Dystonic reaction associated with ondansetron administration in a patient with normal pressure hydrocephalus

Diaz-Parlet, Jay; Subramani, Sudhakar

doi:10.1016/j.jclinane.2015.03.037

Cited by 2 publications

(10 citation statements)

References 15 publications

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“…Its effectiveness and favourable sideeffect profile compared to other anti-emetics, including metoclopramide, prochlorperazine and droperidol, have led to its widespread use in both oncology and anaesthesia [8,10]. However, there have since been several case reports of ondansetronrelated acute dystonic reactions [1,2,[4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…However single doses of 4 mg have also been reported as the cause of acute dystonic reactions [1,[4][5][6][7]. Extrapyramidal side effects are unpredictable, with cases reported in patients who have previously been administered the drug uneventfully [2,4]. Graded reactions have been reported in which repeated administrations of ondansetron resulted in increasing severity of the extrapyramidal reaction, from none to mild and then severe [6].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The maintenance of posture and the regulation of involuntary motor function is achieved via a dynamic balance between the inhibitory neurotransmitters dopamine and gammaaminobutyric acid, and the excitatory neurotransmitter acetylcholine within the extrapyramidal tracts [1][2][3]6]. Ondansetron is thought to indirectly reduce inhibitory dopaminergic activity [1,[4][5][6]8] and the resultant reduction in D2 dopaminergic activity may also increase stimulatory cholinergic activity [9]. This disturbance in dopaminergic-cholinergic balance can rarely result in extrapyramidal symptoms [1].…”

Section: Introductionmentioning

confidence: 99%

“…Ondansetron has a low affinity for dopamine receptors and so extrapyramidal side effects are rare [1]. However, several case reports describe extrapyramidal reactions in which the causative agent is either ondansetron or less commonly, propofol [1–7]. Reported extrapyramidal effects include dystonia, whereby sustained muscle contractions cause repetitive movements or abnormal postures; and oculogyric crises, characterised by paroxysmal, conjugate and tonic eye deviation.…”

Section: Introductionmentioning

confidence: 99%

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Severe acute drug‐induced dystonia in the post‐operative period requiring tracheal re‐intubation

Baigent,

Morris

2023

Anaesthesia Reports

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SummaryOndansetron is a highly selective 5‐hydroxytryptamine receptor antagonist and the most commonly used anti‐emetic for the prevention of postoperative nausea and vomiting. Ondansetron has a low affinity for dopamine receptors and so extrapyramidal side effects are rare. Here, we present the case of a 14‐year‐old girl who developed a severe post‐operative acute dystonic reaction which included oculogyric crisis. We believe that ondansetron was the most likely cause, although propofol may have been a synergistic or alternative causative agent. The patient had no significant past medical history and had previously undergone two uneventful general anaesthetics which included both ondansetron and propofol. The prolonged duration and severity of the reaction and failure to fully respond to specific treatments resulted in the need for tracheal intubation and transfer to a paediatric intensive care unit. She subsequently recovered uneventfully with no ongoing neurological sequalae. Ondansetron‐induced dystonic reactions are rare and unpredictable and can occur in patients who have previously received the drug without complication. They are thought to be caused by an imbalance between inhibitory and excitatory neurotransmitters in the extrapyramidal system. Specific treatments include anticholinergics, antihistamines and benzodiazepines.

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