Ondansetron headache

Ondansetron Abdominal pain anxiety/agitation arrhythmias increased AST and ALT chills/shivehng constipation diarrhea dizziness drowsiness/sedation extrapyramidal syndrome malaise/fatigue fever/pyrexia gynecological disorder headache hypotension hypoxia injection site reaction musculoskeletal pain ... 

Ondansetron generally does not cause severe toxicity. Headache and constipation are the most frequent adverse effects. Light-headedness, dizziness, and transient increases in serum aminotransferase activity can occur. Extrapyramidal effects have occurred rarely, and anaphylactoid reactions have been reported. 

A 36-year-old woman with rapid-cycling bipolar II disorder and premenstrual mood exacerbation was treated as an out-patient with lamotrigine 400 mg/day, clonazepam 0.5 mg tds, and quetiapine 100 mg/day. She gained 9 kg in 6 months and was advised to reduce the dose of quetiapine to 50 mg/day. After 1 day, she reported nausea, dizziness, headache, and anxiety severe enough to preclude normal daily activities. She was instructed to take quetiapine 75 mg/day, but her symptoms continued and only resolved when she took 100 mg/day. Slower reduction in the dose of quetiapine (by 12.5 mg/day every 5 days) with an antiemetic, ondansetron, also failed. On a third attempt, prochlorperazine successfully reduced her withdrawal symptoms, although moderate nausea persisted for 2 days after complete withdrawal. 

Granisetron and tropisetron appear to have the same safety profile as ondansetron (6). Their adverse reactions include mild rises in transaminases (up to 17%), slight headache (8-42%), transient diarrhea (2-5%), which may be followed during longer-term therapy by constipation, dizziness (5%), and dry mouth (5-17%) the incidence of xerostomia is higher than with metoclopramide. Other reported adverse effects include anorexia, paresthesia, constipation or abdominal discomfort, changes in blood pressure, fever, facial edema, leg cramps, hot flushes, and enlargement of the spleen (7). 

In a large double-blind study comparison of single-dose oral granisetron versus intravenous ondansetron in the prevention of nausea and vomiting induced by chemotherapy in 1085 patients, the drugs were equally effective and gave rise to a similar frequency of adverse effects, commonly headache, weakness, and constipation (15). Dizziness and blurred vision were reported by significantly more of the patients who received ondansetron. 

The antiemetic effect of combined intravenous ondansetron 8 mg, oral dexamethasone 20 mg, and oral lorazepam 0.5 mg was significantly better than that of intravenous metoclopramide 10 mg, dexamethasone 20 mg, and oral lorazepam 0.5 mg in 30 patients receiving chemotherapy for ovarian cancer in a randomized trial (23). All the antiemetics were given 30 minutes before and 6 hours after chemotherapy. Significantly more patients given metoclopramide (40% versus 13%) complained of adverse effects. The most frequent adverse effects with both regimens were sedation and headache. 

In a prospective randomized, double-blind, placebo-controlled study in 100 patients scheduled for elective orthopedic surgery and presenting with pruritus induced by epidural or intrathecal morphine, intravenous ondansetron 8 mg was effective in 70% of cases and placebo in 30% (23). Ondansetron was well tolerated, did not change the degree of analgesia, and was not associated with adverse effects usually associated with ondansetron, such as headache, abdominal pain, and cardiac dysrhythmias. 

D. Toxicity Adverse effects of ketanserin are those of alpha blockade and Hj blockade. The toxicides of ondansetron, granisetron, and dolasetron include diarrhea and headache. Dolasetron has been associated with QRS and QT prolongation in the ECG and should not be used in patients with heart disease. Alosetron caused significant constipation in some patients. 

Ergonovine for Alzheimer s disease Methysergide for acute migraine headache Ondansetron for acute migraine headache Ranitidine for Parkinson s disease Which of the following is most useful in the treatment of hyperprolactinemia ... 

Ondansetron versus palonosetron In a randomized, open comparison of ondansetron and palonosetron in the treatment of chemotherapy-induced nausea and vomiting in 143 patients with acute myelogenous leukemia receiving high-dose cytarabine, the two drugs were equally efficacious [26 ]. The most common treatment-related adverse events were constipation and headache and 22 patients reported events that were possibly or probably related to ondansetron or palonosetron. There were no cardiac adverse events that were considered possibly or probably related to ondansetron or palonosetron. 

A 26-year-old primigravida was given intravenous ondansetron 6 mg every 12 hours after a cesarean section and after 14 hours developed a severe headache aggravated by postural change [31 ]. Ondansetron was withdrawn, and she improved dramatically within a few hours, with complete recovery over the next 24 hours. 

Sharma R, Panda A. Ondansetron-induced headache in a parturient mimicking postdural puncture headache. Can J Anaesth 2010 57 187-8. 

Singh V, Sinha A, Prakash N. Ondansetron-induced migraine-type headache. Can J Anaesth 2010 57 872-3. 

Comparative studies Azasetron versus ondansetron Intravenous azasetron 10 mg and ondansetron 8 mg have been compared in a double-blind, randomized trial in 98 patients with postoperative nausea and vomiting after gynecological laparoscopic surgery under general anesthesia [23 "]. Azasetron was more efficacious in the intermediate postoperative period (12-24 hours). Both drugs caused headache, dizziness, and constipation and the frequencies were similar. 

Nervous system A 26-year-old woman undergoing emergency cesarean delivery under spinal anesthesia with bupivacaine 10 mg was pre-medicated with intravenous ranitidine 50 mg and metoclopramide 10 mg, and received intramuscular diclofenac for postoperative analgesia [32 ]. Starting at 12 hours postoperatively she was given intravenous ondansetron 6 mg every 12 hours for nausea and vomiting. About 2 hours after the first dose she developed a severe headache, which persisted for over 90 hours and was characterized by aggravation of symptoms in coincidence with doses of ondansetron. The headache resolved completely a few hours after ondansetron withdrawal. 

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