Literature case analysis of cardiotoxicity due to 5-HT 3 receptor antagonists
10.3760/cma.j.cn114015-20230817-00610
- VernacularTitle:5-羟色胺3受体拮抗剂相关心脏毒性文献病例分析
- Author:
Wen JI
1
;
Shuping WANG
;
Zhenguo TANG
;
Wen ZHANG
Author Information
1. 青岛市胶州中心医院药学部，青岛 266300
- Publication Type:Journal Article
- Keywords:
Antiemetics;
Receptors, serotonin, 5-HT 3;
Drug-related side effect and adverse reactions;
Cardiotoxicity;
Ondansetron;
Dolasetron;
Granisetron;
Tropise
- From:
Adverse Drug Reactions Journal
2024;26(4):204-210
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics of cardiotoxicity due to 5-hydroxytryptamine 3 receptor (5-HT 3) antagonists. Methods:Relevant databases at home and abroad (up to June 20, 2023) were searched and case literature of cardiotoxicity induced by 5-HT 3 receptor antagonist were collected. Relevant information of patients, medication status (drug name, usage and dosage, indication, combined drugs), occurrence of cardiotoxicity, evaluation of the association between 5-HT 3 receptor antagonists and cardiotoxicity, intervention measures and outcomes were extracted and analyzed descriptively and statistically. Results:A total of 23 case reports, 22 in English and 1 in Chinese, were enrolled in the analysis. There were 26 patients, 6 males and 20 females, and the age ranged from 8 to 60 years, with an average of 40 years. The reasons for drug use were perioperative antiemesis in 19 patients, chemotherapy antiemesis in 2 patients, and other reasons in 5 patients. Ondansetron was used in 19 patients, dolasetron in 4 patients, granisetron, tropisetron and palonosetron in 1 patient each. Except for 1 patient with overdose by self-medication, the dosage in 25 patients was within the recommended range in labels. A total of 50 case time of cardiotoxicity occurred in 26 patients, mainly including tachycardia (12 cases), electrocardiogram (ECC) changes (11 cases), bradycardia (9 cases), cardiac arrest (1 case), and myocardial infarction (1 case), etc. Twenty-one patients experienced cardiotoxicity after initial medication, of which 8 occurred immediately after the initial medication, 5 patients occurred after ≥2 times of medication. After the occurrence of cardiotoxicity, 26 patients stopped 5-HT 3 receptor antagonists successively, of which 24 stopped the drug immediately and received symptomatic treatments, 1 stopped the drug after 8 days of medication without other intervention, and 1 stopped the drug and received symptomatic treatment after the symptoms aggravated. After drug withdrawal and/or symptomatic treatments, the mentioned symptoms disappeared and ECC returned to normal in 25 patients. Of them, 22 patients had a recovery time of ≤48 hours, while the other 3 patients had their ECG returned to normal at 1 week, 2 weeks, and 2 months, respectively; one patient died due to ineffective treatment for ventricular fibrillation. Conclusions:The cardiotoxicity induced by 5-HT 3 receptor antagonists mostly occurs after the initial medication, and mainly manifests as tachycardia, bradycardia, ECG changes, etc. Most patients have a good prognosis after timely drug withdrawal and symptomatic treatments, and in severe cases, it can lead to death.
