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Short-course Ondansetron for the Prevention of Methotrexate-induced Nausea in Children With Crohn Disease

Kempinska, Anna*; Benchimol, Eric I.; Mack, Amanda; Barkey, Janice; Boland, Margaret; Mack, David R.

Journal of Pediatric Gastroenterology and Nutrition: October 2011 - Volume 53 - Issue 4 - p 389–393
doi: 10.1097/MPG.0b013e31822855e7
Original Articles: Gastroenterology

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.

*Department of Pediatrics, University of Ottawa

Department of Pediatrics, University of Ottawa, Division of Gastroenterology, Hepatology & Nutrition, Children's Hospital of Eastern Ontario and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.

Address correspondence and reprint requests to David R. Mack, MD, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H 8L1 (e-mail:

Received 9 January, 2011

Accepted 13 April, 2011

This study was funded in part by the Jason family through funds generated at the SnowFlake Ball in Ottawa, Canada.

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN