DogLovingPA Posted November 13, 2015 Share Posted November 13, 2015 For patients where Zofran and Phenergan have significant drug interactions - what do you guys use for N/V? I've used meclizine (because I had it lying around) for myself before with decent results. Reglan +/- Benadryl? Other meds you guys have found effective and safe? Link to comment Share on other sites More sharing options...
cinntsp Posted November 13, 2015 Share Posted November 13, 2015 Zofran interacts with EVERYTHING and we still give it to EVERYONE. Link to comment Share on other sites More sharing options...
UGoLong Posted November 13, 2015 Share Posted November 13, 2015 I don't really think of meclizine as an antiemetic but a specialized antihistamine to address vertigo or motion sickness, with the side effect of addressing nausea. Link to comment Share on other sites More sharing options...
DogLovingPA Posted November 14, 2015 Author Share Posted November 14, 2015 Zofran interacts with EVERYTHING and we still give it to EVERYONE. Very true. Most providers where I am diligently check med interactions and try to avoid significant ones when we can. I try to avoid it in folks already on multiple meds that interact and prolong the QT. I don't really think of meclizine as an antiemetic but a specialized antihistamine to address vertigo or motion sickness, with the side effect of addressing nausea. Agreed. I don't know how much help it would be in active vomiting, but maybe help nausea. Just looking for ideas of other meds out there that are safer to use for nausea. Link to comment Share on other sites More sharing options...
sk732 Posted November 14, 2015 Share Posted November 14, 2015 Prochlorperazine or Chlorpromazine work well, though you sometimes need to add Benadryl. There is still good old fashioned Gravol, depending on the effects you're trying to avoid - just use lower doses. The anti-psychotics of course do mess around with QT's and may cause additive risk of EPS if the patient is on something else for sleep or agitation. I used to give meclizine when I was in the military to ensure people were not horribly stoned if they were prone to seasickness but had jobs that required more stimulation than sedation...of course they stopped making it here and we could only get it from compounding pharmacies or from the USN when we were around them. Divers and special ops guys kind of relied on the stuff as you might imagine. SK Link to comment Share on other sites More sharing options...
winterallsummer Posted November 14, 2015 Share Posted November 14, 2015 Zofran first. Compazine second. Phenergan third. If all else fails, I bolus half a liter (unless CI) give haldol plus or minus a benzo (in truly intractable emesis). Anectodal but works very well for me. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 15, 2015 Moderator Share Posted November 15, 2015 Zofran, Phenergan, reglan, Compazine, inapsine, Haldol in that order. can add Benadryl to any. Link to comment Share on other sites More sharing options...
jen0508 Posted November 19, 2015 Share Posted November 19, 2015 Where did inapsine go? Our hospital hasn't carried it in over 2 years. That stuff was great. Not just for vomiting but for belly pain, chest pain, and really any overly dramatic pt that had nothing wrong with them Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 19, 2015 Moderator Share Posted November 19, 2015 Where did inapsine go? Our hospital hasn't carried it in over 2 years. That stuff was great. Not just for vomiting but for belly pain, chest pain, and really any overly dramatic pt that had nothing wrong with them it got a black box warning for long qt (like zofran...) and so most hospitals pulled it... Link to comment Share on other sites More sharing options...
Miaow Posted November 20, 2015 Share Posted November 20, 2015 For our pregnant patients we're back to Diclegis (unison + B6) and then phenergan (PO or PR!), reglan and lastly Zofran (which seems to work poorly and gives a vicious headache in a lot of people!). Link to comment Share on other sites More sharing options...
jen0508 Posted November 20, 2015 Share Posted November 20, 2015 it got a black box warning for long qt (like zofran...) and so most hospitals pulled it... That's frustrating. Everything has a Blackbox warning, even otc ibuprofen. I want my droperidol back! Link to comment Share on other sites More sharing options...
DogLovingPA Posted November 21, 2015 Author Share Posted November 21, 2015 For our pregnant patients we're back to Diclegis (unison + B6) and then phenergan (PO or PR!), reglan and lastly Zofran (which seems to work poorly and gives a vicious headache in a lot of people!). I've just started writing diclegis (as two separate Rx's due to cost). Haven't heard a lot of feed back yet. Have you ever used it in non-pregnant folks? Link to comment Share on other sites More sharing options...
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