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Comparing the efficacy of ondansetron and granisetron augmentation in treatment-resistant obsessive-compulsive disorder

a randomized double-blind placebo-controlled study

Sharafkhah, Mojtabaa; Aghakarim Alamdar, Mobinab; Massoudifar, Alic; Abdolrazaghnejad, Alid; Ebrahimi-Monfared, Mohsene; Saber, Rezab; Mohammadbeigi, Abolfazlf

International Clinical Psychopharmacology: September 2019 - Volume 34 - Issue 5 - p 222–233
doi: 10.1097/YIC.0000000000000267
Original Articles

This study aimed to assess the efficacy and tolerability of ondansetron vs. granisetron in patients with treatment-resistant obsessive-compulsive disorder. A randomized clinical trial conducted on 135 patients with a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of obsessive-compulsive disorder, who were treatment-resistant and receiving stable treatment with selective serotonin reuptake inhibitors and antipsychotic, received 14 weeks (phase I, intervention period) of placebo (n = 45), ondansetron (n = 45, 4 mg), and granisetron (n = 45, 2 mg) daily augmentations. Patients were rated every 2 weeks using the Yale-Brown Obsessive Compulsive Scale. Upon completion of intervention course, patients were followed for 4 weeks (phase II, discontinuation period). The collected data were analyzed in SPSS Version 22, with χ2 test; Fisher’s exact test and independent t-test, according to the intention-to-treat principle. Two-factor repeated measure analysis of variance was used to compare score changes over phases. P < 0.05 was considered to be statistically significant. At week 14, reduction in Yale-Brown Obsessive Compulsive Scale scores in ondansetron, granisetron and placebo groups was 41.5%, 39.7% and 15.2%, respectively (P = 0.001). Complete response in the ondansetron group was significantly higher than in the granisetron group ((P = 0.041), risk ratio (95% confidence interval) = 2.33 (1.18–3.045)]. Relapse occurred by three (7.31%) patients in the granisetron group, whereas it was not seen in the ondansetron group [P < 0.001, risk ratio (95% confidence interval) = 2.81 (1.016–4.51)]. The results of this present study confirm the benefit of using ondansetron and granisetron as augmenting agents in treatment-resistant obsessive-compulsive disorder. Our results supported the potential superiority of ondansetron compared to granisetron. This needs to be confirmed in further placebo-controlled augmentation studies.

Randomized controlled trial clinical trial registration number: IRCT20130726014170N2.

aDepartment of Neurology and Psychiatry, School of Medicine, Arak University of Medical Sciences, Arak

bDepartment of Neurology, School of Medicine, Arak University of Medical Sciences, Arak

cDepartment of Psychiatry, School of Medicine, Hormozgan University of Medical Sciences, Hormozgan

dDepartment of Emergency Medicine, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan

eDepartment of Neurology, School of Medicine, Arak University of Medical Sciences, Arak

fNeuroscience Research Center, Qom University of Medical Sciences, Qom, Iran

Received 29 December 2018 Accepted 15 April 2019

Correspondence to Ali Massoudifar, MD, Psychiatrist, Department of Psychiatry, School of Medicine, Hormozgan University of Medical Sciences, Zip Code: 3819693345, Hormozgan, IR Iran, Tel: +98 9203109596; fax: +98 8633133193; e-mail:

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