title: Short-course ondansetron for the prevention of methotrexate-induced nausea in children with Crohn disease.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Pediatrics, University of Ottawa, Ottawa, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Kempinska
authors.forename: Eric I
authors.initials: EI
authors.lastname: Benchimol
authors.forename: Amanda
authors.initials: A
authors.lastname: Mack
authors.forename: Janice
authors.initials: J
authors.lastname: Barkey
authors.forename: Margaret
authors.initials: M
authors.lastname: Boland
authors.forename: David R
authors.initials: DR
authors.lastname: Mack
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000473:pathology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D009325:Nausea / Q000139:chemically induced* / Q000150:complications / Q000517:prevention & control*; D017294:Ondansetron / Q000008:administration & dosage / Q000627:therapeutic use*; D009864:Ontario; D011292:Premedication / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D017294:Ondansetron; D008727:Methotrexate