safe long term 5ht3 antagonist use?

the MOUSE

im on ondansetron 8mg everyday rn for my persistent nausea/vomiting esp in morning but also throughout day. i think its safe long term, the qt risk is from higher doses? tmmrw meeting doc to discuss acidosis, potential further treatments like phenergan.

haidut suggested from this link
https://raypeatforum.com/community/threads/serotonin-endotoxin-pufa-as-primary-causes-of-depression-and-diabetes-can-be-easily-blocked.22823/post-328970

that

@haidut
"5-HT3 antagonists (ondansetron, tropisetron, granisetron, etc) "

Which one is the safest among above given medicines?

They are about the same in terms of risk. All of them have QT prolongation risks in higher doses but when used in doses recommended by Peat (1mg -2mg daily) should be pretty safe. Progesterone seems to reduce that risk further.
https://raypeatforum.com/community/threads/progesterone-reverses-the-side-effects-of-anti-serotonin-drugs-like-ondansetron.10554/

Palonosetron, Tropisetron however may be interestign alternatives as 5ht3 antagonists?

Mulloch94

I think Ginger is relatively safe, and it's a 5-ht3 antagonist. I'm not sure what else would work, maybe mirtazapine? Wished that DaveFoster guy was still around, he'd probably be able to answer that more definitively than me.

Another tactic you could take would be addressing all the things that can promote QT prolongation or arrhythmia and working it backwards to minimize your chances of adverse effects with ondansetron.

What causes QT prolongation? Magnesium deficiency, potassium deficiency, androgen deficiency, progesterone deficiency, adrenaline excess, serotonin excess, estrogen excess.

So if you cant find a suitable replacement I would focus on getting plenty of potassium and magnesium in your diet. Coconut water is an excellent source of both, and you could also make Mag bicarbonate water for additional magnesium. Make sure your DHT and progesterone are at good levels. You probably won't run into any issues with a low-dose of ondansetron.

the MOUSE

@Mulloch94 thnx bro. which form of potassium u reckon is best? im thinking potassium bicarb as can help my acidosis too. my serum hc03 has been 25, anion gap 19 for like a yr now.

mirtazapine might be pre good in my case, ill bring that up. i have some issues falling/maintaining sleep. low appetite. it appears it can cause fluid retention and swelling tho. idk much bout long term effects too as of now but definitely gonna research this further

i agree ginger is pre good, used to take that when i didnt have ondansetron.

Mulloch94

@the-MOUSE Potassium bicarbonate would probably work really well. I've never used it before but the K in it would be absorbed really well. I get most of my potassium from fruits, meat, and coconut water. Just one 12oz tetra pack of coconut water has like 1 gram of potassium in it, so it's loaded with potassium. Potassium will help with fluid retention as well. I make my magnesium bicarbonate with mag hydroxide and carbonated water. I would venture to guess you do something similar to make potassium bicarbonate.