Urticaria after off-label ondanestron use

Journal of Medical Case Reports has published a case report where the authors present what appeared to be a serious adverse reaction to the widely used medication, ondansetron, because of off-label use.

Ondansetron is a 5 hydroxytryptamine3 (serotonin) receptor antagonist used mainly as an antiemetic to treat nausea and vomiting following chemotherapy.

Ondansetron is generally a well-tolerated drug with few side effects, the most commonly reported being headache, constipation, and dizziness. There have been no significant drug interactions previously reported with this drug’s use.

In this case report, a 19-year-old woman presented to an emergency department with 3–4 episodes of nausea, vomiting and epigastric distress, where she was treated with 4mg of ondansetron intravenously. She immediately developed urticaria, which was treated with intravenous dexamethasone 4mg and chlorpheniramine maleate 20mg. The reaction abated within a few minutes and she was discharged within an hour. She was asymptomatic at 72 hours of follow-up.

Karishma et al write: “The wide availability of these drugs in India has promoted their off label use in the treatment of gastritis, migraine and so on. Our case represents an off label use in a patient who could have been treated with a safer drug….Our case report underscores the importance of physicians judiciously using the drug, particularly in the outpatient setting so as to reduce the incidence of avoidable adverse drug reactions.” Share your experiences of off-label administration of odansetron or any other drug by publishing a case report with us.


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