毒理性
5-HT3受体拮抗剂在治疗期间偶尔会导致血清酶水平升高,但这些通常较轻且无症状,并且会迅速解决。由于它们在手术期间和化疗中使用,因此有报道称使用后出现了肝损伤的情况,但在已发布的病例中可能还有其他药物或因素发挥了作用。5-HT3受体拮抗剂治疗期间血清酶升高的发生率在1%到8%之间,通常不高于安慰剂治疗观察到的水平。虽然在使用5-HT3受体拮抗剂治疗期间有描述过中度的血清酶升高,但归因于这些药物的伴有黄疸的临床明显急性肝损伤的报告极为罕见和孤立。损伤的发生在接触后1到2周内,损伤模式为肝细胞型,没有免疫过敏或自身免疫特征。有报道称重新接触后损伤复发的案例。尚未有归因于5-HT3受体拮抗剂的急性肝衰竭、慢性肝炎或胆管消失综合征的实例。
阿洛司琼可能性评分:D(可能是临床明显肝损伤的原因)。
多拉司琼可能性评分:E(不太可能是临床明显肝损伤的原因)。
格雷司琼可能性评分:E(不太可能是临床明显肝损伤的原因)。
昂丹司琼可能性评分:D(可能是临床明显肝损伤的原因)。
帕洛诺司琼可能性评分:E(不太可能是临床明显肝损伤的原因)。
The 5-HT3 receptor antagonists have been linked to occasional instances of serum enzyme elevations during therapy, but these are generally mild and asymptomatic, resolving rapidly. Because they are used at the time of surgery and with chemotherapy, instances of liver injury arising after their use have been reported, but other drugs or factors may have played a role in the published cases. The rate of serum enzyme elevations with 5-HT3 receptor antagonist therapy has ranged from 1% to 8% and has generally been no greater than that observed with placebo therapy. While moderate serum enzyme elevations during 5-HT3 receptor antagonist therapy have been described, there have been have been only rare and isolated reports of clinically apparent acute liver injury with jaundice attributed to these agents. The onset of injury has been within 1 to 2 weeks of exposure and the pattern of injury hepatocellular and without immunoallergic or autoimmune features. Instances of recurrence after re-exposure have been published. No instances of acute liver failure, chronic hepatitis or vanishing bile duct syndrome have been attributed to the 5-HT3 receptor antagonists.
Alosetron likelihood score: D (possible cause of clinically apparent liver injury).
Dolasetron likelihood score: E (unlikely cause of clinically apparent liver injury).
Granisetron likelihood score: E (unlikely cause of clinically apparent liver injury).
Ondansetron likelihood score: D (possible cause of clinically apparent liver injury).
Palonosetron likelihood score: E (unlikely cause of clinically apparent liver injury).
来源:LiverTox