Abstract
Background: Ondansetron, a 5-hydroxytryptamine (5-HT) receptor antagonist, is generally regarded as a safe and well tolerated antiemetic. Meanwhile, some reports mentioned that it is a probable cause of single generalized seizures after intravenous administration. Our report may be the first to indicate repeated generalized seizures after intramuscular therapeutic dose of ondansetron. Methods and Results: We report a 24-year-old female with nausea and vomiting related to gastritis that experienced repeated ondansetron-induced seizures shortly after a single intramuscular therapeutic dose. Two minutes after intramuscular injection of 4 mg ondansetron, our patient developed the first generalized seizure. Within the following two hours, seizures occurred two more times. In the emergency department, the patient developed a fourth, but weaker and shorter, generalized seizure. The patient was not hypoglycemic, but her blood hemoglobin and serum electrolytes were below normal. A few hours later, the patient was discharged. The dramatic onset of the seizures, as well as the complete recovery and absence of any neurological sequel in our patient, indicated that it was probably related to ondansetron. Conclusion: Patients should be informed about the potential side effects of ondansetron especially the life-threatening repeated generalized seizures, and clinicians should restrict its use to hospitalized patients.
Highlights
Ondansetron a selective 5-hydroxytryptamine (5-HT3) receptor antagonist is frequently used to treat severe nausea and vomiting associated with cancer chemotherapy, radiotherapy, anesthesia, surgery as well as drug over-dosage or poisoning [1]
We report a 24-year-old female with nausea and vomiting related to gastritis that experienced repeated ondansetroninduced seizures shortly after a single intramuscular therapeutic dose
Patients should be informed about the potential side effects of ondansetron especially the lifethreatening repeated generalized seizures, and clinicians should restrict its use to hospitalized patients
Summary
(5-HT3) receptor antagonist is frequently used to treat severe nausea and vomiting associated with cancer chemotherapy, radiotherapy, anesthesia, surgery as well as drug over-dosage or poisoning [1]. The patient had no previous history of seizures, head injury or meningitis. She developed four generalized tonic-clonic seizures; the first one occurred within two minutes after the injection. Within the following two hours, seizures occurred two more times. The patient developed a fourth, but weaker and shorter, generalized seizure. She received intravenous rehydration therapy in the form of 500 mL of ringer followed by 500 ml of normal saline. Her random blood glucose level was 80 mg/dl as checked by a glucometer.
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