Limited Use Note(s)

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ONDANSETRON HYDROCHLORIDE4mg
Reason For Use CodeClinical Criteria
215For the treatment of emesis in cancer patients receiving highly emetogenic chemotherapy.
LU Authorization Period: 1 year
216For patients receiving intravenous chemotherapy or radiation therapy who have not experienced adequate control with other available anti-emetics.
LU Authorization Period: 1 year
217For patients receiving intravenous chemotherapy or radiation therapy who experience intolerable side effects with other anti-emetics.
LU Authorization Period: 1 year
218For the treatment of emesis in patients receiving radiation therapy which consists of single fraction treatment to the abdominal cavity, hemi-body irradiation and total body irradiation.
NOTE: The therapeutic value of Ondansetron Hydrochloride more than 24 hours after the last dose of chemotherapy is unproven.
LU Authorization Period: 1 year
454For the treatment of emesis in cancer patients receiving moderately emetogenic chemotherapy (MEC) regimens.
LU Authorization Period: 1 year