Best alternative to zofran?

[Aidey]

With all the drug shortages going on we are looking at an alternative to zofran. I'm curious what other people are using and what people think is the best/safest alternative while being cost effective. Are their any drugs you strongly object to being used prehospital?

I believe zofran is currently around $15 per 4mg vial, but I'm not 100% sure.

 

[NomadicMedic]

Look at Anzemet. Works great.

 

[Aidey]

I'm personally pushing for one of the other -setron meds, but I know as a class they are more expensive than the others so I have to be prepared to push for one of the cheaper alternatives.

 

[NomadicMedic]

Droperidol works well, too. But, I bet you'd be hard pressed to find a doc that'll let you use it as an antiemetic prehospital.

I haven't experienced the Zofran shortage yet. We still give it out like candy.

Now fentanyl. That's a different story.

 

[Handsome Robb]

I haven't experienced the Zofran shortage yet. We still give it out like candy.

Seconded. Easily the most used med on the unit.

Aidey, I don't have any experience with it first hand but my old partner among many of the other older medics I have worked with swear by phenergan, especially for someone who is actively vomiting. Just have to be ready for the possibility of a dystonic reaction.

 

[STXmedic]

I've got both phenergan and zofran. Phenergan seems to work much better from my personal experience. You just have to be smart about giving it. Only side effect that I've seen is the sedation.

 

[NYMedic828]

FDNY just got zofran about 4 months ago and I am yet to give it once.

Do you guys give it if a patient complains of being nauseous or vomits whatsoever?

 

[Handsome Robb]

FDNY just got zofran about 4 months ago and I am yet to give it once.

Do you guys give it if a patient complains of being nauseous or vomits whatsoever?

Yep pretty much. It depends on the severity and it is up to us as the provider to make that call. Most medics give it pretty freely.

It's been my soapbox recently, but I'm here to help make patients more comfortable wether it be helping with their nausea or their pain.

When I'm on the ski car we give it to everyone who gets narcotic analgesia for the most part since the road we have to wind down has a tendency to really make people ski with narcotics onboard. Hell it makes some people sick with nothing on board.

 

[Aidey]

Droperidol works well, too. But, I bet you'd be hard pressed to find a doc that'll let you use it as an antiemetic prehospital.

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.

I've used promethazine before and I am comfortable with it, but I can see people objecting because some idiot won't dilute it and the patient will file a complaint. I also prefer something non-sedating, and I know the docs like non-sedating also. This especially applies if I am giving anti-emetics with fentanyl.

 

[Aidey]

FDNY just got zofran about 4 months ago and I am yet to give it once.

Do you guys give it if a patient complains of being nauseous or vomits whatsoever?

Pretty much. I will also give it to people highly likely to get nauseous, like MI patients or people I am giving activated charcoal to.

 

[NomadicMedic]

I think I give Zofran to at least 50% of my calls. Our dose here is 8mg, and we carry it in both the ODT and IV.

I really do miss Phenergan for when I used to give Morphine. It was the perfect pain management/antiemetic/sedation mix for little old ladies with femoral head fractures. (or almost anyone with a traumatic injury) 12.5 of Phenergan and 2 to 4mg of morphine made extrication and PT movement easy.

Like most kind and caring medics, I really like to mitigate my patients complaints. If I can do that with an antiemetic and pain management, then I've done my job.

 

[Medic Tim]

Gravol

 

[Tigger]

Sports medicine job only stocks phenergan, and it works very well for the athlete that gets ill and nauseous pre-game. We'll have hour medics give it IV and then get them back out on the ice if they pass inspection.

 

[mycrofft]

Don't eat the green hamburger no matter how well it's cooked.:wacko:

 

[Aidey]

I think I give Zofran to at least 50% of my calls. Our dose here is 8mg, and we carry it in both the ODT and IV.

I really do miss Phenergan for when I used to give Morphine. It was the perfect pain management/antiemetic/sedation mix for little old ladies with femoral head fractures. (or almost anyone with a traumatic injury) 12.5 of Phenergan and 2 to 4mg of morphine made extrication and PT movement easy.

Like most kind and caring medics, I really like to mitigate my patients complaints. If I can do that with an antiemetic and pain management, then I've done my job.

I told my boss I would rather have the ODT than Inapsine. I admit I do miss promethazine for those cases. I was more thinking of the people I don't want to sedate. This is one of those situations were I wish we had more than one option so we could pick what is most appropriate.

 

[R99]

Well it isn't metaclopramide there for darn sure

Promethazine is top notch but too sedating

Both were withdrawn here in 2009

 

[Shishkabob]

Promethazine is top notch but too sedating

"Too" sedating?


Shoot, most of the people with nausea/vomiting could use a little sedation.

 

[R99]

"Too" sedating?


Shoot, most of the people with nausea/vomiting could use a little sedation.

We used 12.5mg IV and that knocked most people down a couple pegs, for smaller people it was way too much

 

[usalsfyre]

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.

Ondansetron works ok till they start vommitting. After that I've found you can push 8mgs and it MIGHT work.

 

[socalmedic]

Zofran is all we use here, and we use a ton of it. we haven't experienced a shortage or a price change (we have a supplier price contract). we haven't actually experienced any shortages that would change out clinical practice. morphine got low for a bit, but never dipped below 40mg per truck.