What is your qtc cutoff for giving zofran?

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vinny88

DrAcula
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In the ED when you have a patient with nausea and already have an ekg on, what qtc will you guys not give zofran at? 500?

Also, do you guys wait for an ekg on all patients before giving it?

-intern

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In the ED when you have a patient with nausea and already have an ekg on, what qtc will you guys not give zofran at? 500?

Also, do you guys wait for an ekg on all patients before giving it?

-intern
qtc < 500. I don't check unless they have documented long QT syndrome or they're getting an EKG anyway.
 
Agree with ~500. Similar for fluoroquinolones, particularly Levaquin, and macrolides.

The whole Zofran and QTc thing I feel is a little reactionary. Was a (not terribly high-powered) study awhile back talking about an average prolongation of ~20 ms in otherwise young/healthy volunteers with routine IV dosing. Very limited study though. Sure, probably more potential than that in many of our patients, but still.

I don't mind sending people home with ODTs and/or ODTs plus the above antibiotics as long as their QTc isn't much beyond 480ish.
 
I had someone go into V Tach once from Zofran, hence why I always keep it in the back of my mind. Like the other people on this forum, I don't bother waiting for an ECG unless I already have one ordered.
 
Don't even worry about it in non elderly peeps not on quinolones. Or have a Hx that's concerning.
Even then, I am not impressed.

This is as the OP put it assuming already had an ECG for some reason.
Otherwise I do NOT order an ECG on young folks with NV I intend on giving/rx ODTs.
 
It's a real thing. I've seen someone die from this before. But they had a known Long QT Syndrome. I'm not sure how long it was.

Like others, my cutoff is 500. And I'd probably only give 4mg if they're close to 500.
 
I had someone go into V Tach once from Zofran, hence why I always keep it in the back of my mind. Like the other people on this forum, I don't bother waiting for an ECG unless I already have one ordered.

Just curious - How much zofran? Did they have comorbidities?
 
Like the above posters, I do not check an ECG before giving, but I'll take pause if I see a QTc over 490ish.

That being said, we use way too much zofran. Nurses often ask me to give it prophylactically (though it hasn't been shown to work well for that) and I'm usually too over-tasked to bother saying no.
 
It's a real thing. I've seen someone die from this before. But they had a known Long QT Syndrome. I'm not sure how long it was.

Like others, my cutoff is 500. And I'd probably only give 4mg if they're close to 500.
Well that's a case report.
If their QTC is 500, what do you give them? Even saline can prolong QT.
 
This is why I give prophylactic magnesium before the prophylactic zofran and opiate /sarcasm

I usually don't give above 500 ms. If I have to give something for nausea in a patient with a prolonged QT, I choose any of the other non black box warning listed antiemetics...umm like placebo, or diclegis. I think those two are actually the same thing, now that I think about it.
 
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Well that's a case report.
If their QTC is 500, what do you give them? Even saline can prolong QT.

well in this case it was pretty clear. he had hx of long qt, received zofran, and shortly thereafter when into torsades and died. It would be hard convincing a jury it was coincidence.

sure lots of antiemetics cause long qt. probably most.

Personally, if I had someone w hx of long qtc, their EKG had a long QT, I'd start with saline. I'd probably go down the ACOG hyperemesis pathway looking for meds that aren't clearly documenting long qt as a side effect. I'd also talk w the patient about realistic expectations.
 
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