Phenergan?

chip193 · Nov 22, 2004

Funny, I was wondering the same thing this morning. Had a patient who could have had morphine but wanted Phenergan instead. Go figure! It must be good because I've heard it feels like fire going in and has the pH of around 2.2. Goodness knows i wouldn't want that in me.
Question for everyone: are you allowed to give it IV push in a peripheral (diluted? Undiluted?)? I had heard this was REALLY bad but everyone does it on my unit, and there is no policy on it.

At the ER, we give 12.5 to 25 IVP with or without a running line. So long as you're sure that the line is patent, there isn't a huge problem. The flush after administration usually relieves the buring.

When I work on the EMS side, 12.5 IVP is a standing order for N/V. Same as above for the line.

allnurses Guide · Nov 22, 2004

Zofran is outrageously expensive, so that's probably why you don't see it much--we did use it quite a bit at the ORs where I've worked in San francisco.
Now, Inapsine (Droperidol)--I am really surprised to hear that you are still using that. Most of the country has simply stopped using it, due to its apparent cardiac problems (I don't know if these are real or alleged, but due to fear of litigation, it's rarely used anymore.) In fact, I am surprised you are even able to get a supply of it--it's pretty much out of distribution.
It was a good drug, though, while we had a ready supply of it and were unaware of it's cardiac effects.

It is crazy, isn't it, the differences in medical practice. We pretty much stopped using Demerol about 5 years ago but I still give it occasionally in the ER . . . Demerol and Phenergan IM .. .

My son had the extrapyramidal side effect of inapsine when we were all sick with N/V/D a few years ago (he was about 14 - I told him that is how taking illegal drugs makes you feel (evil diabolical mom :) and he said he would never take them if that was so - he hated it) . .. I have had a couple of patients say they are "allergic" to inapsine for that reason. But we have standing orders after ortho surgery for inapsine or phenergan or anzamet (this is fairly new -used to be a one time dose but now they are using it Q12). Also, pepcid and reglan are scheduled IV for these patients.

When I was in nursing school 6 years ago we gave pepcid as a piggyback and then when I started nursing we gave it IV push. Some older nurses refused to do that and made up their own piggyback.

Tweety . . . . . crazy sounds better than weird :chuckle

steph

bosco · Dec 12, 2004

We give phenergan ALL the time where I work. We always dilute it in a 50ml piggyback and run it over about 15 minutes. I've never had complaints about that burning.

bellcollector · Dec 12, 2004

I don't recall if I have ever had it IV but I do know I have gotten it for fibro flare pain and migraines IM with demerol. Honestly by the time I go to ER I am in so much pain I really couldn't tell you if it burns or not. I always figured adding the phenergan to the demerol was because I was already nauseas if not vomiting. I also have periodic limb movement disorder(uncontrolled overwhelming desire to move limbs due to tingly feeling) and I have always felt that though the demerol/phenergan gets the pain uder control it makes my jittering and jerking worse. Is this a side effectof either drug or the combo?

Very informative thread. As an LPN studying for my RN I appreciate these kinds of threads.

PA-C in Texas · Dec 13, 2004

I think that giving Phenergan IM is one of the most inhumane things you can do to a person. It's more sensible to give it slowly in a line that is running with NS. Generally, if you don't give it in the 22g that you put in between someone's knuckles, there isn't a problem.

JVanRN · Dec 13, 2004

I knew a girl that abused amminopylline PO....is it like speed or something? Didn't understand that either...did'nt have asthma.

hippienurse · Dec 13, 2004

I am a migraine sufferer (and nursing student, lol) and wanted to add my experience. I have gotten Phenergan and Demerol together many times IM. They give me the demerol in one shot and then the phenergan in another and I never had any burning so I don't see how it could be so inhumane?

apaisRN, RN, CRNA · Dec 13, 2004

I love Phenergan, myself. I had it in the ER for a staphyloccal food poisoning spell. I wanted to die with the cramps, vomiting and diarrhea and the phen made me sleep happily for hours. I have had it IV twice and it didn't burn either time. I have had several post-op patients whom Zofran had no effect but phenergan fixed the vomiting. It seems to work great PR too though so maybe that's the safest, most lawsuit-proof way to give it. When I worked med/surg I don't remember a lot of problems with burning (our policy is to give through running IV) and now in ICU we don't use it much, and most patients have a big ol' subclavian anyway.

I think final word is, it's a useful drug that you have to be careful with.

allnurses Guide · Dec 13, 2004

I am a migraine sufferer (and nursing student, lol) and wanted to add my experience. I have gotten Phenergan and Demerol together many times IM. They give me the demerol in one shot and then the phenergan in another and I never had any burning so I don't see how it could be so inhumane?

We mix the Demerol and Phenergan in one shot so you only have to feel pain one time. :)

I'm still wondering while reading all these posts if the pain with IV Phenergan is most likely a coincidence. That maybe the IV site was already about to go "bad" and whatever went in would have hurt and caused a blown IV?

I've been giving it for 6 years and never had one complaint or IV site go bad while giving phenergan. I have had IV sites go bad - infiltration or whatever. That happens.

Just seems interesting to have so many stories about giving phenergan that don't include pain and IV's gone bad.

steph

CSLee3, ASN, BSN, LVN, EMT-P · Dec 13, 2004

I see a lot of drug seekers (and legit pain pts) for various reasons in my ER. A couple of the docs have started odering Benedryl and Reglan IVP, one followed by the other. And guess what, it works for severe pain, like migraines, usually knocks them out and 9 out of 10 are happy and have no idea what they just got! I was a believer after that! Also keep in mind Phenergan is Catagory C or X (in some references) for pregnancies...be careful.

Also I have seen a lot of requests for non-narcotic Ultram. Apparently, very popular on the street. Anybody seen ultram abuse?

chip193 · Dec 13, 2004

I see a lot of drug seekers (and legit pain pts) for various reasons in my ER. A couple of the docs have started odering Benedryl and Reglan IVP, one followed by the other. And guess what, it works for severe pain, like migraines, usually knocks them out and 9 out of 10 are happy and have no idea what they just got! I was a believer after that! Also keep in mind Phenergan is Catagory C or X (in some references) for pregnancies...be careful.
Also I have seen a lot of requests for non-narcotic Ultram. Apparently, very popular on the street. Anybody seen ultram abuse?

Toradol, Reglan, and/or Phenergan is the new migrane thing at our place. It has been very, very effective.

Chip

ICUnowOHN · Dec 13, 2004

Never heard of anyone seeking phenergan, just c/o drowsiness.

Anyone out there hear anything about the possibility of them coming out with a version of Toradol that can be taken long term ? I had it after a lengthy surgical procedure, and I have a bad back ( 2 discs screwed up ), and I was trying to climb off the table/gurney, as they were taking me to recovery from the horibble back pain. It works better than any narc I've been given. I know they won't give it for long term d/t liver damage issues.

Toradol, Reglan, and/or Phenergan is the new migrane thing at our place. It has been very, very effective.
Chip