Treatment for uncontrolled N/V post chemo

[MillieT]

I have a heartbreaking patient who has uncontrolled N/V for 2 weeks + post chemo. She was on Zofran 8mg TID and up to 25mg phenergan IV every 4hrs prn, which I gave 12.5mg-25mg IV every 4hrs and one dose of Compazine 5mg. She was neutropenic, febrile, confused with possible hallucinations, tremors, hpotensive and then developed rigors after 4 episodes of intense vomiting. After getting home, I wondered if the confusion, tremors, rigor and possibly the low BP could of been from the phenergan, so I started researching protocols for N/V treatment. If so phenergan sucks.

I found that the most common regimen online was Zofran, Emend and dexamethosone. Does anyone else use Emend and dexamethosone regularly? Is it effective? Is there a reason dexamethasone couldn't be used in neutropenic pts (I know it can be immunosuppressive at higher doses)?

Thanks for any info, I want to be able to suggest other options if this happens again.

[tewdles, RN]

we pre med with IV aloxi, benadryl, zofran and ativan. We have had a lot of luck using IV emend for pt's with really severe post chemo nausea. The only down side is its a bit** to get the ins. companies to pay for it. Sancuso patches have worked very well too for at home management when Zofran or compazine isnt enough.

I get aloxi and will receive emend on Saturday when my chemo is disconnected. I think both work pretty well, at least for me and I am having a good deal of N/V/D side effects from the prescribed course.

[wtbcrna, MSN, DNP, CRNA]

Have you tried scopolamine patches?

Droperidol is still one of the most effective anti-emectics and despite the black box warning low dose/0.625mg is very safe and probably safer at those doses than Zofran or other 5ht3 antagonists.

[tewdles, RN]

I am thinking about scop patches, the oxali makes me so dizzy that I wonder if it would work for some of that nausea. I just don't relish the thought of the dry mouth that will come with it.

[kids]

When my mom was undergoing chemo she would have episodes of n/v that were unphased by antiemetics. A low dose of ativan coupled with decadron Q4 hours x3 stopped it cold every time.

I hate, hate Compazine, in my experience it really isn't that effective for n/v and causes so much confusion in older people.

[OCNRN63, RN]

We use Dex and Zofran or Dex and Aloxi; Emend is added if the regimen is highly emetogenic. Some pts. pre-med several days before with Decadron. We also sometimes use Ativan if the pt is very sensitive.