毒理性
5-HT3受体拮抗剂在治疗过程中偶尔与血清酶水平升高有关联,但这些通常比较轻微且无症状,能够迅速解决。由于它们在手术期间和化疗时使用,因此有报道称使用后出现了肝损伤的情况,但在已发表的病例中可能还有其他药物或因素发挥了作用。5-HT3受体拮抗剂治疗中血清酶水平升高的发生率在1%到8%之间,通常不会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出现中度血清酶升高的情况,但只有罕见和孤立的报告称出现了明显的急性肝损伤并伴有黄疸,归因于这些药物。损伤的发生在接触后1到2周内,损伤模式为肝细胞型,且没有免疫过敏或自身免疫特征。有关于重新接触后复发的案例发表。没有将急性肝衰竭、慢性肝炎或消失胆管综合征归因于5-HT3受体拮抗剂的案例。
阿洛司琼可能性评分:D(可能导致临床上明显的肝损伤)。
度洛赛琼可能性评分:E(不太可能导致临床上明显的肝损伤)。
格雷司琼可能性评分:E(不太可能导致临床上明显的肝损伤)。
昂丹司琼可能性评分:D(可能导致临床上明显的肝损伤)。
帕洛诺司琼可能性评分:E(不太可能导致临床上明显的肝损伤)。
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