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Myeloma, Zofran and Heart Damage
What do myeloma, Zofran and heart damage have to do with each other? According to research, 85%-95% of myeloma patients taking emetogenic chemotherapy (chemotherapy that makes you nauseous) are prescribed 5-HT3 receptor antagonists. This class of anti-nausea drugs are called antiemetic prophylaxis therapies.
Drugs like Zofran are intended to reduce chemotherapy-induced nausea.
Unfortunately, according to the research linked below, antiemetic therapies are cardiotoxic. If you underwent an autologous stem cell transplant, you probably had both melphalan and Zofran. Both therapies are cardiotoxic, meaning they can damage your heart.
The problem, as I see it, is that newly diagnosed MM patients, on average, are older and have comorbidities like a weak heart. So being prescribed two drugs that can cause heart damage could cause the patient serious heart problems.
ONDANSETRON (ZOFRAN) – PHARMACIST REVIEW
I was prescribed several cardiotoxic therapies myself when I underwent conventional therapies for my MM back in ’94-’95. I was diagnosed with chemotherapy-induced cardiomyopathy in 2015. (CIC)
I learned about the cardiotoxicity of different chemo regimens long after my ASCT. My oncologist knew about cardiotoxicity, but Dr. Berger never said anything to me about this possible side effect. The average MM survival was 3-5 years back then. Why would Dr. Berger need to worry about long-term side effects???
I don’t know if I could have prevented my own heart damage. But I do know what I have been doing since my diagnosis of CIC in 2015. When I was prescribed metoprolol for my heart, I had a bad reaction so I stopped taking it. I decided to live a heart-healthy lifestyle with:
- Nutrition
- Supplementation
- Lifestyle therapies
I live with chronic atrial fibrillation, meaning my heart is always slightly off. But other than that, my ejection fraction, blood pressure, etc., are all pretty normal. My heart-healthy lifestyle is working.
Have you undergone antiemetic prophylaxis therapies like Zofran? Have you undergone cardiotoxic chemo regimens like Melphalan? How is your heart health?
If you’d like to learn more about evidence-based non-conventional heart-healthy therapies, scroll down the page, post a question or a comment, and I will reply to you ASAP.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Cardiotoxicity of different 5-HT3 receptor antagonists analyzed using the FAERS database and pharmacokinetic study
Abstract
To comprehensively compare the risk of cardiotoxicity with 5-HT3 receptor antagonists (5-HT3RAs) and to explore the underlying pharmacokinetic factors that might contribute to cardiotoxicity. The FDA Adverse Event Reporting System (FAERS) data (January 2004 to March 2023) were extracted.
Disproportionality analysis, sensitivity analyses, and time-to-onset assessments were conducted to evaluate cardiac risk signals associated with 5-HT3RAs. Physiologically based pharmacokinetic (PBPK) models were developed to study the drug distribution characteristics in cardiac tissues.
After excluding duplicate reports, a total of 1174 reports of cardiotoxicity related to 5-HT3RAs (including ondansetron, granisetron and palonosetron) were identified in the FAERS database. Removing cases with diagnosed heart disease and electrolyte disorders at baseline, all cardiotoxicity signals persisted except the arrhythmia signal in palonosetron.
Stratified sensitivity analyses (pre-/post-2012 FDA safety alert) revealed the signal for electrocardiogram QT prolonged persisted both in pre-alert and post-alert. Palonosetron demonstrated a longer latency than ondansetron and granisetron, which exhibited similar time-to-onset values.
The PBPK model extrapolation results showed that ondansetron concentration in cardiac tissue was 2.3 times higher than that in plasma, which might support that it is more susceptible to cardiotoxicity. The study revealed that different 5-HT3RAs exhibited varying degrees and types of cardiotoxicity.
Among these,
- ondansetron (Zofran) demonstrated the highest signals of cardiotoxicity,
- followed by palonosetron (Aloxi),
- with granisetron (Kytril) showing the least.
Ondansetron concentration in cardiac tissue far exceeded that in plasma, which might partially explain the observed cardiotoxicity. In conclusion, it suggested to prioritize low cardiac toxicity 5-HT3RAs for patients especially for those with heart diseases, and to strengthen the monitoring and management of cardiac toxicity furtherly…
Patients over 60 years of age who were associated with cardiotoxic AEs related to 5-HT3RAs accounted for 26.4% of the non-missing age data in the FAERS database, which is consistent with the literature findings9,10,11.
Given that older cancer patients, who are also the main recipients of 5-HT3RAs, often have multiple comorbidities and polypharmacy13, they may face an elevated risk of cardiac AEs. Notably, serious fatal cases were also predominantly observed in older patients10, highlighting the need for caution when using medications in this population…
While specific statistics for
multiple myeloma (MM) patients alone are not precisely documented, 5-HT3 receptor antagonists are a standard component of antiemetic prophylaxis for most cancer patients receiving chemotherapy. The percentage of patients who receive this therapy is high, typically between 85% and 95% of patients receiving moderately- or highly-emetogenic chemotherapy.
5-HT3 receptor antagonist drugs are a class of antiemetics that block the action of serotonin at 5-HT3 receptors, primarily used to prevent and treat nausea and vomiting from chemotherapy, radiation, or anesthesia. Common examples include ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet), and palonosetron (Aloxi).
myeloma, Zofran and heart damage myeloma, Zofran and heart damage myeloma, Zofran and heart damage