Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/12/14 20:49:50」(JST)
wiki en
| Systematic (IUPAC) name | |
|---|---|
| (RS)-9-methyl-3-[(2-methyl-1H-imidazol-1-yl)methyl]-2,3-dihydro-1H-carbazol-4(9H)-one | |
| Clinical data | |
| Trade names | Zofran Ondisolv |
| AHFS/Drugs.com | monograph |
| MedlinePlus | a601209 |
| Pregnancy cat. | B1 (AU) B (US) |
| Legal status | Prescription Only (S4) (AU) ℞-only (US) |
| Routes | Oral, rectal, IV, IM |
| Pharmacokinetic data | |
| Bioavailability | ~60% |
| Protein binding | 70%-76% |
| Metabolism | Hepatic (CYP3A4, CYP1A2, CYP2D6) |
| Half-life | 5.7 hours |
| Excretion | Renal |
| Identifiers | |
| CAS number | 99614-02-5 Y |
| ATC code | A04AA01 |
| PubChem | CID 4595 |
| IUPHAR ligand | 2290 |
| DrugBank | DB00904 |
| ChemSpider | 4434 Y |
| UNII | 4AF302ESOS Y |
| KEGG | D00456 Y |
| ChEMBL | CHEMBL46 Y |
| Chemical data | |
| Formula | C18H19N3O |
| Mol. mass | 293.4 g/mol |
|
SMILES
|
|
|
InChI
|
|
| Y (what is this?) (verify) |
|
Ondansetron (INN) (/ɒnˈdænsɛtrɒn/; developed and first marketed by GlaxoSmithKline as Zofran) is a serotonin 5-HT3 receptor antagonist used mainly as an antiemetic (to treat nausea and vomiting), often following chemotherapy. It affects both peripheral and central nerves.[1] Ondansetron reduces the activity of the vagus nerve, which deactivates the vomiting center in the medulla oblongata, and also blocks serotonin receptors in the chemoreceptor trigger zone. It has little effect on vomiting caused by motion sickness, and does not have any effect on dopamine receptors or muscarinic receptors.
Contents
- 1 Medical uses
- 1.1 Chemotherapy
- 1.2 Post-operative
- 1.3 Pregnancy
- 1.4 Cyclic vomiting syndrome
- 1.5 Gastroenteritis
- 2 Adverse effects
- 3 History
- 4 Brand names
- 5 Publication bias
- 6 Research
- 6.1 Psychiatric disorders
- 6.2 Substance use
- 6.3 Postanesthetic shivering
- 7 References
- 8 External links
Medical uses[edit]
Although an effective anti-emetic agent, the high cost of brand-name ondansetron initially limited its use to controlling postoperative nausea and vomiting (PONV) and chemotherapy-induced nausea and vomiting (CINV).[2]
Chemotherapy[edit]
The 5-HT3 receptor antagonists are the primary drugs used to treat and prevent chemotherapy-induced nausea and vomiting (CINV). A common use case is to give them intravenously about 30 minutes before commencement of a chemotherapy treatment.
Post-operative[edit]
A number of medications including ondansetron appear to be effective in controlling post-operative nausea and vomiting (PONV).[3] It is unclear if it is better than or worse than other agents like droperidol, metoclopramide, or cyclizine.[3]
Pregnancy[edit]
Ondansetron is used off-label to treat morning sickness and hyperemesis gravidarum of pregnancy.[4] A cohort study of over 600,000 pregnancies in Denmark found that ondansetron administration during pregnancy is not associated with a significantly increased risk of spontaneous abortion, stillbirth, major birth defect, preterm birth, low birth weight, or small for gestational age.[5] However, in practice, ondansetron is typically used after trials of other drugs have failed.[4]
Cyclic vomiting syndrome[edit]
Ondansetron is one of several anti-emetic agents used during the vomiting phase of cyclic vomiting syndrome.[6]
Gastroenteritis[edit]
Trials in emergency department (ED) settings support the use of ondansetron to reduce vomiting associated with gastroenteritis and dehydration.[7] A retrospective review found that it was used commonly for this purpose, being administered in over 58% of cases. Its use reduced hospital admissions, but was also associated with higher rates of return visits to the ED. Furthermore, patients who had initially received ondansetron were more likely to be admitted on the return visit than patients who had not received the drug. However, this effect may simply be due to the agent being used more frequently in patients who present with more severe illness. Its use was not found to mask serious diagnoses.[8]
Adverse effects[edit]
Ondansetron is a well-tolerated drug with few side effects. Constipation, dizziness and headache are the most commonly reported side effects associated with its use. There have been no significant drug interactions reported with this drug's use. It is broken down by the hepatic cytochrome P450 system and it has little effect on the metabolism of other drugs broken down by this system.
On September 15, 2011, the U.S. FDA issued a Medwatch Safety Alert for ondansetron in patients with congenital Long QT syndrome, a heart arrhythmia. The FDA further required GlaxoSmithKline to conduct a thorough QT study to determine the degree to which ondansetron may cause QT interval prolongation.[9] On June 29, 2012, the FDA issued a Drug Safety Communication Update entitled New information regarding QT prolongation with ondansetron (Zofran).[10] Ondansetron was included in the List of Potential Signals of Serious Risks/New Safety Information Identified by the FDA Adverse Event Reporting System (FAERS) between January– March 2013.[11] As a result of these concerns, the rarely prescribed 32-mg dose of ondansetron was voluntarily removed from the market in December, 2012.[12][13]
History[edit]
A vial of ondansetron for intravenous injection
Ondansetron was developed around 1984 by scientists working at Glaxo's laboratories in London. It is in both the imidazole and carbazole families of heterocyclic compounds. After several attempts the company successfully filed for U.S. patent protection for the drug in 1986 and was granted in June 1988[14] while a use patent was granted in June 1988.[15] A divisional use patent was granted on November 26, 1996.[16] Ondansetron was granted FDA approval as Zofran in January 1991.[17] Glaxo did pediatric research on Zofran's uses, and gained a patent extension as a result, extending U.S. exclusivity until December 24, 2006.[18] The FDA subsequently approved the first generic versions in December 2006, with marketing approval granted to Teva Pharmaceuticals USA and SICOR Pharmaceuticals.[19]
Brand names[edit]
Ondansetron is marketed by GlaxoSmithKline (GSK) under the trade name Zofran. Other manufacturers include Pfizer Injectables (Ondanzetron), Opsonin Pharma Bangladesh (Anset), Strativa Pharmaceuticals (Zuplenz), Indswift Ltd. (Ondisolv), Cipla Ltd. (Emeset), Gedeon Richter Ltd. (Emetron), Korea United Pharmaceuticals (Emodan), Zentiva a.s. (Ondemet), Strides Arcolab (Setronax), Emistat (Unimed and Unihealth Bangladesh Ltd.) Glenmark Generics Ltd. (India) (Ondansetron) and Novell Pharmaceutical Laboratories (Ondavell). On May 29, 2006, Baxter Healthcare received tentative approval[20] to market its own label of Ondansetron Injection, USP, 8 mg/50 mL and 32 mg/50 mL iso-osmotic sodium chloride solution, beginning upon expiration of GSK's patent later that year.
Publication bias[edit]
In 1997, ondansetron was the subject of a meta-analysis case-study published in the British Medical Journal. Researchers examined 84 trials, with 11,980 patients receiving ondansetron, published between 1991 and September 1996. Intravenous ondansetron 4 mg versus placebo was investigated in 16 reports and three further reports which had been duplicated six times. The number needed to treat (NNT) to prevent vomiting within 24 hours was 9.5, with 95% confidence interval 6.9 to 15, in the 16 non-duplicated reports. In the three duplicated reports, the NNT was significantly lower at 3.9 (3.3 to 4.8) with P<0.00001. When all 25 reports were combined the apparent number needed to treat improved to 4.9 (4.4 to 5.6). Inclusion of duplicate reports led to a 23% overestimation of ondansetron's antiemetic efficacy.[21]
In addition, the authors found that the covert duplication of reports on ondansetron was not easy to detect, because of lack of cross-referencing between papers, and that reports containing duplicate findings were cited in eight reviews of the drug.[21] Their analysis was a subject of an editorial in the Journal of the American Medical Association in 1999.[22]
Research[edit]
Psychiatric disorders[edit]
A 2006 double-blind, randomized controlled trial indicated that ondansetron may have value in the treatment of schizophrenia, as an adjunct to haloperidol. The study found the combination to significantly improve negative schizophrenia symptoms, and people taking both drugs experienced fewer of the adverse effects commonly associated with haloperidol.[23] An earlier, smaller, open-label trial had found ondansetron to be useful in treating antipsychotic-induced tardive dyskinesia in people with schizophrenia, and the study patients also showed significant improvement in the disease's symptoms.[24][25]
Early studies have also examined ondansetron as a possible treatment for psychosis resulting from advanced Parkinson's disease.[26] Its apparent benefits despite a lack of any significant antagonistic properties at dopamine receptors or the 5-HT2A receptor raises interesting questions about the etiology of psychosis.
Hewlett and others found that the treatment of obsessive compulsive disorder with Ondansetron 1 mg three times daily was associated with a significant decrease in the Yale Brown Obsessive Compulsive scores in a small (n=8), 8-week, open-label study.[27]
Substance use[edit]
Ondansetron lowers the cravings for alcohol, especially in early-onset alcoholics. In one cognitive-behavioral therapy study, ondansetron patients with early-onset alcoholism had fewer drinks per day and reported more days without drinking at all, as compared to the other groups in the study. Also of note, individuals with the LL genotype show significant improvements in alcohol misuse when treated with ondansetron, compared with individuals with the other genotypes of the 5HTTLPR polymorphism, who showed no improvement over placebo.[28][29][30]
Researchers at the Stanford University School of Medicine have demonstrated that ondansetron might be useful and effective for treating withdrawal symptoms of opioid addictions.[31] Unlike the existing treatments methadone and buprenorphine, it is not itself an opioid.[31] Additionally, it does not require continued supervision like treatment with clonidine.[31]
The original experiment used mice who were injected with increasing doses of morphine, assayed with naloxone and then underwent haplotypic analysis to isolate a gene candidate.[32] HTR3A which codes for the 5-HT3 receptor emerged as the primary candidate, which suggested 5-HT3 antagonist ondansetron as a possible treatment.[32] The researchers were then able to show using an acute morphine administration model the efficacy in withdrawal symptom control in humans.[32]
Postanesthetic shivering[edit]
Two small, placebo-controlled trials have been conducted to assess the efficacy of ondansetron for postanesthetic shivering, a common occurrence after surgery. Ondansetron was found to be as effective as pethidine (meperidine, Demerol) when given as a single IV dose before anesthesia.[33]
References[edit]
- ^ Wilde MI, Markham A (November 1996). "Ondansetron. A review of its pharmacology and preliminary clinical findings in novel applications". Drugs 52 (5): 773–94. doi:10.1111/j.1527-3458.2001.tb00195.x. PMID 9118822.
- ^ Cooke, C. E.; Mehra, I. V. (1994). "Oral ondansetron for preventing nausea and vomiting". American journal of hospital pharmacy 51 (6): 762–771. PMID 8010314. edit
- ^ a b Carlisle JB, Stevenson CA (2006). "Drugs for preventing postoperative nausea and vomiting". Cochrane Database Syst Rev (3): CD004125. doi:10.1002/14651858.CD004125.pub2. PMID 16856030.
- ^ a b Smith JA, Refuerzo JS, Ramin SM. "Treatment and outcome of nausea and vomiting of pregnancy". UpToDate.
- ^ Pasternak B, Svanström H, Hviid A (February 2013). "Ondansetron in pregnancy and risk of adverse fetal outcomes". N. Engl. J. Med. 368 (9): 814–23. doi:10.1056/NEJMoa1211035. PMID 23445092.
- ^ Abell TL, Adams KA, Boles RG, Bousvaros A, Chong SK, Fleisher DR, Hasler WL, Hyman PE, Issenman RM, Li BU, Linder SL, Mayer EA, McCallum RW, Olden K, Parkman HP, Rudolph CD, Taché Y, Tarbell S, Vakil N (April 2008). "Cyclic vomiting syndrome in adults". Neurogastroenterol. Motil. 20 (4): 269–84. doi:10.1111/j.1365-2982.2008.01113.x. PMID 18371009.
- ^ Freedman SB, Adler M, Seshadri R, Powell EC (April 2006). "Oral ondansetron for gastroenteritis in a pediatric emergency department". N. Engl. J. Med. 354 (16): 1698–705. doi:10.1056/NEJMoa055119. PMID 16625009.
- ^ Sturm JJ, Hirsh DA, Schweickert A, Massey R, Simon HK (May 2010). "Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses?". Ann Emerg Med 55 (5): 415–22. doi:10.1016/j.annemergmed.2009.11.011. PMID 20031265.
- ^ "Zofran (ondansetron): Drug Safety Communication - Risk of Abnormal Heart Rhythms". U.S. Food and Drug Administration. 9/15/2011. Retrieved 2013-08-18. Check date values in:
|date=(help) - ^ "FDA Drug Safety Communication: New information regarding QT prolongation with ondansetron (Zofran)". U.S. Food and Drug Administration. 06-29-2012. Retrieved 2013-08-18. Check date values in:
|date=(help) - ^ "Potential Signals of Serious Risks/New Safety Information Identified by the FDA Adverse Event Reporting System (FAERS) between January– March 2013". U.S. Food and Drug Administration. 05/15/2013. Retrieved 2013-08-18. Check date values in:
|date=(help) - ^ "FDA Drug Safety Communication: Updated information on 32 mg intravenous ondansetron (Zofran) dose and pre-mixed ondansetron products". U.S. Food and Drug Administration. 12-4-2012. Retrieved 2013-08-18. "The U.S. Food and Drug Administration (FDA) is notifying health care professionals that the 32 mg, single intravenous (IV) dose of the anti-nausea drug Zofran (ondansetron hydrochloride) will no longer be marketed because of the potential for serious cardiac risks. This dose has been removed from the Zofran drug label." Check date values in:
|date=(help) - ^ Frieden, Joyce (Dec 4, 2012). "High-Dose Zofran Pulled From Market". Medpage Today. Retrieved 2013-08-18.
- ^ US patent 4695578, Coates IH, Bell JA, Humber DC, Ewan GB, "1,2,3,9-tetrahydro-3-imidazol-1-ylmethyl-4H-carbazol-4-ones, composition containing them, and method of using them to treat neuronal 5HT function disturbances", issued 1987-09-22, assigned to Glaxo Group Limited
- ^ US patent 4753789, Tyers MB, Coates IH, Humber DC, Ewan GB, Bell JA, "Method for treating nausea and vomiting", issued 1988-06-28, assigned to Glaxo Group Limited
- ^ US patent 5578628, Tyers MB, Coates IH, Humber DC, Ewan GB, Bell JA, "Medicaments for the treatment of nausea and vomiting", issued 1996-11-26, assigned to Glaxo Group Limited
- ^ GlaxoSmithKline. "Zofran". Prescribing Information. U.S. Food and Drug Administration.
- ^ "One Year Post-Pediatric Exclusivity Post-marketing Adverse Event Review: Drug Use Data Zofran". Memorandum. U.S. Food and Drug Administration. 2006-03-07.
- ^ "FDA Approves First Generic Ondansetron Tablets, Orally Disintegrating Tablets and Oral Solution". News Release. U.S. Food and Drug Administration. 2006-12-17.
- ^ "Center for Drug Evaluation & Research (FDA) letter of tentative approval for Ondansetron NDA by Baxter Healthcare Corp" (PDF).
- ^ a b Tramèr MR, Reynolds DJ, Moore RA, McQuay HJ (September 1997). "Impact of covert duplicate publication on meta-analysis: a case study". BMJ 315 (7109): 635–40. doi:10.1136/bmj.315.7109.635. PMC 2127450. PMID 9310564.
- ^ Rennie D (November 1999). "Fair conduct and fair reporting of clinical trials". JAMA 282 (18): 1766–8. doi:10.1001/jama.282.18.1766. PMID 10568651.
- ^ Zhang ZJ, Kang WH, Li Q, Wang XY, Yao SM, Ma AQ (2006). "Beneficial effects of ondansetron as an adjunct to haloperidol for chronic, treatment-resistant schizophrenia: a double-blind, randomized, placebo-controlled study". Schizophrenia Research 88 (1–3): 102–10. doi:10.1016/j.schres.2006.07.010. PMID 16959472.
- ^ Zullino DF, Eap CB, Voirol P (2001). "Ondansetron for tardive dyskinesia". Am J Psychiatry 158 (4): 657–8. doi:10.1176/appi.ajp.158.4.657-a. PMID 11282718.
- ^ Sirota P, Mosheva T, Shabtay H, Giladi N, Korczyn AD (February 2000). "Use of the selective serotonin 3 receptor antagonist ondansetron in the treatment of neuroleptic-induced tardive dyskinesia". Am J Psychiatry 157 (2): 287–9. PMID 10671405.
- ^ Zoldan J, Friedberg G, Livneh M, Melamed E (1995). "Psychosis in advanced Parkinson's disease: treatment with ondansetron, a 5-HT3 receptor antagonist". Neurology 45 (7): 1305–8. doi:10.1212/WNL.45.7.1305. PMID 7617188.
- ^ Hewlett WA, Schmid SP, Salomon RM (2003). "Pilot trial of ondansetron in the treatment of 8 patients with obsessive compulsive disorder". J Clin Psychiatry 64 (9): 1025–30. doi:10.4088/JCP.v64n0907. PMID 14628977.
- ^ "Ondansetron can prevent alcohol craving". June 11, 2006. Retrieved 2007-11-05.
- ^ Sellers EM, Toneatto T, Romach MK, Somer GR, Sobell LC, Sobell MB (1994). "Clinical efficacy of the 5-HT3 antagonist ondansetron in alcohol abuse and dependence". Alcohol Clin Exp Res 18 (4): 879–85. doi:10.1111/j.1530-0277.1994.tb00054.x. PMID 7978099.
- ^ "Genes Predict Success of Ondansetron Treatment for Alcoholism". January 25, 2011. Retrieved 2011-01-25.
- ^ a b c "Stanford scientists identify drug to treat opioid addiction". 17 FEB 2009. Retrieved 19 FEB 2009.
- ^ a b c Chu LF, Liang DY, Li X, Sahbaie P, D'arcy N, Liao G, Peltz G, David Clark J (March 2009). "From mouse to man: the 5-HT3 receptor modulates physical dependence on opioid narcotics". Pharmacogenet. Genomics 19 (3): 193–205. doi:10.1097/FPC.0b013e328322e73d. PMC 2730361. PMID 19214139.
- ^ Generali JA, Cada DJ (August 2009). "Ondansetron: postanesthetic shivering". Hospital Pharmacy 44 (8): 670–1. doi:10.1310/hpj4408-670.
External links[edit]
- U.S. National Library of Medicine: Drug Information Portal - Ondansetron
|
|||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||
UpToDate Contents
全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.
- 1. 小児における、アデノイド切除同時施行例を含む扁桃摘出に対する麻酔 anesthesia for tonsillectomy with or without adenoidectomy in children
- 2. Prevention and treatment of chemotherapy-induced nausea and vomiting in adults
- 3. 救急外来における眼部損傷の概要 overview of eye injuries in the emergency department
- 4. 妊娠の悪心および嘔吐の治療および転帰 treatment and outcome of nausea and vomiting of pregnancy
- 5. Anesthesia for head and neck surgery
English Journal
- Inhibition of temporomandibular joint input to medullary dorsal horn neurons by 5HT3 receptor antagonist in female rats.
- Okamoto K1, Katagiri A2, Rahman M2, Thompson R2, Bereiter DA2.
- Neuroscience.Neuroscience.2015 Jul 23;299:35-44. doi: 10.1016/j.neuroscience.2015.04.037. Epub 2015 Apr 23.
- Repeated forced swim (FS) conditioning enhances nociceptive responses to temporomandibular joint (TMJ) stimulation in female rats. The basis for FS-induced TMJ hyperalgesia remains unclear. To test the hypothesis that serotonin 3 receptor (5HT3R) mechanisms contribute to enhanced TMJ nociception aft
- PMID 25913635
- Fluvoxamine alleviates seizure activity and downregulates hippocampal GAP-43 expression in pentylenetetrazole-kindled mice: role of 5-HT3 receptors.
- Alhaj MW1, Zaitone SA, Moustafa YM.
- Behavioural pharmacology.Behav Pharmacol.2015 Jun;26(4):369-82. doi: 10.1097/FBP.0000000000000127.
- Epilepsy has been documented to lead to many changes in the nervous system including cell loss and mossy fiber sprouting. Neuronal loss and aberrant neuroplastic changes in the dentate gyrus of the hippocampus have been identified in the pentylenetetrazole (PTZ) kindling model. Antiseizure activity
- PMID 25590967
- Development and in-vivo evaluation of ondansetron gels for transdermal delivery.
- Patel DR1, Joshi A, Patel HH, Stagni G.
- Drug development and industrial pharmacy.Drug Dev Ind Pharm.2015 Jun;41(6):1030-6. doi: 10.3109/03639045.2014.925916. Epub 2014 Jun 12.
- Nausea and vomiting are some of the major side effects caused by certain drug therapies, e.g. chemotherapy, radiotherapy and general anesthesia. Because of the nature of the symptoms, oral delivery is inappropriate, while intravenous administration may be unpractical. The aim of the present study wa
- PMID 24919508
Related Pictures
★リンクテーブル★
| リンク元 | 「オンダンセトロン」 |
| 関連記事 | 「zofran」 |
「オンダンセトロン」
「zofran」
- 同
- Zofran
- 関
- Ondansetron