Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by ZULLINO, D. F. Articles by VOIROL, P. Search for Related Content Articles by ZULLINO, D. F. Articles by VOIROL, P. Other Neuroleptics

Ondansetron for Tardive Dyskinesia

To the Editor: We read with great interest the article by Pinkhas Sirota, M.D., and colleagues (1) on the use of ondansetron in the treatment of neuroleptic-induced tardive dyskinesia. The findings are especially remarkable in light of reports on the efficacy of clozapine and olanzapine in treating tardive dyskinesia (2, 3); these drugs having some affinity for the serotonin 5-HT₃ receptor.

In the Method section of their article, the authors stated that their patients had received a stable psychotropic drug regimen for at least 6 months before study entry. It would, however, be interesting to know what type of antipsychotics the patients had been receiving, especially if clozapine or olanzapine could have biased the results. It would also be interesting to know if concomitant medications could have induced an increase in plasma concentrations of the given antipsychotics. Increasing a dose of antipsychotics may, although transiently, alleviate tardive dyskinesia.

A literature search by the authors did not reveal any effects of ondansetron on the metabolism of other medications. In vitro studies have, however, shown that ondansetron is a competitive inhibitor of the CYP2D6-dependent O-demethylation of dextromethorphan, with a K_i value of 29 µM, and a competitive inhibitor of the CYP3A4-dependent metabolism of cyclosporine A, with a K_i of 31 µM (4). Pharmacokinetic interactions between ondansetron and antipsychotic drugs, whose metabolism largely depends on CYP2D6 and CYP3A4, cannot therefore be excluded.

References

1. Sirota P, Mosheva T, Shabtay H, Giladi N, Korczyn AD: Use of the selective serotonin 3 receptor antagonist ondansetron in the treatment of neuroleptic-induced tardive dyskinesia. Am J Psychiatry 2000; 157:287–289[Abstract/Free Full Text]
2. Bassitt DP, Louza Neto MR: Clozapine efficacy in tardive dyskinesia in schizophrenic patients. Eur Arch Psychiatry Clin Neurosci 1998; 248:209–211[CrossRef][Medline]
3. Raja M, Azzoni A, Maisto G: Three cases of improvement of tardive dyskinesia following olanzapine treatment. Int J Neuropsychopharmacol 1999; 2:333–334[CrossRef][Medline]
4. Fischer V, Vickers AE, Heitz F, Mahadevan S, Baldeck JP, Minery P, Tynes R: The polymorphic cytochrome P-4502D6 is involved in the metabolism of both 5-hydroxytryptamine antagonists, tropisetron and ondansetron. Drug Metab Dispos 1994; 22:269–274[Abstract]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by ZULLINO, D. F. Articles by VOIROL, P. Search for Related Content Articles by ZULLINO, D. F. Articles by VOIROL, P. Other Neuroleptics

Get information about faster international access.

Privacy Policy

Copyright © 2001 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us