Benadryl use with Dilaudid.. just curious!

[mandaaRN]

Just trying to learn about the use of Benadryl and Dilaudid.

Is benadryl usually given before Dilaudid or after? And why is it used with Dilaudid?

I know itchy skin can be a side effect, but what are some other alternative nursing interventions to relieve itching?

Thanks so much!

[Ozzybear]

I've never heard of Narcan being indicated for itching..as I understood it Narcan is an opioid reversal..can you explain to me the purpose of Narcan being dripped with a Pca? Seems to me that the Narcan would cancel the effects of the PCA..I'm confused.

Narcan in low doses via IV drip along with a PCA will not diminish the opioid effects of the drug but the side effects such as pruritis and N/V

[azhiker96, BSN, RN]

Nubain in low doses is good for pruritis associated with spinals. Larger doses will reverse the analgesic effects though so you must titrate it slowly.

[JessiekRN]

Narcan in low doses via IV drip along with a PCA will not diminish the opioid effects of the drug but the side effects such as pruritis and N/V

Thank you..I had never heard of this or seen it in practice..thanks!!

[Munch]

I remember being hospitalized for 10 days this was a couple of weeks after my brain surgery and I had a Dilaudid PCA up until the minute before I was discharged(the PCA was at a pretty high dose too being a pain management patient I had/still do have a high tolerance. Anyway before they hooked up the PCA(the morning after I was admitted they were waiting for anesthesia to come in since they were in charge of my pain management). So before the PCA came I was on 1mg dilaudid IVPQ2hrs plus 60mgs of MS contin TID. The hospital didn't have the long acting narcotic I was taking at home so they put me on the MScontin as a substitute..the first dose about an hour into it I started breaking out and I was itching like crazy. They gave me solu-medrol through my IV and it worked like a charm. Just one dose made worked like a charm and it didn't have any mind altering side effects.

[ICU_RN2]

I've never heard of using narcan for itching either! And I worked on a med surg floor with a tonnn of PCA usage! Great to know! Thanks!

[rn/writer, RN]

Our post-axial anesthesia orders for itching usually call for Benadryl as the first choice, Nubain or Narcan as a second choice if the Benadryl is ineffective, and Narcan or Nubain as the third choice, depending on which one was ordered second.

As Ozzybear mentioned, the doses of the opiate antagonists are small--just enough to take the edge off the itching without losing the analgesic effect.

I'd say the Benadryl by itself does the trick about 75% of the time.

[luvmyhubbybunches]

We have plenty that come through ER that want their 3 drugs of choice-Dilaudid, Phenergan and Benadryl. I give all three together and trust me, they will ask me, "does that have my Benadryl in it?" and I smile and say "of course it does." Then, I bite my tongue to keep from saying the rest of what I really want to say!!!

[Creamsoda, ASN, RN]

I thought Benadryl with Dilaudid was just to increase the high

Hahahaha, don't forget the phenergan!

[PeepnBiscuitsRN]

I was told a couple of times that the Benadryl was to increase a "high". We get a lot of people with drug seeking behaviors, and the only thing they want is Dilaudid, and they know the exact dose, and are on the call light at the EXACT time it's due. I had a nurse tell me that there was a patent who was a frequent flyer who basically was discharged, and walked out the west doors, and right back (literally) in the ER doors, and wanted wanted "my 1 mg of IV Dilaudid. and my 50mg of Benadryl...now."

I recently had a patient who basically had a temper tantrum with the evening nurse because the nurse offered him something else for pain (like Percocet or Vicodin) and basically raged because he wanted the IV Dilaudid. Didn't even want the PO Dilaudid or the PO Benadryl- just IV.

But, I remember during labor with my son, I had an intrathecal (unsure about the spelling) narcotic to take the edge off, and I itched so bad I literally gouged my face up. There's pictures of me with gouge marks all over my face. Only after I finally had the section did they give me Benadryl, and I was one happy mama after that...lemmie tell you!

[rjflyn, ASN, RN]

Of course there now is a national shortage of injectable Benadryl, so the truly in need wont complain when you offer oral meds. The ones who will complain will be the ones who solely want it more for the high than anything else.

[kids]

I don't worry too much about my PCA c-section PCA patients getting high. Besides, I give the Benadryl s-l-o-w-l-y. You know what they're after when they ask you to push it fast.

IV Benedryl feels so awful I can't imagine wanting it fast. I'd think it would kill a buzz more than augment it .

[Justin.Heshizer]

Yes, Phenergan works well for itching. I have used it in place of Benadryl on multiple occasions. Most of the time I am told it worked better than Benadryl for itching. So try it out one day and see if it works for your patients.