Best alternative to zofran?

[MediMike]

In regards to the narcotic discussions on here, we have the option to utilize Zofran 4-8mg or Benadryl 12.5-25mg. The narcotics produce a histamine release leading to the nausea, so rather than making them nauseated then resolving it, giving the Benadryl concurrent with the Narc prevents the issue from occurring, along with the sedative effects of Benadryl. I'm a pretty big fan

 

[jwk]

In regards to the narcotic discussions on here, we have the option to utilize Zofran 4-8mg or Benadryl 12.5-25mg. The narcotics produce a histamine release leading to the nausea, so rather than making them nauseated then resolving it, giving the Benadryl concurrent with the Narc prevents the issue from occurring, along with the sedative effects of Benadryl. I'm a pretty big fan

Now THAT is the best post of the thread so far.

 

[jwk]

That is what we had before Zofran, and what they are threatening to go back to. My reaction was something along the lines of "oh HELL no!". It has the worst safety profile of all of them.

How much droperidol were you giving? Most anesthetists that have used it swear by it, but many hospitals won't carry it because of concerns with QT changes (way overblown near-bogus issue). It's far superior to anything else we have available.

 

[Aidey]

6.25 of promethazine works awesome without nearly as much sedation or as bad of a risk profile.

Why ODTs rather than Inapsine? The black box warning was WAY overblown. Don't forget the FDA just put out a warning about ondansetron for essentially the same thing.

The studies I read indicated that the negative cardiac affects of Zofran appear when the doses of Zofran being used were significantly higher than what we use pre-hospital (~40mg IV), and along the lines of zero with oral zofran. With Inapsine the negative affects were seen with lower doses. I also read something (which of course I can't find now grrrrrr.) that indicated that Inapsine potentiates the QT prolongation affect of other medications more strongly than Zofran does. The list of medications that both medications can interact with is long and includes many common meds that a lot of our patients are on and I know very few people who work under our protocols are aware of all of this.

I'm frankly factoring in the lowest common denominator. The current recommendation is that anyone given Inapsine has a 12 lead first, and cardiac monitoring for 2-3 hours after. This is not going to happen. Is it necessary? Possibly not, but it is the current recommendation and since I know it is not going to be followed I do not believe it is a wise choice. It is basically setting ourselves up for huge trouble if something goes wrong, even if it isn't necessarily related to the Inapsine.

In regards to the narcotic discussions on here, we have the option to utilize Zofran 4-8mg or Benadryl 12.5-25mg. The narcotics produce a histamine release leading to the nausea, so rather than making them nauseated then resolving it, giving the Benadryl concurrent with the Narc prevents the issue from occurring, along with the sedative effects of Benadryl. I'm a pretty big fan

Now THAT is the best post of the thread so far.

Promethazine is also an antihistamine, which is part of the reason it complements opiates so well.

How much droperidol were you giving? Most anesthetists that have used it swear by it, but many hospitals won't carry it because of concerns with QT changes (way overblown near-bogus issue). It's far superior to anything else we have available.

I say "we" as in my agency. I wasn't here when it was in the protocols and I don't know what the dose was. There was apparently some sort of 'incident' when it was in the protocols but I didn't get any of the story aside from the fact that someone "slammed" it and then something bad happened. It was mentioned in passing before I knew of the proposal to use Inapsine as a back up, so I didn't ask any details. It was apparently the reason we switched to Zofran though.