these cases, their healthcare provider may recommend an alternative medication.

What can I take instead of ondansetron

If you are unable to take ondansetron or find that it doesn’t provide sufficient nausea relief, there are other options you can explore. Other antiemetics include: 

• Other serotonin (5-HT3) antagonists 
• NK-1 receptor antagonists (such as aprepitant)
• Antihistamines (promethazine, meclizine
• Anticholinergics (scopolamine, dimenhydrinate)
• Phenothiazines (prochlorperazine)
• Gastrointestinal stimulants (metoclopramide)
•  Olanzapine
•  Benzodiazepines 
• Cannabinoids
• Certain steroids 

A variety of medicines may be used to treat nausea in different ways, and not all patients will find the same medication to be the right fit. “One option is Promethazine (phenergan), a first-generation antihistamine that blocks histamine receptors to promote strong anti-nausea and sedative effects, similar to Zofran,” says Ryan Sultan, MD, a double board‑certified psychiatrist, and the founder and medical director of Integrative Psych in Chelsea, New York. “Aprepitant (Emend) is another, typically used for chemotherapy nausea. It’s typically used alongside ondansetron to produce an effect better than using either medication individually. When used by itself, aprepitant stays active in the body longer than ondansetron to offer extended relief.”

The best choice of medication will also depend on the underlying cause of your nausea. There are many reasons you might be experiencing nausea or vomiting—morning sickness from the first trimester of pregnancy, migraine headaches, cancer treatment, postoperative nausea, or other health conditions. Figuring out why you’re experiencing nausea will help you and your healthcare team identify the best anti-nausea medication for you.

Below are some of the most common Zofran alternatives:

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see the latest drug prices.

Save up to 80% on Ondansetron with SingleCare

Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.

Ondansetron 4 mg (10 Tablet)

23666 - Hampton, VA

$5.11

i Price with signup

Get free coupon

$5.11

i Price with signup

Get free coupon

See Ondansetron prices at all pharmacies

Top 5 ondansetron alternatives

Here are some of the most common alternatives to ondansetron:

1. Phenergan

Phenergan (promethazine) is an antiemetic medication often used as an alternative to ondansetron. The two drugs are used to treat nausea and vomiting, but contain different active ingredients and mechanisms of action. While Zofran contains ondansetron, a serotonin receptor antagonist, Phenergan contains promethazine, an antihistamine. Brand-name Phenergan has been discontinued and is now available only in its generic version, promethazine. It can be taken as an oral tablet, solution, injection, or suppository, and your healthcare provider will prescribe the proper dose, typically between 12.5 and 25 milligrams (mg) every four to six hours, not exceeding 100 mg per day.

“Promethazine helps stop the feeling of nausea by calming the part of the brain that causes vomiting,” says Jessica Iroanya, Pharm.D., a registered pharmacist and medication therapy management specialist in San Antonio, Texas. “It works well, but it can make you drowsy, so it’s best to take it when you are able to comfortably rest.”

2. Emend

While ondansetron is used to prevent nausea and vomiting in a wide range of cases, Emend (aprepitant) is an NK-1 receptor antagonist specifically used to treat nausea and vomiting triggered by cancer treatments like chemotherapy. It works by blocking a receptor in the brain that can cause vomiting. Unlike ondansetron, it’s rarely taken alone and is instead paired with another anti-nausea medication for better efficacy. It’s typically taken as a capsule, with a dosage of anywhere from 80 to 125 mg. 

Common side effects of aprepitant include:

• Tiredness
• Headache
• Stomach pain
• Diarrhea
• Constipation
• Loss of appetite
• Dehydration

3. Reglan

Reglan (metoclopramide) is a gastrointestinal stimulant sometimes used for patients with gastroesophageal reflux (GERD) after other drugs have been ineffective. It’s also used to treat patients with gastroparesis who are unable to empty their stomach due to paralysis of the GI tract. However, it’s also prescribed by healthcare providers off-label to treat nausea and vomiting. It’s a medication best taken short-term and should not be taken for more than twelve weeks at a time, as severe side effects become more likely with prolonged use. A serious movement disorder called tardive dyskinesia may be more likely in older patients who take it for longer periods of time.

4. Antivert

Antivert—or meclizine generically—is a popular antihistamine used to prevent nausea. It blocks the effects of histamines in the body. The medication is frequently prescribed for people with extreme dizziness from vertigo or Meniere’s disease. It’s sold as 25 mg tablets and can be taken several times throughout the day. It’s also commonly recommended to prevent motion sickness.

5. Scopolamine

Scopolamine is a prescription anticholinergic drug primarily used to treat motion sickness and postoperative nausea and vomiting (PNOV). Unlike many nausea medications that come in tablet form, scopolamine is available exclusively as an extended-release transdermal patch, which is worn behind the ear. It should only be used for up to three days at a time, and side effects such as dry mouth may occur as long as the medication remains in the bloodstream. The FDA has not approved Scopolamine for use by children under 18.

Over-the-counter serotonin receptor antagonists

Serotonin receptor antagonists, such as ondansetron, require a prescription and are not available over the counter. Patients seeking Zofran or another serotonin receptor antagonist should consult with their healthcare provider to determine the right anti-nausea drug to prevent or relieve nausea.

Natural alternatives to ondansetron

For people seeking to relieve nausea without medication, there are natural alternatives to ondansetron that can be safe and effective. 

“There’s a growing interest in simple ingredients and non-toxic products when it comes to wellness,” Dr. Iroanya says. “For people traveling by air or on cruise ships, I also suggest Sea-Bands, which are acupressure wristbands that help prevent motion sickness. I’ve personally tried the ginger version of Dramamine and had a good experience with it.”

However, she warns that natural remedies may not be as effective as ondansetron, especially for severe nausea. “It’s best to check with your provider to make sure the new option will help manage your symptoms properly.”

Ali Navidi, PsyD, an expert in effective gut-brain therapies of GI Psychology in Virginia, says he’s had clinical experience supporting the use of hypnosis for nausea relief in chemotherapy, hyperemesis gravidarum (excessive vomiting in pregnancy), cyclic vomiting syndrome, anxiety, and more. “I can remember working with a young lady who had endured years of nausea, finding relief and transitioning off medication only after she learned how to use self-hypnosis.” While some studies suggest that mind-body techniques may be effective for nausea in some circumstances, they may not work for everyone.

Ultimately, it’s crucial to consult with a healthcare provider to determine whether a natural alternative to ondansetron will be sufficient or if you should consider the use of prescription drugs in the treatment of nausea.

How to switch to an ondansetron alternative

Switching to an ondansetron alternative is possible, but it should be done carefully. Dr. Sultan says it’s key to work through the transition with the help of your healthcare provider.

“You can safely switch to a Zofran alternative by first working with your clinician to accurately address the cause of the nausea, as different causes may respond better to specific alternatives,” Dr. Sultan says. From there, your healthcare provider will determine an effective transition plan.

Sometimes, healthcare providers will consider a dual approach. “For conditions like chemotherapy-induced nausea, a combination of pharmaceutical and natural treatments may be more effective than monotherapy,” Dr. Sultan adds.

Your healthcare provider will likely recommend a treatment plan that’s slow and steady, as abruptly switching from ondansetron may cause nausea and vomiting to return. If you have any questions or concerns about the medication, please seek medical advice from your healthcare provider.