Can Zofran Cause Tingling in Hands and Feet?
Tingling in the hands and feet (paresthesias) is not a recognized adverse effect of ondansetron (Zofran), and your symptoms are more likely related to your underlying Multiple Sclerosis or potentially post-COVID-19 neurological sequelae rather than the medication itself.
Ondansetron and Neurological Side Effects
The provided evidence does not identify peripheral neuropathy or paresthesias as adverse effects of ondansetron. The medication is a selective 5-HT3 receptor antagonist primarily used for nausea and vomiting, and its side effect profile does not typically include tingling sensations in the extremities.
More Likely Explanations in Your Case
Multiple Sclerosis-Related Symptoms
- MS commonly causes sensory symptoms including paresthesias (tingling, numbness) in the hands and feet due to demyelination affecting sensory pathways 1.
- Patients with MS can experience pseudo-relapses where pre-existing symptoms temporarily worsen due to various triggers including infections, stress, or medications 1.
- Your baseline MS disease activity and disability level influence the likelihood of symptom fluctuations 2, 3.
Post-COVID-19 Neurological Effects
- COVID-19 can cause long-term neurological sequelae (post-COVID-19 neurological syndrome) that may persist after the acute infection 2.
- SARS-CoV-2 can enter the central nervous system and potentially initiate or enhance neurodegenerative processes through demyelination mechanisms similar to MS 2.
- COVID-19 infection is associated with new MS symptoms in 57% of patients, with 82 patients developing entirely new neurological symptoms during or after infection 3.
- Patients with higher disability scores and longer MS duration are more susceptible to symptom worsening during or after COVID-19 2, 3.
Clinical Recommendations
Immediate Assessment Needed
- Document whether these symptoms are new or represent worsening of pre-existing MS symptoms 3.
- Evaluate for other neurological changes including weakness, vision changes, balance problems, or altered mental status that might indicate MS relapse or post-COVID complications 1.
- Consider timing: symptoms appearing 2-6 weeks after COVID-19 infection warrant evaluation for post-infectious inflammatory processes 1, 4.
Diagnostic Considerations
- Review your current disease-modifying therapy (DMT) status, as certain DMTs like interferon-β, glatiramer acetate, and teriflunomide do not increase risk of severe COVID-19 outcomes and should generally be continued 1, 2.
- If symptoms represent true new neurological deficits rather than sensory fluctuations, neuroimaging and clinical assessment for MS relapse may be warranted 3.
- Laboratory evaluation including inflammatory markers may help distinguish between MS activity and post-infectious inflammation 1, 5.
Important Caveats
- Do not discontinue Zofran based solely on tingling symptoms without consulting your prescribing physician, as this is unlikely to be the cause.
- Do not assume all new symptoms are simply MS progression—post-COVID neurological complications can occur independently and may require different management 2.
- If you are on immunosuppressive DMTs (particularly rituximab or ocrelizumab), be aware these may affect both COVID-19 outcomes and symptom presentation 1, 2.
Contact your neurologist promptly if tingling is accompanied by weakness, progression of symptoms, or functional impairment, as these may indicate active demyelination requiring treatment 3.