January 10, 2023

Anti-nausea drug response in children

Genetic variation in a metabolic enzyme was not associated with response to the anti-nausea drug odansetron in children, Vanderbilt researchers report.

Ondansetron is commonly used in children and adults to prevent postoperative nausea and vomiting (PONV). Variation in the gene for the metabolic enzyme CYP2D6 can affect response to ondansetron, and it is recommended that alternative anti-emetic therapy be considered for adults who are ultrarapid metabolizers. However, data from pediatric populations are limited. 

Sara Van Driest, MD, PhD, and colleagues conducted a retrospective study in patients under age 18 who underwent tonsillectomy and received ondansetron to prevent PONV. 

They used data from BioVU, Vanderbilt’s DNA biobank linked to de-identified electronic health records. In a cohort of 652 individuals, CYP2D6 metabolizer status was not associated with PONV, which affected 105 patients (16.1%). 

The findings, reported in Clinical and Translational Science, do not support the use of CYP2D6 genotype or phenotype to guide anti-emetic therapy after tonsillectomy in children. They also highlight the need for further studies to validate genotype-drug response data in pediatric populations and to understand why ondansetron isn’t as effective for some children.

Co-authors of the study include Katherine Black, MD, MPH, B. Randall Brenn, MD, Andrea Gaedigk, PhD, MS, and Jonathan Wanderer, MD, MPhil. The research was supported by the National Institutes of Health (grants GM007569, HD106446) and the Burroughs Wellcome Fund. BioVU projects are supported by numerous sources: institutional funding, private agencies, and federal grants.