Zofran (ondansetron)

[Aidey]

Errr...methinks that increased risk of vomiting would be more of an aspiration risk versus whatever sedative effects (very minimal to nonexistent) you'd see by administering ondansetron. We switched from promethazine to ondansetron for precisely that reason...it doesn't have the sedative effects that other antiemetic medications produce.

Lower risk of vomiting + less airway woes + less mess to clean up beats teaching a would-be alcoholic a lesson. That would seem to go along with slamming naloxone to piss off an addict.

This for me too basically.

I like having both promethazine and ondansetron available, although we are moving to just ondansetron. Promethazine works on motion sickness where as ondansetron has little effect if any. We routinely transfer pts to a hospital about 5 hours away, and it is nice to be able to treat motion sickness if it develops. Some pts with chronic problems also prefer one over the other at times too.

 

[redcrossemt]

Don't agree. The ETOH effect is enough of an LOC/airway risk. I see no reason to exacerbate an existing risk. I know what recovery position, suction and a mop are for. Comes down to choice I suppose.

What's an "LOC risk"?

Recovery position and oropharyngeal suction does not totally prevent aspiration, and the very dangerous ARDS and pneumonia that will accompany this patient's long critical care course after aspiration. Zofran may actually prevent the vomitting in the first place, placing the patient at a much decreased rate of mortality and morbidity.

I don't care if the patient is EtOH+ or not. We shouldn't punish our patients by withholding treatment to make them miserable. That is unethical, and creates a huge risk to your patient in this situation.

In as far as the risk of somolence... Clinical trials indicated that 20% of patients taking Zofran experienced drowsiness, compared to 23% of those given a placebo. Compared to the other common option, a sedative anti-histamine called Phenergan, Zofran has a very limited risk of drowsiness. In addition, what is going to happen if your drunk gets sleepy? They can't protect their own airway? Pretty easy for us to fix... just put in a simple airway adjunct.

 

[redcrossemt]

Promethazine works on motion sickness where as ondansetron has little effect if any.

Also, +1 on this.

Phenergan for motion sickness and vertigo.

Zofran for GI related nausea and vomitting.

 

[redcrossemt]

Oh yeah, and hello 82A599!

 

[rescue99]

What's an "LOC risk"?

Recovery position and oropharyngeal suction does not totally prevent aspiration, and the very dangerous ARDS and pneumonia that will accompany this patient's long critical care course after aspiration. Zofran may actually prevent the vomitting in the first place, placing the patient at a much decreased rate of mortality and morbidity.

I don't care if the patient is EtOH+ or not. We shouldn't punish our patients by withholding treatment to make them miserable. That is unethical, and creates a huge risk to your patient in this situation.

In as far as the risk of somolence... Clinical trials indicated that 20% of patients taking Zofran experienced drowsiness, compared to 23% of those given a placebo. Compared to the other common option, a sedative anti-histamine called Phenergan, Zofran has a very limited risk of drowsiness. In addition, what is going to happen if your drunk gets sleepy? They can't protect their own airway? Pretty easy for us to fix... just put in a simple airway adjunct.

We're thinking all drunks are going to be everything except really drunk! There are not too many cases where we have to go as far as tubing to protect the airway albeit, it occasionally does occur. Non drinkers and kids could be in more trouble but honestly, so what if the victim vomits? Under normal conditions we put them in a recovery position which is first line treatment anyway. Barf can be cleaned up. I'm certainly not afraid of a cleaning up a little mess. If my partner is that big a weenie, I'll do it for heaven sake.

What I am opposed to is introducing drugs into the system of person with an already decreased LOC without a good reason. Especially if its a kid whose immature system typically hasn't had much in the way of drugs yet. It just isn't necessary under most conditions.That fifth of rum sitting in a kid's stomach will do a whole lot more harm than the initial vomiting will. If he/she is still barfing in a few hours, then consider Zofran.

 

[redcrossemt]

Rescue99, I think what you are saying now is more reasonable than your initial comments indicating that N/V from alcohol intoxication wasn't legitimate, and that we should let them ride it out to teach them a lesson.


As a side note, Zofran has been found to be safe in the pediatric patient. 4mg IM or IV is fine for those patients over 12 y/o. Between 4-12 y/o, 0.1 mg/kg is recommended. With patients younger than 4 y/o, you should consult medical control as I can't find any literature describing safety and efficacy in that population. I do believe that the SEM protocols require medical control for patients under 12 y/o anyway.

 

[rescue99]

Rescue99, I think what you are saying now is more reasonable than your initial comments indicating that N/V from alcohol intoxication wasn't legitimate, and that we should let them ride it out to teach them a lesson.


As a side note, Zofran has been found to be safe in the pediatric patient. 4mg IM or IV is fine for those patients over 12 y/o. Between 4-12 y/o, 0.1 mg/kg is recommended. With patients younger than 4 y/o, you should consult medical control as I can't find any literature describing safety and efficacy in that population. I do believe that the SEM protocols require medical control for patients under 12 y/o anyway.

^_^Unless I write a book, not all thoughts are jotted down at one time. I still have those first thoughts but yes, there are other, more reasonable reasons as well.

 

[maxwell]

It's really the only anti-emetic I use. It's safe, fast, effective, and well-tolerated all around. It is very, very expensive though. Especially the oral dissolving tablet thingys "Zofran ODT."

...and I never give anything to my fans of the Carbon-Carbon bond - except for restraints and a mask.

 

[82-Alpha599]

Nice to see you to redx, maybe ill last a little longer this time. Eh?

 

[Fox800]

It's really the only anti-emetic I use. It's safe, fast, effective, and well-tolerated all around. It is very, very expensive though. Especially the oral dissolving tablet thingys "Zofran ODT."

...and I never give anything to my fans of the Carbon-Carbon bond - except for restraints and a mask.

There are generic versions available now.

 

[Medic946]

We've been using Zofran for about a year and I love it!! Good for the drunks, doesn't sedate like Phenergan. Use it IV slow push for best results as far as I've seen.

 

[motomedic]

Used it last night for the first time. Although I was the Engine medic an did not transport, I hear it works well and we give it often due to are lengthy mountain commutes. Cheers

 

[m33kr0b]

Zofran was my drug of choice when I was doing chemo.

 

[CBFPD]

It's really the only anti-emetic I use. It's safe, fast, effective, and well-tolerated all around. It is very, very expensive though. Especially the oral dissolving tablet thingys "Zofran ODT."

...and I never give anything to my fans of the Carbon-Carbon bond - except for restraints and a mask.

We pay $0.27 per 4mg Ondansetron Orally Disintegrating Tablet. Pretty cheap....

 

[SurgeWSE]

I love Zofran and will use it with anyone who is complaining of nausea and with pain meds that tend to cause nausea. Keep in mind, it is prophylaxis for emesis. The ones that are already puking their guts out when you get there would be better served with Phenergan.

 

[SES4]

Fantastic drug. Awesome that a generic is now available as well.

I had surgery and required both Phenergen and Zofran while hospitalized. And as stated Phen.= Already Puking, did not do much for me otherwise and knocked me on my butt. Zofran though allows you to function generally (each person is different and drugs effect each person differently so I try not to make blanket statements).

 

[FFMedic75]

Although the drunks probably don't deserve it, you or your partner end up cleaning up the inevitable mess. So yes I give it to drunks as long as they meet the requirements laid out in my protocols.

 

[JeJmFs]

Love Zofran. We have been using it in our service for a few months. Still have the good ol Phenergan. I have heard several of our medics say that they like Phenergan better and several say they like Zofran better. I personally dont know what is better. We now have protocol to give a 2nd 4mg dose of Zofran if the 1st does not work. I do like Phenergan for long distance transports though.... makes the pt.s sleepy.

 

[redcrossemt]

Good bump on this thread. I will tell you anecdotally after using Zofran on the truck for a couple months, I really like having it! It has in most cases stopped active vomiting for my patients, and 8mg has been 100% effective in relieving nausea.

 

[TheMowingMonk]

From what we have been taught about Zofran its unlikely to be effective on nausea caused by EtOH. But from what you guys are saying it sounds like it has been working on EtOH? what have people experianced with it and EtOH?