OBJECTIVES: Methotrexate (MTX) is an effective treatment for Crohn disease (CD); however, its application may be limited by the occurrence of nausea. We assessed whether a short course of ondansetron minimized this adverse event. PATIENTS AND METHODS: A retrospective case-control study of patients with CD who received MTX at the Children's Hospital of Eastern Ontario between 2001 and 2009 was conducted. RESULTS: Sixty-four patients received MTX during this time period. The mean age of diagnosis was 12.0 ± 3.0 years (± standard deviation), and the mean age when MTX was initiated was 13.6 ± 2.6 years. Those receiving only 1 or 2 doses of MTX (N = 4) and stopped for reasons other than development of nausea were not included in the analysis. Fifty patients received ondansetron premedication using a 4- to 8-week tapering schedule with MTX, and only 1 patient (2.0%) developed nausea within the first 3 months of MTX. In contrast, 6 of 10 patients (60.0%, P < 0.001) not premedicated with ondansetron reported nausea following MTX within 3 months. Four of these 6 patients subsequently received ondansetron and had no further complaints. Following ondansetron discontinuation, 5 of 50 (10%) patients developed nausea with subsequent MTX injections, but responded to reinstitution of ondansetron. Some children developed anticipatory nausea (6/60, 10%) and 3 experienced nausea relief after initiating premedication with ondansetron. CONCLUSIONS: Nausea following MTX is a common complaint in patients with CD. For most, this adverse effect may be prevented through the use of a short-course ondansetron as premedication. Ondansetron to treat MTX-induced nausea also can be successfully used but a proactive preventive strategy can be achieved.
OBJECTIVES:Methotrexate (MTX) is an effective treatment for Crohn disease (CD); however, its application may be limited by the occurrence of nausea. We assessed whether a short course of ondansetron minimized this adverse event. PATIENTS AND METHODS: A retrospective case-control study of patients with CD who received MTX at the Children's Hospital of Eastern Ontario between 2001 and 2009 was conducted. RESULTS: Sixty-four patients received MTX during this time period. The mean age of diagnosis was 12.0 ± 3.0 years (± standard deviation), and the mean age when MTX was initiated was 13.6 ± 2.6 years. Those receiving only 1 or 2 doses of MTX (N = 4) and stopped for reasons other than development of nausea were not included in the analysis. Fifty patients received ondansetron premedication using a 4- to 8-week tapering schedule with MTX, and only 1 patient (2.0%) developed nausea within the first 3 months of MTX. In contrast, 6 of 10 patients (60.0%, P < 0.001) not premedicated with ondansetron reported nausea following MTX within 3 months. Four of these 6 patients subsequently received ondansetron and had no further complaints. Following ondansetron discontinuation, 5 of 50 (10%) patients developed nausea with subsequent MTX injections, but responded to reinstitution of ondansetron. Some children developed anticipatory nausea (6/60, 10%) and 3 experienced nausea relief after initiating premedication with ondansetron. CONCLUSIONS:Nausea following MTX is a common complaint in patients with CD. For most, this adverse effect may be prevented through the use of a short-course ondansetron as premedication. Ondansetron to treat MTX-induced nausea also can be successfully used but a proactive preventive strategy can be achieved.
Authors: David R Mack; Eric I Benchimol; Jeff Critch; Jennifer deBruyn; Frances Tse; Paul Moayyedi; Peter Church; Colette Deslandres; Wael El-Matary; Hien Huynh; Prévost Jantchou; Sally Lawrence; Anthony Otley; Mary Sherlock; Thomas Walters; Michael D Kappelman; Dan Sadowski; John K Marshall; Anne Griffiths Journal: J Can Assoc Gastroenterol Date: 2018-07-10
Authors: Rishi S Mehta; Zachary L Taylor; Lisa J Martin; Michael J Rosen; Laura B Ramsey Journal: Clin Transl Sci Date: 2021-08-23 Impact factor: 4.689