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Plasma and cerebrospinal fluid pharmacokinetics of ondansetron in humans.

Publication ,  Journal Article
Chiang, MD; Frey, K; Lee, C; Kharasch, ED; Tallchief, D; Sawyer, C; Blood, J; Back, H; Kagan, L; Haroutounian, S
Published in: Br J Clin Pharmacol
February 2021

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.

Duke Scholars

Published In

Br J Clin Pharmacol

DOI

EISSN

1365-2125

Publication Date

February 2021

Volume

87

Issue

2

Start / End Page

516 / 526

Location

England

Related Subject Headings

  • Plasma
  • Pharmacology & Pharmacy
  • Ondansetron
  • Neuralgia
  • Infusions, Intravenous
  • Humans
  • Administration, Intravenous
  • 3214 Pharmacology and pharmaceutical sciences
  • 1115 Pharmacology and Pharmaceutical Sciences
 

Citation

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Chiang, M. D., Frey, K., Lee, C., Kharasch, E. D., Tallchief, D., Sawyer, C., … Haroutounian, S. (2021). Plasma and cerebrospinal fluid pharmacokinetics of ondansetron in humans. Br J Clin Pharmacol, 87(2), 516–526. https://doi.org/10.1111/bcp.14412
Chiang, Manting D., Karen Frey, Chris Lee, Evan D. Kharasch, Dani Tallchief, Christopher Sawyer, Jane Blood, Hyunmoon Back, Leonid Kagan, and Simon Haroutounian. “Plasma and cerebrospinal fluid pharmacokinetics of ondansetron in humans.Br J Clin Pharmacol 87, no. 2 (February 2021): 516–26. https://doi.org/10.1111/bcp.14412.
Chiang MD, Frey K, Lee C, Kharasch ED, Tallchief D, Sawyer C, et al. Plasma and cerebrospinal fluid pharmacokinetics of ondansetron in humans. Br J Clin Pharmacol. 2021 Feb;87(2):516–26.
Chiang, Manting D., et al. “Plasma and cerebrospinal fluid pharmacokinetics of ondansetron in humans.Br J Clin Pharmacol, vol. 87, no. 2, Feb. 2021, pp. 516–26. Pubmed, doi:10.1111/bcp.14412.
Chiang MD, Frey K, Lee C, Kharasch ED, Tallchief D, Sawyer C, Blood J, Back H, Kagan L, Haroutounian S. Plasma and cerebrospinal fluid pharmacokinetics of ondansetron in humans. Br J Clin Pharmacol. 2021 Feb;87(2):516–526.
Journal cover image

Published In

Br J Clin Pharmacol

DOI

EISSN

1365-2125

Publication Date

February 2021

Volume

87

Issue

2

Start / End Page

516 / 526

Location

England

Related Subject Headings

  • Plasma
  • Pharmacology & Pharmacy
  • Ondansetron
  • Neuralgia
  • Infusions, Intravenous
  • Humans
  • Administration, Intravenous
  • 3214 Pharmacology and pharmaceutical sciences
  • 1115 Pharmacology and Pharmaceutical Sciences