Abstract
We report a case of drug-induced myoclonus possibly related to palonosetron, a second-generation 5-hydroxytryptamine-3 receptor antagonist which was administered as a prophylaxis for postoperative nausea and vomiting in a 28-year-old female. The recurrent episodes of myoclonus jerk involving the head, neck and shoulder persisted for a period of 4 days. The patient also exhibited an episode of severe bradycardia leading to hypotension 7 h after surgery. To our knowledge, this is the first report presenting these adverse events potentially associated with the use of palonosetron.
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References
Rojas C, Stathis M, Thomas AG, Massuda EB, Alt J, Zhang J, Rubenstein E, Sebastiani S, Cantoreggi S, Snyder SH, Slusher B. Palonosetron exhibits unique molecular interactions with the 5-HT3 receptor. Anesth Analg. 2008;107(2):469–78.
Rojas C, Thomas AG, Alt J, Stathis M, Zhang J, Rubenstein EB, Sebastiani S, Cantoreggi S, Slusher BS. Palonosetron triggers 5-HT(3) receptor internalization and causes prolonged inhibition of receptor function. Eur J Pharmacol. 2010;626(2–3):193–9.
Laporte AM. Autoradiographic mapping of central 5-HT(3) receptors. In: Hamon M, editor. Central and peripheral 5-HT(3) receptors. London: Academic Press; 1992. p. 157–87.
Hoyer D, Hannon JP, Martin GR. Molecular, pharmacological and functional diversity of 5-HT receptors. Pharmacol Biochem Behav. 2002;71(4):533–54.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–45.
Gallagher RM, Kirkham JJ, Mason JR, Bird KA, Williamson PR, Nunn AJ, Turner MA, Smyth RL, Pirmohamed M. Development and inter-rater reliability of the Liverpool adverse drug reaction causality assessment tool. PLoS One. 2011;6(12):e28096.
Sprung J, Choudhry FM, Hall BA. Extrapyramidal reactions to ondansetron: cross-reactivity between ondansetron and prochlorperazine? Anesth Analg. 2003;96(5):1374–6 (table of contents).
Tolan MM, Fuhrman TM, Tsueda K, Lippmann SB. Perioperative extrapyramidal reactions associated with ondansetron. Anesthesiology. 1999;90(1):340–1.
Pappert EJ, Goetz CG, Stebbins GT, Belden M, Carvey PM. 5-Hydroxytryptophan-induced myoclonus in guinea pigs: mediation through 5-HT1/2 receptor subtypes. Eur J Pharmacol. 1998;347(1):51–6.
Turkel SB, Nadala JG, Wincor MZ. Possible serotonin syndrome in association with 5-HT(3) antagonist agents. Psychosomatics. 2001;42(3):258–60.
Bevan JC. Propofol-related convulsions. Can J Anaesth. 1993;40(9):805–9.
Bragonier R, Bartle D, Langton-Hewer S. Acute dystonia in a 14-year-old following propofol and fentanyl anaesthesia. Br J Anaesth. 2000;84(6):828–9.
Hilty CA, Drummond JC. Seizure-like activity on emergence from sevoflurane anesthesia. Anesthesiology. 2000;93(5):1357–9.
Afonso N, Dang A, Namshikar V, Kamat S, Rataboli PV. Intravenous ondansetron causing severe bradycardia: two cases. Ann Card Anaesth. 2009;12(2):172–3.
Baguley WA, Hay WT, Mackie KP, Cheney FW, Cullen BF. Cardiac dysrhythmias associated with the intravenous administration of ondansetron and metoclopramide. Anesth Analg. 1997;84(6):1380–1.
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Chaw, S.H., Chan, L., Lee, P.K. et al. Prolonged drug-induced myoclonus: is it related to palonosetron?. J Anesth 30, 1063–1066 (2016). https://doi.org/10.1007/s00540-016-2228-8
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DOI: https://doi.org/10.1007/s00540-016-2228-8