Zyprexa for pain management in the ED

[ARinaldi3]

Anyone else have a lot of success with Zyprexa for pain? 

[LT_Oneal_PAC]

7 hours ago, ARinaldi3 said:

Anyone else have a lot of success with Zyprexa for pain? 

I’ve not heard anyone doing this. Does it actually work on pain or is it more like propofol and just knocks people out? What dosages are you using for pain? Not saying it’s crazy, just never heard of this.

[EMEDPA]

I've seen (and used) haldol for patients with difficult to control pain as part of a cocktail, but not zyprexa or geodon at this point, but they probably work just as well.

[ARinaldi3]

15 hours ago, LT_Oneal_PAC said:

I’ve not heard anyone doing this. Does it actually work on pain or is it more like propofol and just knocks people out? What dosages are you using for pain? Not saying it’s crazy, just never heard of this.

 

11 hours ago, EMEDPA said:

I've seen (and used) haldol for patients with difficult to control pain as part of a cocktail, but not zyprexa or geodon at this point, but they probably work just as well.

There are several articles on NCBI, Cleveland Clinic utilizing Zyprexa, Haldol for chronic pain, neuropathic pain. I have used it at least weekly for pain management of acute pain syndromes with large success---not zonking people out if appropriately dosed. It does require an EKG to r/o long QT, but I've found it to be more effective than narcotics even with patients who are not exhibiting DSB, high tolerance, chronic opioid users. Examples of such I can recall are with a cervicogenic migraine failing outpatient muscle relaxants and migraine cocktail (Toradol, Bendaryl, Reglan), Kidney stone failing Dilaudid (Toradol was contraindicated), SBO with acute pain + nausea, vomiting, IBD flare (this pt was on chronic opioids as OP), and elderly woman with agitation and chronic Diverticulitis with microperforation. The dosages are wonky, but usually only do 4 mg - 7 mg IM and depend on age/frailty/medications/drug use hx.

My hospital system is trying to push toward alternative medications for pain management to avoid heavy narcotic use but not neglect patient pain-- goal is mostly tot maintain high press ganey scores with patient satisfaction. I've done Lido drips too, but those require titration. One other thing my director is hoping to introduce in the future---Oxytocin. Not well versed on that but I can't see myself being comfortable with any woman of child bearing age.

Speaking of such--I was told by a OBGYN resident that Toradol was safe in <20 weeks gestation. Looked online and theres some merit, but also can't imagine using this either. Aside from Tylenol or topical pain relievers, is there anything that you go to for pregnant women?

Edited March 4, 2020 by ARinaldi3