What nausea/vomiting regimen do you use?

[12R34Y]

Reading a post on the general residency thread got me thinking about what do YOU think the best EM N/V drugs are?

I know this was discussed a year or 2 ago, but couldn't find it on a search.

I've done some searching online and it seems that compazine usually wins when compared to others that I've seen in head to head comparisons.

just curious as to what you all are using.

later

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[kungfufishing]

I use all of em, kind of depends on the scenario. I do like compazine for both migraines and nausea.

 

[turtle md]

Zofran for the kiddos works wonders - a little ODT and you may save them from the horros of an IV...

 

[EctopicFetus]

Zofran for the kiddos works wonders - a little ODT and you may save them from the horros of an IV...

Zofran is amazing for kiddos.

We dont use compazine at all here. Then Reglan/phenergan is by choice. No pref.

 

[12R34Y]

We seem to be evenly split on our staff/residents preference on anti-emetics.

I think everyone knows that compazine is your drug of choice for migraine headache/nausea.

Some claim they use reglan for all of the diabetics (because most are horribly controlled) and they say that it tightens LES tone and helps with their gastroparesis. I'm not sure that one does of reglan will have a tremendous effect on gastroparesis, but i'm sure it can't hurt?

The other reason lots seem to love reglan is that it is class B in pregnancy so they give it to all of the ladies.

Compazine/phenergan are CLass C although used in pregnancy a lot.

any thoughts on this rationale?

We use zofran but only if refractory to a dose of compazine/phenergan/reglan because it is so outrageously expensive.

later

 

[Snoopy]

IV Zofran is now available as generic and is quite inexpensive. It is also available orally in generic form but that hasn't done much for the price.

I used to use Phenergan as first line, but now I use Zofran a little more liberally. We don't have IV Compazine available but it used to be my favorite for migraine. Now I use Reglan for migraine.

 

[bartleby]

Reglan: First choice. Low risk of akithesia easily addressed with IV benadryl. As it is a promotility agent, I skip this one if possible in people with gastroenteritis.

Phenergan: Good choice, but can be mildly sedating, so it's not a great choice if you're trying to get an elderly person up & out quickly. Of note, if the IV infiltrates when being given in a concentrated form (i.e. subcutaneous administration), it can cause lesions and necrosis, so either deep IM administration or smaller, diluted dosing (12.5mg at a time) is preferable

Compazine: Not a bad choice, cheap, generic, also works for headaches

Zofran: as expensive as the orally disintegrating form (ODT) is, it can save several times its cost in avoiding IV placement. Doesn't work for headaches.

 

[edinOH]

I have great results with phenergan for migraine. I really hate reglan in anyone other than the diabetic gastroparesis folks. It probably stems from the time I saw my wife receive it and about crawl out of her skin. I still use it for migraine though sometimes.

I had to break my habit from residency of using phenergan primarily for nausea/vomiting. Where I'm at now zofran seems to be the prefered choice. I get great results from it and I'm able to avoid the sedative effects. Nice for getting people discharged after their garden variety gastroenteritis.

Rarely use compazine.

I doubt any kid has come out with three legs from phenergan early in pregnancy. If you can afford kytril or zofran, great. Otherwise I give alot of phenergan in the pregnant women.

 

[doctawife]

All I use is Zofran - but then again, all I see are kids, so that makes sense. Compazine + kids = badness.

Zofran + kids = successful po trial and an exit from my ER, which equals success for me. 'Cause I need those rooms for patients who are actually sick, instead of just puking.

 

[deleted6669]

reglan 10/benadryl 25. works as well as zofran 4 at 10% of the cost.
I reserve zofran for kids or adults who can't take regaln/benadryl.

 

[dodoc07]

There is actually a rationale for anti-emetic therapy based on etiology of nausea: http://www.eperc.mcw.edu/FastFactPDF/Concept%20005.pdf

It's interesting to note that metoclopramide works both as an anti-dopaminergic (central) as well as on the gut receptors (peripheral) so you are essentially getting two effective anti-emetics for the price of one.

Another note: haloperidol is a very effective agent that is vastly underutilized for nausea.

Hopefully this will save you alot of guesswork and anecdotal "he said, she said", as evidenced on this thread.