50 mg of Phenergan IV push!!!!!!!!!

Unless used for sedation, the maximum recommended amount for phenergan via the IV route is 25 mg. I've had enough experience to know that 25 mg IV can knock a person into la la land for a good long time, depress their respiratory and other generally unpleasant things. It's useless as a pain medication, it does not "potentiate" anything... all it does is sedate the patient and prevent them from being able to receive any other narcotic pain reliever, again due to it's sedative effect.

IM is not a route to be used for routine pain medications as it is generally unreliable with regards to absorption.

I would think a long acting oral medication, along with an antiinflammatory and possibly a second shorter acting narcotic for breakthrough pain would be preferable to IV medication... definitely preferable to IM anything.

Good for you to notice how inappropriate this order is, not to mention painful for the patient!

(btw... I was thinking exactly what you were, Canoehead..."graduated from morphine to demerol" )

I had a neurosurgery patient a while back that had an infected VP shunt and was getting 150mg Demerol q 2!!!!!!!!!!!!!!!!!!!!!! I mean count the like 50 things wrong with this picture :\

my research says phenergan 50 IV is for sedation purposes, although it can be given IM 50mg for other purposes. i can't imagine giving that q4 through an IV. poor thing.
zofran is my favorite, seems like it works every time, but i hear it is very expensive.
I agree with the other poster that said to hang the 50mg phenergan in a bag piggyback.
thanks for allowing me to do some research, hope you find your answer,i know i've learned something. xoxo Jen

We NEVER NEVER NEVER give Phenergan IV here. One of the hospitals I worked ER at had a massive lawsuit with a lady who lost 2 fingers, part of her hand and much tissue loss from the forearm. I tooke care of her later as an ER patient also so I know she is not a myth. Seeing the damage that this woman sustained made me understand why Phenergan in an IM only medication.

nursenatalie...funny that when I worked in NC that was the pain control choice-Demerol and Phenergan. I haven't given Demerol in the 2 years that I have been gone. Thanks for the trip down memory lane!!! Things never change in good ol' NC.

Had a pt with crappy veins who was getting 25 mg Phenergan q 6 hrs. Even diluted, it about killed her with the pain. Anyway, she refused any more and we had to restart the IV because everything else was giving her pain through the IV. Called the MD and he okayed Phenergan supp.

I'm surprised at how the hospital nracotic protocols differ from place to place.I
know that no more than 50 mg demerol is pushed and if the doctor orders 75 mg iv, its piggybacked. 25 mg seems to be too small a dose to do anything. My 2 cents. I'm no nurse yet but that's what my friends tell me and my experience. Anyone have experience with Gravol IV? THAT burns !!!!!!!!!

Yikes! That guy needed a PICC in a bad way.

As far as Phenergan goes, it is my favorite antiemetic. (Also love Vistaril and occassionally thorazine) Why, you may ask? The potentiation theory seems to have been debunked recently, but Phenergan is VERY sedating. I have found that 2mg hydromorphone/25 mg promethazine or 20 mg nalbuphine/25 mg promethazine will put someone to sleep real quick, and many of my patients seem to appreciate that. If someone is asleep, they are not feeling pain. So I think it does lessen pain in a sense.

I will occassionally use high dose Phenergan and some brevital sodium in the ER for "conscious sedation" procedures, but generally not as an adjunct to analgesia.

Now on another note... isn't Toradol just a glorious drug? Between using that and Nubain, my orders for controlled substances are probably half of what they would be otherwise.

My mental chart for pain relief is as follows:

Muskuloskeletal: Toradol or Nubain, Morphine for severe fractures.
Visceral: Diluadid
Chest Pain: MS (occassionally Nubain)
Pain with possible hemodynamic instability: Fentanyl
Headache: Toradol or Nubain

I always give Phenergan with Nubain because I have found that it can cause some dysphoria in some patients due to its selective action on kappa opiod receptors. Phenergan pretty much prevents the problem.

Another little side note... I cannot order Schedule II controlled substances, but I can administer them myself under standing orders from the my supervising physician(s).

-James