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Anti emetics


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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. 

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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

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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...

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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?  

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