Guest guest Posted May 28, 2008 Report Share Posted May 28, 2008 I am looking for input on how services are using ONDANSETRON. One of our Doctors is wanting us to start to have it available for use. Both PO and IV/IM. I have used it on a very limited bases. So I thought I would throw it out to the brains that are larger than mine for input. Thanks Tabor Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 28, 2008 Report Share Posted May 28, 2008 , First of all, it is a great drug to add to your " tool box " . Secondly, we have used Zofran for several years, and it is by far, the drug that is used the most at our department. It is a very useful drug that has many benefits over promethazine. Let's compare the two.... promethazine - condraindicated in children under 2 - causes CNS depression - caution in use in elderly - phenothiazines have shown to cause seizure activity and dystonia - not recommended in use on pregnant patients ondansetron - may be used on children as young as 1 month old - does not " snow " your patient - is acceptable to use on pregnant patients - no relative contraindications One issue that I have run into is that promethazine still works better on the patients that are violently vomiting. One ER doc stated that Phenergan is for vomiting, and Zofran is for nausea. This is mostly true. Also, studies show that ondansetron is inaffective in " motion induced nausea " , where as promethazine would be the drug of choice. Some pediatric facilities have completely gone away from promethazine and use ondansetron only. Cook Childrens in Ft Worth has been known to give pedi patients ondansetron ODT, and then push oral fluids without ever having to start an IV. Hope this helps, D. Stone > > I am looking for input on how services are using ONDANSETRON. > > One of our Doctors is wanting us to start to have it available for > use. Both PO and IV/IM. > > I have used it on a very limited bases. > > So I thought I would throw it out to the brains that are larger than > mine for input. > > Thanks > > Tabor > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 29, 2008 Report Share Posted May 29, 2008 All good points Donnie. My biggest problems with phenergan are that I recall vividly as a resident the label stating for IM use only. The pocket books all said that while not labelled for IV use, it is commonly done. Sometime later, the FDA amended the label. The problem became one of tradition trampling progress. The real problem is the use in less than large flowing IVs. It is caustic to veins and caused problems. In my services, I have replaced it with compazine or reglan. These may be given safely IV or IM. All three (reglan, compazine, and phenergan) are commonly used in pregnancy for hyperemesis gravadarum without issue. In fact, at least since I was in medical school, these were placed in bags of IV fluid and run in over days to stop pregnancy induced vomiting. Reglan and compazine are also effective and listed by the headache foundation for use in migraine, tension, and non-specific headache. They can cause dyskinesia, but this is easily treated and " cured " with benadryl. In fact, my use of reglan or compazine for headache is to put 10mg of either in a liter of NS with benadryl 50mg and run in as a bolus. The mild sedation in these cases is a plus! If someone gets dystonia from these, you look like a miracle worker when you give the benadryl! Donnie is very correct that zofran does not tend to work well once a patient begins vomiting. The company has also dropped the price through the floor for injectible zofran. It has not done so for the oral preparations. Thirty of the orally disintegrating tabs was over $100.00 a couple of months ago! In the words of our med school pharmacology professor, " Don't be the first to pick up a new drug (I will add device/procedure/etc) or the last to throw away an old one. " Doc P > > , > > First of all, it is a great drug to add to your " tool box " . > Secondly, we have used Zofran for several years, and it is by far, > the drug that is used the most at our department. It is a very > useful drug that has many benefits over promethazine. Let's compare > the two.... > > promethazine > > - condraindicated in children under 2 > - causes CNS depression > - caution in use in elderly > - phenothiazines have shown to cause seizure activity and dystonia > - not recommended in use on pregnant patients > > ondansetron > > - may be used on children as young as 1 month old > - does not " snow " your patient > - is acceptable to use on pregnant patients > - no relative contraindications > > One issue that I have run into is that promethazine still works > better on the patients that are violently vomiting. One ER doc > stated that Phenergan is for vomiting, and Zofran is for nausea. > This is mostly true. Also, studies show that ondansetron is > inaffective in " motion induced nausea " , where as promethazine would > be the drug of choice. > > Some pediatric facilities have completely gone away from promethazine > and use ondansetron only. Cook Childrens in Ft Worth has been known > to give pedi patients ondansetron ODT, and then push oral fluids > without ever having to start an IV. > > Hope this helps, > > D. Stone Quote Link to comment Share on other sites More sharing options...
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