Zofran potentiates opiates?

[Christopher]

I don't have anything to cite that hasn't already been listed here, but I can confirm that several of the docs I deal with routinely push zofran with morphine/opiates as a standard precaution against nausea side effects.

If you need an antiemetic when you push opiates, it is probably because they're being given too quickly.

 

[jwk]

I don't have anything to cite that hasn't already been listed here, but I can confirm that several of the docs I deal with routinely push zofran with morphine/opiates as a standard precaution against nausea side effects.

Zofran is routinely given for surgery patients who have received opiates.

If you need an antiemetic when you push opiates, it is probably because they're being given too quickly.

Opiates frequently cause nausea whether they're pushed fast or not, although having been admitted for PONV following surgery because I got 10mg of MS pushed, I agree that giving them fast can make it worse. We give antiemetics to virtually every general anesthetic patient that gets any narcotics at all. Most patients would actually prefer to have a little more pain if it means less nausea, although pain can cause nausea as well.

 

[abckidsmom]

Zofran is routinely given for surgery patients who have received opiates.





Opiates frequently cause nausea whether they're pushed fast or not, although having been admitted for PONV following surgery because I got 10mg of MS pushed, I agree that giving them fast can make it worse. We give antiemetics to virtually every general anesthetic patient that gets any narcotics at all. Most patients would actually prefer to have a little more pain if it means less nausea, although pain can cause nausea as well.

And opiates combined with significant stress and an hour long ride backwards over curvy roads means I always give Zofran with opiates in my standard practice.

 

[Medic Tim]

And opiates combined with significant stress and an hour long ride backwards over curvy roads means I always give Zofran with opiates in my standard practice.

This ^^^

If I have to transport, most people get Zofran, dimenhyrdinate or metoclopramide as it is a REALLY rough and long 2 hours to the highway.

 

[TransportJockey]

And opiates combined with significant stress and an hour long ride backwards over curvy roads means I always give Zofran with opiates in my standard practice.

Same here... Unfortunately all we have are ODT zofran tabs... I'm trying to get my medical director to get us IV antiemetics again though.

 

[truetiger]

Where'd they go?

 

[TransportJockey]

Where'd they go?

Is this to me? If it is... The county formulary we used when we stood up our operation took phenergan out because too many medics were using it with the intention of snowing pain management patients. We are operating under our own protocols and formulary now and I'm trying to get that part changed

 

[truetiger]

Ahh, that's got to be rough. I've never had much success with the tablets.

 

[TransportJockey]

Ahh, that's got to be rough. I've never had much success with the tablets.

Neither have we. That's why I'm advocating for change

 

[jwk]

And opiates combined with significant stress and an hour long ride backwards over curvy roads means I always give Zofran with opiates in my standard practice.

Even with no stress or opiates, I'd need Zofran for an hour long ride backwards over a curvy road!

 

[RocknRollRPh]

Unfortunately only hydroxyzine does this

Thank you for this discussion. Clinically, the only phenothiazine antihistamine that actually potentiates the analgesic activity of narcotics is hydroxyzine. And this is in short supply if it can be found at all. Had a patient who needed it and it could not be sourced! Promethazine (Phenergan) does not actually potentiate analgesia; studies have shown pretty clearly that it actually decreases it, although this combination has long been in the hallowed halls of medicine. It does help the nausea, it does potentiate the CNS depression of narx - along with a host of others - but alas, hydroxyzine is the only antinauseant that truly increases pain relief.

 

[Carlos Danger]

Thank you for this discussion. Clinically, the only phenothiazine antihistamine that actually potentiates the analgesic activity of narcotics is hydroxyzine. And this is in short supply if it can be found at all. Had a patient who needed it and it could not be sourced! Promethazine (Phenergan) does not actually potentiate analgesia; studies have shown pretty clearly that it actually decreases it, although this combination has long been in the hallowed halls of medicine. It does help the nausea, it does potentiate the CNS depression of narx - along with a host of others - but alas, hydroxyzine is the only antinauseant that truly increases pain relief.

Awesome to see a pharmacist on here. Are you also a paramedic or EMT?

Either way, welcome.

 

[chaz90]

Awesome to see a pharmacist on here. Are you also a paramedic or EMT?

Either way, welcome.

Concur, welcome to the forum!