Mehra Karishma K, Gogtay Nithya J, Ainchwar Rohan, Bichile Lata S
Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India.
J Med Case Rep. 2008 Aug 14;2:274. doi: 10.1186/1752-1947-2-274.
Ondansetron, a 5-hydroxytryptamine3 receptor antagonist widely used in the prevention and treatment of chemotherapy-induced nausea and vomiting, is associated with various unusual adverse drug reactions. In this paper, we describe a hypersensitivity reaction to a single intravenous dose of ondansetron.
A 19-year-old woman presented to the emergency department of our institute with 3-4 episodes of nausea, vomiting and epigastric distress. She had a diagnosis of polycystic ovarian disease and had been on treatment with cyproterone acetate 2 mg, ethinyl estradiol 0.035 mg, finasteride 5 mg and metformin 500 mg for a month. She had been taking oral roxithromycin 500 mg per day for the past 3 days for treatment of a mild upper respiratory tract infection. She also occasionally took rabeprazole 10 mg for gastritis which had worsened after treatment with roxithromycin. She was treated with a single 4 mg dose of ondansetron intravenously. She immediately developed urticaria, which was treated with intravenous dexamethasone 4 mg and chlorpheniramine maleate 20 mg. The reaction abated within a few minutes and she was discharged within an hour. She was asymptomatic at 72 hours of follow-up.She had no history of ondansetron exposure, or drug or food allergies. On the Naranjo's causality assessment scale, the adverse event was 6 indicating a "probable" reaction to ondansetron.
5-hydroxytryptamine3 receptor antagonists have been associated with life-threatening adverse reactions such as hypotension, seizures and anaphylaxis. The wide availability of these drugs in India has promoted their off label use in the treatment of gastritis, migraine and so on. Our case represents an off label use in a patient who could have been treated with a safer drug.Some authors have suggested that anaphylaxis may be a class effect while others think it may be drug specific. In our case, the reaction could be either anaphylaxis or anaphylactoid, but the latter seems more likely given the history of absence of prior sensitization. Other components of the drug, such as solvent, also need to be considered as a cause of this reaction. Considering all of the existing evidence, we need to be more cautious while using ondansetron and also to be aware of the various unusual side effects, especially when used in an out-of-hospital set-up.Our case report underscores the importance of physicians judiciously using the drug, particularly in the outpatient setting so as to reduce the incidence of avoidable adverse drug reactions.
昂丹司琼是一种广泛用于预防和治疗化疗引起的恶心和呕吐的5-羟色胺3受体拮抗剂，与各种不寻常的药物不良反应有关。在本文中，我们描述了一例对单次静脉注射昂丹司琼的过敏反应。
一名19岁女性因出现3 - 4次恶心、呕吐和上腹部不适到我院急诊科就诊。她被诊断为多囊卵巢疾病，已服用醋酸环丙孕酮2毫克、炔雌醇0.035毫克、非那雄胺5毫克和二甲双胍500毫克治疗一个月。在过去3天里，她每天服用口服罗红霉素500毫克以治疗轻度上呼吸道感染。她还偶尔因胃炎服用雷贝拉唑10毫克，在服用罗红霉素后胃炎加重。她接受了单次静脉注射4毫克昂丹司琼的治疗。她立即出现荨麻疹，随后接受了静脉注射4毫克地塞米松和20毫克马来氯苯那敏的治疗。反应在几分钟内减轻，她在一小时内出院。在随访72小时时她无症状。她既往无昂丹司琼暴露史，也无药物或食物过敏史。根据纳兰霍因果关系评估量表，该不良事件评分为6分，表明对昂丹司琼“很可能”有反应。
5-羟色胺3受体拮抗剂与危及生命的不良反应有关，如低血压、癫痫发作和过敏反应。这些药物在印度广泛可得，促使其在治疗胃炎、偏头痛等方面的超说明书使用。我们的病例代表了在一名本可用更安全药物治疗的患者中的超说明书使用。一些作者认为过敏反应可能是类效应，而另一些人则认为可能是药物特异性的。在我们的病例中，该反应可能是过敏反应或类过敏反应，但考虑到既往无致敏史，后者似乎更有可能。药物的其他成分，如溶剂，也需要被视为该反应的一个原因。考虑到所有现有证据，我们在使用昂丹司琼时需要更加谨慎，同时要意识到各种不寻常的副作用，特别是在院外环境中使用时。我们的病例报告强调了医生明智使用该药物的重要性，特别是在门诊环境中，以减少可避免的药物不良反应的发生率。
