Major Adverse Cardiac Events with Ondansetron: A Systematic Review

作者：Michael Cristian Garcia, Bhavya Gandhi, Faisal Quadri, Mahnoor Shahab, Kassie Rong, Genevieve Ramnarine, Ishleen Sudan, Sophia Zhang, Michelle Yu, Sara Mojdehi, L. Mbuagbaw, Anne Holbrook · 发表于：Clinical Pharmacology & Therapeutics · 年份：2025 · DOI：10.1002/cpt.70189 · 被引用次数：2 · 研究领域：Nausea and vomiting management、Cardiac electrophysiology and arrhythmias、Cardiac, Anesthesia and Surgical Outcomes

Ondansetron frequently triggers medication safety alerts because of its listing as a ‘known risk’ QT interval‐prolonging medication. We aimed to summarize literature on QT‐prolongation‐related major adverse cardiac events associated with ondansetron. We searched Medline, Embase, International Pharmaceutical Abstracts, and Cochrane Central for randomized controlled trials comparing ondansetron to placebo in adults. Major adverse cardiac events (MACE) included death, nonfatal cardiac arrest, ventricular tachyarrhythmia including torsades de pointes, seizure, or syncope. Random‐effects meta‐analyses were performed with a treatment arm continuity correction for single‐ and double‐zero event studies. We included 170 randomized trials ( n = 23,421, 70.7% female, 48.3% aged >65), 119 trials (70.0%) involving surgical patients, and 77 (45.4%) including electrocardiograms. Mean follow‐up was 10 days (SD: 21.8) (median: 1 day). Risk of bias was high for 11.8% of trials, and low for 28.8%. Only seven MACE (all deaths) were reported. Ondansetron was not associated with increased mortality ( n = 23,421, RR: 1.03, 95% CI: 0.76–1.39, I 2 = 0.0%), or arrhythmias. Lack of events precluded prespecified meta‐analyses. Further research on QT‐prolonging medications and their attributed adverse cardiac events and medication alert optimization is needed.