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

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 Cl) who received MIX 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 +/- 1 3.0 years (+/- standard deviation), and the mean age when MIX 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 I patient (2.0%) developed nausea within the first 3 months of MIX. 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 MIX 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 MIX 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.