Effectiveness of Zofran

[zzyzx]

Does anyone know if their are studies showing the effectiveness of Zofran for the relief of nausea and for the prevention or reduction of vomiting episodes in patients outside of those getting chemotherapy? In other words, do we really know how well it works for patients who are vomiting because of ETOH, food poisoning, etc.

 

[Carlos Danger]

There are literally hundreds of studies on ondansetron. Most probably concern its use for chemo or post-op nausea, but undoubtedly there are some that look at its efficacy in the EM/EMS environment.

It's not something I've spent much time looking at the research on, but I do remember reading somewhere that while it works very well as a preventative, it's only effective as a rescue drug around 40% of the time. A lot of folks in anesthesia who use these drugs everyday will tell you that once they are nauseous, it's too late for ondansetron....give them something that works on different receptors.

 

[Akulahawk]

From what I recall about ondansetron, there's a pretty big difference between the chemo dose and the usual nausea dose. I've given plenty of the 4mg dosing for normal nausea but never the bigger 16mg dose for chemo. What I've also seen on most of the floors I've been on is that there's usually a backup antinausea med in the event that the ondansetron doesn't work.

 

[medicaltransient]

The box of Zofran amps we are supplied with comes with great clinical information including the pertinent associated research. I believe the studdies consisted of feeding people epicac and then Zofran to see the percentage of people that vomited. Get into your departments supply closet and find the package insert. Most all the drugs in our supply closet come with some sort of pamphlet that is a welth of information and a reliable source.

 

[MackTheKnife]

Whatever happened to Phenergan or Emetecon?

 

[Carlos Danger]

Whatever happened to Phenergan or Emetecon?

Promethazine is still used, often as a 2nd line agent due to its side effects.

I never heard of emetecon. I had to Google it and according to Wikipedia it is no longer manufactured.

 

[TransportJockey]

Whatever happened to Phenergan or Emetecon?

We still carry phenergan as well as zofran. I tend to use zofran for.nausea and prophylaxis, whereas I use phenergan for active emesis

 

[RocKetamine]

We still carry phenergan as well as zofran. I tend to use zofran for.nausea and prophylaxis, whereas I use phenergan for active emesis

Same here. I usually give 4 mg for prophylaxis, 8 mg for active nausea, and phenergan for vomiting. Our protocols allow up to 32 mg of Zofran though, haven't needed more than 8 so far. haha

 

[johnrsemt]

I have never had a problem with Zofran not stopping vomiting; but I usually give it as soon as they tell me that they are nauseated. Nice thing with Zofran you can give it IV, IM, and IN (although you usually have to have doc's ok on IN, but if you can't get a quick IV it works much faster than IM).
Phenergan can NOT be given IM due to the necrotic issues it has; and since it burns the skin if the IV infiltrates, I wouldn't give it IN either.

 

[Carlos Danger]

Phenergan can NOT be given IM due to the necrotic issues it has

IM is actually the route that the FDA want you to use.

This is the FDA black box warning on promethazine:

WARNINGS
Respiratory Depression – Pediatrics

PHENERGAN Injection should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. Postmarketing cases of respiratory depression, including fatalities, have been reported with use of promethazine in pediatric patients less than 2 years of age. Caution should be exercised when administering PHENERGAN Injection to pediatric patients 2 years of age and older (see WARNINGS - RESPIRATORY DEPRESSION).

Severe Tissue Injury, Including Gangrene

PHENERGAN Injection can cause severe chemical irritation and damage to tissues regardless of the route of administration. Irritation and damage can result from perivascular extravasation, unintentional intra-arterial injection, and intraneuronal or perineuronal infiltration. Adverse reactions include burning, pain, thrombophlebitis, tissue necrosis, and gangrene. In some cases, surgical intervention, including fasciotomy, skin graft, and/or amputation have been required (see WARNINGS - SEVERE TISSUE INJURY, INCLUDING GANGRENE).

Due to the risks of intravenous injection, the preferred route of administration of PHENERGAN Injection is deep intramuscular injection. Subcutaneous injection is contraindicated. See DOSAGE AND ADMINISTRATION for important notes on administration.

 

[TransportJockey]

Doesnt the vial even out can be used for deep im?

 

[johnrsemt]

So how can it be necrotic to surrounding tissue if the IV infiltrates, but not if it is given IM?
I do know that it can give a burning sensation to the skin/vein if it is not given slowly or diluted as it is given.

 

[Carlos Danger]

So how can it be necrotic to surrounding tissue if the IV infiltrates, but not if it is given IM?

I guess just that there's lots more blood flow in the muscle tissue than in the SC tissue, so the drug gets absorbed more quickly. Same reason meds work faster when they are given IM vs. SC.

 

[WestMetroMedic]

I am trying to push ODT zofran with my agency. Great for your nauseated patient who needs some tummy control RFN and IVs access is iffy. Just about anyone who has had ondansetron ODT will attest that it is just as good, if not better than IV. Cost is equivalent to IV as well.

Zofran carries a caveat with it though of QT prolongation on par with another great anti-emetic, droperidol.
http://www.fda.gov/Drugs/DrugSafety/ucm271913.htm