Antiemetic activity of ondansetron in acute gastroenteritis

Abstract

Background: The mechanism of nausea and vomiting associated with gastroenteritis is unknown. The role of 5‐HT3 receptors in emesis associated with gastroenteritis was investigated in paediatric patients. Methods: A randomized, double‐blind, placebo‐controlled, parallel‐group study was conducted in three groups of 12 patients each, receiving either a single i.v. dose of ondansetron (0.3 mg/kg), metoclopramide (0.3 mg/kg) or placebo (sterile saline). Food was restricted and oral rehydration was administered for 4 h. Results: During 0–24 h, the number of emetic episodes experienced was significantly greater (P=0.048) with placebo (mean=5) than ondansetron (mean=2) and the proportion of patients experiencing no emesis was significantly greater (P=0.039) with ondansetron (58%) than placebo (17%). A numerical difference, in favour of ondansetron, was observed between ondansetron and metoclopramide groups for both of the above parameters. Fewer treatment failures were observed with ondansetron (17%) than placebo (33%) and metoclopramide (42%). More diarrheal episodes were observed in the groups receiving anti‐emetic treatment. All three treatments were well tolerated. Conclusions: Ondansetron, a 5HT3 receptor antagonist, was significantly superior to placebo in preventing emesis associated with acute gastroenteritis, in paediatric patients. Therefore, serotonin, acting through 5HT3 receptors, may play a role in this form of emesis.

The Management of Children with Gastroenteritis and Dehydration in the Emergency Department

“…Serotonin type-3 receptor antagonists also have been shown to be effective antiemetics in postsurgicalinduced emesis in children (70 -72). All of these studies also noted a lack of major side effects, including extra- (73). Thirty-six children were enrolled: 12 receiving placebo, 12 receiving metoclopramide 0.3 mg/kg, and 12 receiving ondansetron 0.3 mg/kg.…”

Effects of metformin on intestinal 5-hydroxytryptamine (5-HT) release and on 5-HT3 receptors

“…It is thus possible that part of the gastrointestinal side effects observed during treatment with metformin could be produced by the release of 5-HT and of other neurotransmitter substances within the duodenal mucosa. The released 5-HT could activate 5-HT 3 receptors present on vagal visceral afferent fibers to elicit gastrointestinal side effects, as has been shown for cancer chemotherapeutic drugs, Xradiation, chronic cryptosporidiosis-induced diarrhea in patients with HIV infection, and acute viral gastroenteritis, conditions where gastrointestinal side effects are prevented or reduced by treatment with 5-HT 3 antagonists (Cubeddu et al 1990(Cubeddu et al , 1997Schwörer et al 1994;Balfour and Goa 1997). It is of interest to note that gastrointestinal side effects are observed in approximately 30% of the patients receiving treatment with metformin (Dandona et al 1983;Bailey and Turner 1996), and that metformin elicited 5-HT release in nearly 40% of the duodenal mucosa specimens examined (present study).…”

Acute anti-emetic withdrawal associated with a hemorrhagic cerebellar arteriovenous malformation

“…10 Its use is also effective and well tolerated in the prevention of emesis from acute gastroenteritis in the pediatric population. 11 The medication has usually been regarded as a benign drug with minor side effects. The drug is usually tolerated over wide ranges with the most common side effects being headache or constipation.…”