Ondansetron in pregnancy revisited: Assessment and pregnancy labelling by the European Medicines Agency (EMA) & Pharmacovigilance Risk Assessment Committee (PRAC)

Per Damkier*, Yusuf Cem Kaplan, Svetlana Shechtman, Orna Diav-Citrin, Matteo Cassina, Corinna Weber-Schoendorfer

*Corresponding author for this work

Research output: Contribution to journalComment/debateResearchpeer-review

Abstract

Ondansetron is an effective antiemetic that is being widely used as a second-line treatment option for severe nausea and vomiting of pregnancy in accordance with clinical guidelines. The safety of ondansetron during pregnancy has—following publication of controversial and seemingly contradictory results—been subject to considerable academic turmoil, specifically with respect to the risk of congenital cardiac malformations and oral cleft. In July 2019, the European Medicines Agency (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) released an updated, comprehensive assessment report on the use of ondansetron in the first trimester. The ensuing Summary of Product Characteristics (SmPC) was updated in November 2019 with important changes to section on “Fertility, pregnancy and lactation.” The SmPC now states that ondansetron should not be used in the first trimester of pregnancy. ENTIS, The European Network of Teratology Information Services, believes that the implementation of this regulatory step—which has important clinical consequences—is insufficiently substantiated and is not serving the interest of pregnant women with severe nausea and vomiting. Herein, we discuss the underlying evidence and argue the case against the EMA decision.

Original languageEnglish
JournalBasic & Clinical Pharmacology & Toxicology
Volume128
Issue number4
Pages (from-to)579-582
ISSN1742-7835
DOIs
Publication statusPublished - Apr 2021

Keywords

  • congenital malformations
  • nausea
  • ondansetron
  • pregnancy
  • vomiting

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