1
|
Yürük Mısırlıoğlu H, Öztürk İnce E, Akkaş M. The effect of intravenous ondansetron on QT interval in the emergency department. Am J Emerg Med 2024; 85:7-12. [PMID: 39153265 DOI: 10.1016/j.ajem.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/23/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024] Open
Abstract
OBJECTIVE Ondansetron, a 5HT3 receptor antagonist, is commonly used in emergency departments to treat nausea and vomiting. In 2011, the Food and Drug Administration (FDA) issued a warning that this medicine may cause QT prolongation, potentially leading to deadly arrhythmias. The objective of this study was to characterize the QT interval prolongation associated with ondansetron use in the Emergency Department. METHODS This was a prospective, observational cohort study of adult patients who presented to the emergency department during a one-year period and were treated with intravenous ondansetron. We investigated the QT prolongation associated with dosages. ECGs were obtained before the medication and 5, 15, and 30 minutes after IV drug administration. Every QT measurement was recorded and compared to the zero point. The severity of drug-induced QT prolongation was determined according to the recommendations of the International Conference on Compliance (ICH). QTc prolongation was categorized as 'negligible' (<5 ms), 'significant' (>20 ms), 'potential concern' (>30 ms), or 'definitely worrying' (>60 ms). RESULTS Of the 435 patients enrolled in the study, 60% (261 patients) were female and the mean age was 39 (±18). The QT prolongation peaked at the fifth minute and remained consistent at the fifteenth and thirty-first minutes. The maximum prolongation of the mean QT duration occured at the fifth minute (7.9 ± 18.1 ms). No patient revealed any problems with cardiac conduction. The prolonged QT interval was not related to the dose of ondansetron, but QT measurements were higher in the 30th minute in patients treated with 8 mg of ondansetron. The effect of ondansetron administration on QT prolongation was found to be above the 'negligible' but below the 'significant' value, according to the ICH recommendations. DISCUSSION In this study, QT prolongation due to ondansetron administration was below the 'important' value according to the recommendations of the ICH. No cases of cardiac arrhythmia were reported in any of the partients. Thus, routine ECG monitoring in patients given ondansetron due to the risk of QTc prolongation does not seem cost-effective when evaluated together with additional factors such as its negative impact on emergency patient flow, waste of personnel and time, and increase in healthcare costs. In the absence of a known risk of cardiac arrhythmia, IV administration of 4 mg and 8 mg of ondansetron doses no risk of QT prolongation in the emergency population.
Collapse
Affiliation(s)
| | - Elif Öztürk İnce
- Department of Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Meltem Akkaş
- Department of Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| |
Collapse
|
2
|
Xiong D, Xiong C. Early Postoperative Ondansetron Exposure is Associated with Reduced 90-Day Mortality in Patients Undergoing Cardiac Surgery. Front Surg 2022; 9:885137. [PMID: 35784927 PMCID: PMC9243460 DOI: 10.3389/fsurg.2022.885137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ondansetron is a widely used anti-emetic for the prevention and treatment of nausea and vomiting for patients in critical care. Recent retrospective cohort studies suggest the potential beneficial effects of ondansetron in critically ill patients. In this study, we investigate the impact of ondansetron use on patient outcomes after cardiac surgery. Material and Methods The MIMIC-III database was used to identify two types of cardiac surgical patients: those who were administered early ondansetron and those who were not given this early medication in the first 48 h in the postoperative period. Multivariable logistic regression was used to investigate the effect of ondansetron exposure on 90-day mortality, acute kidney injury, and malignant ventricular arrhythmias. Sensitivity analyses utilizing the inverse probability of treatment weighting and covariate balancing propensity score models were conducted to test the robustness of our findings. Results A total of 12.4% of patients received ondansetron. Ondansetron use was associated with a lower risk of 90-day mortality in the multivariable logistic regression model (OR: 0.31, 95% CI: 0.13 to 0.72; P = 0.006) and sensitivity analyses. Additionally, ondansetron exposure was associated with less postoperative acute kidney injury (OR: 0.82, 95%CI: 0.69 to 0.96; P = 0.017) but did not increase the risk of postoperative malignant ventricular arrhythmias (OR: 0.38, 95%CI: 0.09 to 1.16; P = 0.191). Conclusions In a population of cardiac surgical patients, early postoperative use of ondansetron appears to be associated with decreased 90-day mortality and acute kidney injury.
Collapse
Affiliation(s)
- Dexin Xiong
- Department of Thoracic Surgery, Wuhan Red Cross Hospital, Wuhan, China
| | - Chao Xiong
- Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
- Correspondence: Chao Xiong
| |
Collapse
|
3
|
Drögemöller BI, Wright GEB, Trueman J, Shaw K, Staub M, Chaudhry S, Miao F, Higginson M, Groeneweg GSS, Brown J, Magee LA, Whyte SD, West N, Brodie SM, Jong G', Israels S, Berger H, Ito S, Rassekh SR, Sanatani S, Ross CJD, Carleton BC. A pharmacogenomic investigation of the cardiac safety profile of ondansetron in children and pregnant women. Pharmacotherapy 2022; 148:112684. [PMID: 35149390 DOI: 10.1016/j.biopha.2022.112684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/22/2022] [Accepted: 02/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ondansetron is a highly effective antiemetic for the treatment of nausea and vomiting. However, this medication has also been associated with QT prolongation. Pharmacogenomic information on therapeutic response to ondansetron exists, but no investigation has been performed on genetic factors that influence the cardiac safety of this medication. METHODS Three patient groups receiving ondansetron were recruited and followed prospectively (pediatric post-surgical patients n = 101; pediatric oncology patients n = 98; pregnant women n = 62). Electrocardiograms were conducted at baseline, and 5- and 30-min post-ondansetron administration, to determine the effect of ondansetron treatment on QT interval. Pharmacogenomic associations were assessed via analyses of comprehensive CYP2D6 genotyping and genome-wide association study data. RESULTS In the entire cohort, 62 patients (24.1%) met the criteria for prolonged QT, with 1.2% of the cohort exhibiting unsafe QT prolongation. The most significant shift from baseline occurred at five minutes post-ondansetron administration (P = 9.8 × 10-4). CYP2D6 activity score was not associated with prolonged QT. Genome-wide analyses identified novel associations with a missense variant in TLR3 (rs3775291; P = 2.00 × 10-7) and a variant linked to the expression of SLC36A1 (rs34124313; P = 1.97 × 10-7). CONCLUSIONS This study has provided insight into the genomic basis of ondansetron-induced cardiac changes and has emphasized the importance of genes that have been implicated in serotonin-related traits. These biologically-relevant findings represent the first step towards understanding this adverse event with the overall goal to improve the safety of this commonly used antiemetic medication.
Collapse
Affiliation(s)
- Britt I Drögemöller
- Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; British Columbia Children's Hospital Research Institute, Canada; Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Canada
| | - Galen E B Wright
- British Columbia Children's Hospital Research Institute, Canada; Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Canada; Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Canada; Department of Pharmacology and Therapeutics, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Jessica Trueman
- British Columbia Children's Hospital Research Institute, Canada; Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Canada
| | - Kaitlyn Shaw
- British Columbia Children's Hospital Research Institute, Canada; Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Canada
| | - Michelle Staub
- Clinical Research Unit, Children's Hospital Research Institute of Manitoba, Canada
| | - Shahnaz Chaudhry
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Canada
| | - Fudan Miao
- British Columbia Children's Hospital Research Institute, Canada
| | | | - Gabriella S S Groeneweg
- British Columbia Children's Hospital Research Institute, Canada; Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Canada
| | - James Brown
- British Columbia Women's Hospital and Health Centre, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada
| | - Laura A Magee
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College, UK
| | - Simon D Whyte
- British Columbia Children's Hospital Research Institute, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada; Department of Pediatric Anesthesia, British Columbia Children's Hospital, Canada
| | - Nicholas West
- British Columbia Children's Hospital Research Institute, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada; Department of Pediatric Anesthesia, British Columbia Children's Hospital, Canada
| | - Sonia M Brodie
- British Columbia Children's Hospital Research Institute, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada
| | - Geert 't Jong
- Department of Pharmacology and Therapeutics, Rady Faculty of Health Sciences, University of Manitoba, Canada; Clinical Research Unit, Children's Hospital Research Institute of Manitoba, Canada; Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Sara Israels
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Howard Berger
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Canada; Epi Methods Consulting, Canada
| | - Shinya Ito
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Canada
| | - Shahrad R Rassekh
- British Columbia Children's Hospital Research Institute, Canada; Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Canada; Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Children's Heart Centre, BC Children's Hospital, University of British Columbia, Canada
| | - Shubhayan Sanatani
- Division of Cardiology, Department of Pediatrics, Children's Heart Centre, BC Children's Hospital, University of British Columbia, Canada
| | - Colin J D Ross
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; British Columbia Children's Hospital Research Institute, Canada; Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Canada
| | - Bruce C Carleton
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; British Columbia Children's Hospital Research Institute, Canada; Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Canada; Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Canada.
| |
Collapse
|
4
|
Yang H, Jeon W, Ko Y, Jeong S, Lee J. The effect of oral ondansetron on QT interval in children with acute gastroenteritis; a retrospective observational study. BMC Pediatr 2021; 21:501. [PMID: 34758763 PMCID: PMC8579543 DOI: 10.1186/s12887-021-02937-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In mildly to moderately dehydrated patients with acute gastroenteritis (AGE), oral rehydration therapy (ORT) is the treatment of choice. Though ondansetron is a very effective antiemetics and leads to succeed ORT, there have been reports QT prolongation in patients using it. We investigated the effect of oral ondansetron on QT interval in mildly to moderately dehydrated children with AGE. METHODS This retrospective observational study was conducted in a single pediatric emergency department (ED) of a tertiary university hospital. We collected the medical records of patients with a primary diagnosis of AGE who received oral ondansetron and underwent an electrocardiogram between January 2017 and June 2018. A pediatric emergency physician calculated the corrected QT interval (QTc) by Bazett's method, and the calculations were reviewed by a pediatric cardiologist. QTc values before (preQTc) and after (postQTc) ondansetron administration were analyzed. ΔQTc was calculated as the change from preQTc to postQTc. We also investigated any cardiac complications from oral ondansetron. RESULTS Total 80 patients were included. The mean age of the patients was 53.31 ± 32.42 months, and 45% were male. The mean dose of oral ondansetron was 0.18 ± 0.04 mg/kg. The mean interval from administration of ondansetron to performance of the electrocardiogram was 65 ± 26 min. The mean preQTc was 403.3 ± 24.0 ms, and the mean postQTc was 407.2 ± 26.7 ms. Two patients had a preQTc ≥460 ms, and one patient had a postQTc ≥460 ms. ΔQTc was ≥30 ms in seven patients (8.8%). No ΔQTc was ≥60 ms. No pre- or postQTc was ≥500 ms. No patient had a fatal cardiac arrhythmia after taking ondansetron. CONCLUSION Oral administration of a single dose of ondansetron in children with AGE did not cause high-risk QTc prolongation or fatal arrhythmia.
Collapse
Affiliation(s)
- Heewon Yang
- Department of Emergency Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Woochan Jeon
- Department of Emergency Medicine, Inje University, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Yura Ko
- Department of Emergency Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Sooin Jeong
- Division of Pediatric Cardiology, Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
| |
Collapse
|
5
|
Tabrizi S, Heidari S, Rafiei H. Investigation role of ondansetron on long QT interval among non-cardiac patients. Ann Med Surg (Lond) 2021; 71:102971. [PMID: 34712483 PMCID: PMC8531560 DOI: 10.1016/j.amsu.2021.102971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Ondansetron is one of the commonly prescribed anti-emetic in emergency department however, high dose of the drug is associated with prolonged QT interval. This study was designed to evaluate the effect of ondansetron on prolongation of QT interval among patients referred to our emergency department. Methods In this cross-sectional study patients referred to the emergency department of Imam Reza hospital from June 2019 to December 2019 were included. Before the administration of ondansetron 12-lead electrocardiography was performed in all the patients. 4 mg of i.v. ondansetron was administered to these patients and ECG was obtained again. QT interval was calculated automatically from the system from these electrocardiographs. Demographic data of these patients along with QT interval findings was recorded in the questionnaire and analyzed statistically using SPSS software. Results A total of 55 patients were included with the mean age of 58 ± 13 years, where 36 were females (65.5%) and 19 were males (34.5%). The mean QT interval before and after injection of 4 mg intravenous ondansetron was not statistically significant, p-value = 0.073. Similarly, QT interval before and after the administration of the drugs was also not significantly different among females and males, p = 0.479 and p = 0.078, respectively. The age of the patients was also not associated with prolonged QT interval, p = 0.948. Conclusions The findings of our study indicated that 4 mg i.v. administration of ondansetron among non-cardiac patients referred to emergency department is not associated with QT interval prolongation. Ondansetron is one of the commonly prescribed anti-emetic in emergency department. High dose of the drug is associated with prolonged QT interval. The findings indicated that 4 mg i.v. administration of ondansetron among non-cardiac patients.
Collapse
Affiliation(s)
- Shahrouz Tabrizi
- Department of Emergency Medicine, Kermanshah University of Medical Science, Imam Reza Hospital, Kermanshah, Iran.,Clinical Research Development Center, Imam Ali and Taleghani Hospital, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Shaghayegh Heidari
- Department of Emergency Medicine, Kermanshah University of Medical Science, Imam Reza Hospital, Kermanshah, Iran
| | - Hooman Rafiei
- Department of Emergency Medicine, Kermanshah University of Medical Science, Imam Reza Hospital, Kermanshah, Iran
| |
Collapse
|
6
|
van der Zanden TM, Mooij MG, Vet NJ, Neubert A, Rascher W, Lagler FB, Male C, Grytli H, Halvorsen T, de Hoog M, de Wildt SN. Benefit-Risk Assessment of Off-Label Drug Use in Children: The Bravo Framework. Clin Pharmacol Ther 2021; 110:952-965. [PMID: 34145575 PMCID: PMC8518427 DOI: 10.1002/cpt.2336] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 11/08/2022]
Abstract
A drug is granted a license for use after a thorough assessment of risks and benefits based on high-quality scientific proof of its efficacy and safety. Many drugs that are relevant to children are not licensed for use in this population implying that a thorough assessment of risks and benefits in the pediatric population has not been made at all, implying a negative risk-benefit balance in children, or implying insufficient information to establish the risk-benefit balance. Use of drugs without positive assessment of risks and benefits exposes children to potential lack of efficacy, unknown toxicity, and harm. To aid guideline committees and individual prescribers, we here present a tutorial of the Benefit and Risk Assessment for Off-label use (BRAvO) decision framework. This pragmatic framework offers a structured assessment of benefits and risks of off-label drug use, including a clinical pharmacological based approach to age-appropriate dose selection. As proof of concept and to illustrate the practical use, we have applied the framework to assess benefits and risks of off-label use of ondansetron for gastroenteritis-induced nausea and vomiting. The framework could also guide decisions on off-label use in other special populations (e.g., pregnant women, elderly, obese, or critically ill patients) where off-label drug use is frequent, thereby contributing to effective and safe pharmacotherapy.
Collapse
Affiliation(s)
- Tjitske M. van der Zanden
- Department of PediatricsErasmus MC – Sophia Children’s HospitalRotterdamThe Netherlands
- Departments of Pharmacology and Toxicology, and Intensive CareRadboud Institute Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
- Dutch Knowledge Center Pharmacotherapy for ChildrenDen HaagThe Netherlands
| | - Miriam G. Mooij
- Department of PediatricsLeiden University Medical Centre – Willem‐Alexander Children’s HospitalLeidenThe Netherlands
| | - Nienke J. Vet
- Department of PediatricsSt. Antonius HospitalNieuwegeinThe Netherlands
| | - Antje Neubert
- Department of Pediatric and Adolescent MedicineUniversity Hospital ErlangenErlangenGermany
| | - Wolfgang Rascher
- Department of Pediatric and Adolescent MedicineUniversity Hospital ErlangenErlangenGermany
| | - Florian B. Lagler
- Department for Pediatrics and Institute for Inherited Metabolic DiseasesParacelsus Medical UniversitySalzburgAustria
| | - Christoph Male
- Department of Paediatrics and Adolescent MedicineMedical University of ViennaAustria
| | - Helene Grytli
- The Norwegian Medicines Manual for Health Personnel and Institute for Cancer ResearchOslo University HospitalOsloNorway
| | - Thomas Halvorsen
- Department of Pediatric and Adolescent MedicineMedicines for Children Network, NorwayHaukeland University HospitalBergenNorway
| | - Matthijs de Hoog
- Department of PediatricsErasmus MC – Sophia Children’s HospitalRotterdamThe Netherlands
| | - Saskia N. de Wildt
- Departments of Pharmacology and Toxicology, and Intensive CareRadboud Institute Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
- Dutch Knowledge Center Pharmacotherapy for ChildrenDen HaagThe Netherlands
- Intensive Care and Pediatric SurgeryErasmus MC Sophia Children’s HospitalRotterdamThe Netherlands
| |
Collapse
|
7
|
Wu HL, Zhan X. Effect of ondansetron on vomiting associated with acute gastroenteritis in a developing country: a meta-analysis. Eur J Pediatr 2020; 179:1181-1189. [PMID: 32495146 DOI: 10.1007/s00431-020-03680-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
In high-income countries. ondansetron is an effective antiemetic in children with gastroenteritis, but data from low- and middle-income countries are sparse. This study aimed to evaluate evidences of the effectiveness of ondansetron in preventing vomiting and reducing the use of intravenous fluids in children with gastroenteritis in developing countries. A total of nine randomized controlled trials (RCTs) involving 2313 participants met the inclusion criteria. Compared with placebo, ondansetron reduced the use of intravenous rehydration (three RCTs, n = 1126, relative risk (RR) 0.60, 95% confidence interval (CI) 0.38-0.95, no significant heterogeneity, I2 = 43%), the risk of failure of oral rehydration therapy among children with gastroenteritis-associated vomiting and dehydration (four RCTs, n = 1370, RR 0.58, 95% CI 0.43-0.79; no significant heterogeneity was found, I2 = 39%) and risk of hospitalization (2 RCTs, n = 264, RR 0.25, 95% CI 0.09-0.73, no heterogeneity, I2 = 0).Conclusions: Compared with placebo, ondansetron reduced the use of intravenous fluids in children with gastroenteritis and dehydration. It has no effect on children with gastroenteritis who do not present with dehydration in developing countries. While ondansetron is effective in controlling vomiting and reducing the rate of hospitalization, there is no evidence that it is effective in reducing the rate of readmission. What is Known: • In high-income countries, ondansetron can reduce the use of intravenous fluids in children with gastroenteritis and dehydration. • No systematic review and meta-analysis of randomized controlled trials were done in a developing country setting. What is New: • In developing countries, ondansetron reduces the use of intravenous fluids in children with gastroenteritis and dehydration. • It has no effect on children with gastroenteritis but without dehydration.
Collapse
Affiliation(s)
- Hai-Lin Wu
- Department of Gastroenterology, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing, P.R China., Chongqing Key Laboratory of Pediatrics, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
| | - Xue Zhan
- Department of Gastroenterology, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing, P.R China., Chongqing Key Laboratory of Pediatrics, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.
| |
Collapse
|
8
|
Safaeian R, Hassani V, Asghari A, Mohseni M, Ashraf H, Koleini ZS. The effects of ondansetron versus dexamethasone on electrocardiographic markers of ventricular repolarization in children undergoing cochlear implant. Int J Pediatr Otorhinolaryngol 2020; 132:109896. [PMID: 32032916 DOI: 10.1016/j.ijporl.2020.109896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/06/2020] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Congenital hearing loss is associated with cardiac rhythm disturbances namely long Q-T syndrome. This study was designed to investigate the effect of anti-emetic doses of ondansetron and dexamethasone on ECG recordings in children undergoing cochlear implant surgery. METHODS Sixty-three pediatric patients scheduled for elective cochlear implantation were enrolled in the study. Two patients were excluded as their baseline ECG showed long QT syndrome. Anesthesia was induced with fentanyl, propofol and atracurium and maintained with propofol. Dexamethasone 0.1 mg.kg-1or ondansetron 0.2 mg.kg-1was randomly administered for the participants approximately 30 min before the end of surgery. ECG recording was performed 15 min after induction of anesthesia and 15 min after dexamethasone/ondansetron administration. RR interval, QRS duration, QT interval, and Tp-e interval were measured by a blinded cardiologist. RESULTS Ondansetron resulted in no significant changes in RR, JTc and QTc intervals; while prolongedTp-e interval. Multivariable logistic regression analysis showed that use of ondansetron was an independent predictor of QTc prolongation after adjustment for age, gender and baseline QTc (OR = 17.94, CI 95% 1.97-168.70, p = 0.011). The incidence of postoperative retching/vomiting in ondansetron group was significantly lower than dexamethasone group. (3.2% vs. 26.7%, p = 0.011). CONCLUSION The risk of arrhythmias with the use of ondansetron in otherwise healthy candidates of cochlear implant is very low. However, the drug may induce significant changes in ECG parameters. The clinical significance of these changes in patients with cardiac conduction abnormalities should be investigated in further studies.
Collapse
Affiliation(s)
- Reza Safaeian
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
| | - Valiollah Hassani
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
| | - Alimohamad Asghari
- Skull Base Research Center, The Five Senses Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Masood Mohseni
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran.
| | - Haleh Ashraf
- Cardiac Primary Prevention Research Center (CPPRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Sadat Koleini
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Campleman SL, Brent J, Pizon AF, Shulman J, Wax P, Manini AF. Drug-specific risk of severe QT prolongation following acute drug overdose. Clin Toxicol (Phila) 2020; 58:1326-1334. [PMID: 32252558 DOI: 10.1080/15563650.2020.1746330] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Severe QT prolongation (SQTP) has been identified as a strong predictor of adverse cardiovascular events in acute drug overdose, but drug-specific causes of SQTP in the setting of acute drug overdose remain unclear. We aimed to perform the most definitive study to date describing drug-specific risk of SQTP following acute drug overdose.Methods: This was a prospective multicenter cohort study at >50 hospital sites across the US using the ToxIC Registry between 2015 and 2018. Inclusion criteria were adults (≥18 years) receiving medical toxicology consultation for acute drug overdose. The primary outcome was SQTP, which was defined using the computer automated Bazett QT correction (QTc) on the ECG with the previously validated cut point of 500 milliseconds. Mean difference in QTc was also calculated for specific drugs. Drugs associated with SQTP were analyzed using multivariable logistic regression to control for known confounders of QT risk (age, sex, race, cardiac disease).Results: From 25,303 patients screened, 6473 met inclusion criteria with SQTP occurring in 825 (13%). Drugs associated with increased adjusted odds of SQTP included Class III antidysrhythmics (sotalol), sodium channel blockers (amitriptyline, diphenhydramine, doxepin, imipramine, nortriptyline), antidepressants (bupropion, citalopram, escitalopram, trazodone), antipsychotics (haloperidol, quetiapine), and the antiemetic serotonin antagonist ondansetron.Conclusions: This large US cohort describes drug-specific risk of SQTP following acute drug overdose. Healthcare providers caring for acute drug overdoses from any of these implicated drugs should pay close attention to cardiac monitoring for occurrence of SQTP.
Collapse
Affiliation(s)
- Sharan L Campleman
- Toxicology Investigators Consortium, American College of Medical Toxicology, Phoenix, AZ, USA
| | - Jeffery Brent
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anthony F Pizon
- Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joshua Shulman
- Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Paul Wax
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Alex F Manini
- Division of Medical Toxicology, Department of Emergency Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | |
Collapse
|
10
|
Patel P, Paw Cho Sing E, Dupuis LL. Safety of clinical practice guideline-recommended antiemetic agents for the prevention of acute chemotherapy-induced nausea and vomiting in pediatric patients: a systematic review and meta-analysis. Expert Opin Drug Saf 2019; 18:97-110. [DOI: 10.1080/14740338.2019.1568988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Priya Patel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada
- Pediatric Oncology Group of Ontario, Toronto, Canada
| | - Edric Paw Cho Sing
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada
| | - L. Lee Dupuis
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|