Plasma and cerebrospinal fluid pharmacokinetics of ondansetron in humans.

Journal Article (Journal Article)

AIMS: Changes in serotonergic sensory modulation associated with overexpression of 5-HT3 receptors in the central nervous system (CNS) have been implicated in the pathophysiology of neuropathic pain after peripheral nerve damage. 5-HT3 receptor antagonists such as ondansetron can potentially alleviate neuropathic pain, but have limited effectiveness, due potentially to limited CNS access. However, there is currently limited information on CNS disposition of systemically-administered 5-HT3 receptor antagonists. This study evaluated the cerebrospinal fluid (CSF) disposition of ondansetron, as a surrogate of CNS penetration. METHODS: Fifteen patients were given a single 16 mg intravenous 15 minute infusion of ondansetron, followed by serial blood and a single CSF sampling. Population pharmacokinetic (PK) modelling was implemented to describe the average and individual plasma and CSF profiles of ondansetron. A two-compartmental model was used to capture ondansetron plasma PK with a single CSF compartment to describe distribution to the CNS. RESULTS: The individual model-estimated CSF to plasma partition coefficients of ondansetron were between 0.09 and 0.20. These values were mirrored in the calculated CSF penetration ratios, ranging from 0.08 to 0.26. CONCLUSIONS: After intravenous administration, CSF concentrations of ondansetron were approximately 7-fold lower than those observed in the plasma. A model could be developed to describe individual CSF concentration-time profiles of ondansetron based on a single CSF data point. The low CSF penetration of ondansetron may explain its limited analgesic effectiveness, and affords an opportunity to explore enhancing its CNS penetration for targeting conditions such as neuropathic pain.

Full Text

Duke Authors

Cited Authors

  • Chiang, MD; Frey, K; Lee, C; Kharasch, ED; Tallchief, D; Sawyer, C; Blood, J; Back, H; Kagan, L; Haroutounian, S

Published Date

  • February 2021

Published In

Volume / Issue

  • 87 / 2

Start / End Page

  • 516 - 526

PubMed ID

  • 32495990

Pubmed Central ID

  • PMC8745407

Electronic International Standard Serial Number (EISSN)

  • 1365-2125

Digital Object Identifier (DOI)

  • 10.1111/bcp.14412


  • eng

Conference Location

  • England