Ondansetron vs. metoclopramide

[LucidResq]

Going through stuff today, trying to acquaint myself with new jump bags, I noticed we carry both ondansetron (Zofran) and metoclopramide (Reglan). I knew Zofran, but hadn't seen Reglan before so I asked the medic what it was and got the short answer : antiemetic, because 2 seconds later we were busy putting bandaids on boo-boos (amusement park EMS yay).

So if both are antiemetics, when would you use one over the other in the prehospital setting? I looked them up in my pharm textbook and didn't really get a good answer and didn't find anything too informative on the web.

Just curious. Thanks.

PS: based on what I've read in the pharm text I'm guessing Zofran would be first choice, because it won't cause sedation or extrapyramidal reactions like Reglan may - so is there some contraindication to Zofran that would make Reglan a better (or the only) option?

 

[Jon]

PA's gone to Zofran... and as far as I know, it has an extraordinarily good safety profile. It seems to get given away like candy. Seems like overkill to have Reglan as well.

Looking at it in Epocrates, there is still a risk of extrapyramidal reactions, though.

 

[medic417]

Personally I like have multiple options. Some drugs work better for nausea, while others work better for active vomiting.

 

[fma08]

Reglan can lower blood digoxin levels, should not be used in a GI bleed either... Zofran can prolong QT interval... Something to think about... Although, I can't really seem to find much either.

 

[mycrofft]

What happened to Tigan?

??????????

 

[emtjack02]

Zofran: I like this one. I usually works with in minutes if not shorter. I have not noticed any serious side effects although I'm sure the list is long.
Reglan: Is an antiemetic as you know but it works by increasing gastric motility instead of working on neurotransmitters like zofran. Interestingly enough I found out that reglan has off label uses for hiccups, migraines, and they also give it to moms that have decreased milk production.

 

[Flight-LP]

Reglan for uncontrolled hiccups works great!

Personal experience, I like Zofran. Quick acting, seems to last longer than Phenergan, doesn't burn as bad in the IV nor does it have to be diluted, and it just seems to work better for more people.

Thats my scientifically accepted response!

 

[Flight-LP]

??????????

cough*old geezer*cough

Haven't seen or heard about it in years!

 

[Ridryder911]

I have found Zofran is ONLY good if the patient has just became nauseated and has not vomited yet. It is expensive in comparison and although physicians may like it, I have found it to work as I described.

Reglan is an alternative antiemetic but I have seen several reactions of "anger" after administration of it. Although sometimes not recommended with GI bleeds, it is routinely ordered for such an occurrence with ulcerations. Compazine is also a good one as well but had lost its popularity. Phenergran is an excellent one if administered properly.

Remember, Benadryl can also act as one too.

R/r 911

 

[medic417]

I have found Zofran is ONLY good if the patient has just became nauseated and has not vomited yet. It is expensive in comparison and although physicians may like it, I have found it to work as I described.


R/r 911

I've actually seen Zofran stop a person in mid vomit.

But again more options if people are properly educated is better. Then you can treat the patient with whats best for them not just practice cook book medicine.

 

[maxwell]

As per the QT prolongation comment, I have one thing to say: meh. (Now, if we were still using droperidol, then I'd say have 'em on isuprel before you gave it.) If medics had any idea how many drugs prolong the QT, they'd sit there and just give periodic NS boluses (oh, right, and MgSO_4).

*Steps off of the QT prolongation soap box*

Zofran...Reglan...doesn't really make a difference. Both zonk you out (I mean, not as bad as compazine did) while stopping you from vomming all over your friends. There are no perfect antiemetic drugs out there. Zofran and Reglan were designed with different targets. Zofran for chemotherapy and Reglan (mostly) for vertigo. In the field, I'd say just go with Zofran. Anecdoteally I've just had better results.
So have these goofballs:

http://www.anesthesia-analgesia.org/cgi/reprint/85/2/395.pdf
http://www.sciencedirect.com/scienc...=8064580&md5=aeceaad4338a28d7f465792ae92356de
http://content.karger.com/ProdukteD...oduktNr=224258&Ausgabe=227653&ArtikelNr=49437

 

[medic417]

Zofran...Reglan...doesn't really make a difference. Both zonk you out (I mean, not as bad as compazine did) while stopping you from vomming all over your friends. There are no perfect antiemetic drugs out there. Zofran and Reglan were designed with different targets. Zofran for chemotherapy and Reglan (mostly) for vertigo. In the field, I'd say just go with Zofran. Anecdoteally I've just had better results.

Actually one of the reasons Zofran has gained favor in ER's is it does not zonk(make you sleepy) most patients.

But again I do not think one size fits all. Have options so your patient actually gets the medicine they need.

 

[Ridryder911]

Zofran is a good drug if administered early on and so is many others. Alike what was described, it does not have the usual s/e as many others of drowsiness and vertigo. It will however; can cause constipation.

 

[Lunah]

We switched from Phenergan to Zofran in our drug boxes a while back -- I definitely prefer Zofran for patients. It just seems to work better overall. But like Ridryder, I've seen that it doesn't always work if the patient is already hurling. Sometimes in the ED, we'll try the Zofran first, then move on to Phenergan if they're still vomiting.

I've never had a patient get drowsy with Zofran. And I love the Zofran ODT tablets for peds! They dissolve in the mouth and usually work pretty well. (We don't have those prehospital, though.)

I've also seen people have those antsy-pantsy reactions to both Compazine and Reglan. Sometimes we'll give Benadryl along with the first dose of either of those to help with that twitchy feeling. One of my coworkers refuses to give Compazine or Reglan as IVP drugs -- she'll put the dose in a 100ml bag of NS and just let it infuse in rather than push it. She claims that helps.

 

[mycrofft]

We still use Tigan with good results, but no more Compazine.

Besides potential for EPS in susceptible pt's, if given in the first (sometimes undetected) trimester it can be teratogenic. Plus, if the pt is detoxing ETOH, Benzo's or other situations where seizure is possible, it increases the likelihood for that to occur.
Nausea=Tigan. Diarreah-Belladona and phenobarb ("Donnatol") plus kaopectate. Work well.

 

[rmellish]

My primary job went from Reglan to Zofran in the last couple of years. We currently have both IV and sublingual flavors.

The other service still carries phenergan IV.

I can't give any of the above, but have seen good results with the zofran in reducing nausea.

 

[mycrofft]

Hey, Thalidomide is coming back...oh, mommy!

It was used improperly in the early Sixties and caused many limb defects in neonates exposed to it in utero...as it was marketed as being very good duing pregnancy. (About as good as mercury.)

 

[Lunah]

Great. Kids with flippers!

 

[remote_medic]

Having been given IV Reglan before I can atest to the fact that it makes you very jumpy and "angry" for lack of a better term.

Never been given Zofran so I can't compare.

 

[Lunah]

The one time I had Phenergan (a few months ago, when I had vertigo), it made me feel simultaneously wasted and antsy. I *hated* it. Ugh. Felt like I could crawl out of my own skin.