IV forms of Zofran and Decadron given PO???

Editorial Team / Moderator · Feb 22, 2010

The first time I had a doc order Decadron PO, I was like, "Hold up, this says IV/IM on the vial!" But yes, it is common to mix it in some apple juice and administer it PO. We do it often, and the doc orders it that way, knowing full well what we have in our Pyxis and how we give it. No one is changing orders or routes of administration arbitrarily.

I've never seen the IV Zofran given PO, though -- we have the Zofran ODT tablets, which are fabulous!

PeachyERNurse, BSN, RN · Feb 22, 2010

Most of the time this is done with kids who do not have IV's in place who have acute airway issues (croup, wheezing, etc) or in the case of Zofran little kids with vomiting but no evidence of significant dehydration. This is especially common since Phenergan got black-boxed. It generally works like magic so no need for the further torture of needles (IV/IM) which can worsen the original issue by getting the kid to scream. You must remember this is in the ER setting not an admitted patient. Also if you've ever tasted Orapred (prednisolone suspension for kids) then you know why we don't like to give it. You can pretty much guarantee your wheezing kid will become a puking one about 5 minutes after you give it. It's nasty!!!

I actually tasted Orapred (just to see what it tasted like), and I didn't think it was bad at all. It was kinda grapey tasting:D.

I've never given IV Decadron by mouth, or even heard of doing it that way, but I have given IV Zofran by mouth when the pharmacy was out of the ODT.

tencat · Feb 22, 2010

At first I was like: "What the heck? WHY?" Then you all straightened me out! That makes so much sense if you can't get a line or don't wan to torture a kiddo. Very cool. I was edumacated today!

Editorial Team / Moderator · Feb 22, 2010

Any day I'm edumacated = a good day.

miwachiru123 · Feb 28, 2010

I was confused the first time I was asked to give IV Decadron as a PO med.

Pharmacy told me that they do actually carry a Decadron oral suspension, but the alcohol concentration is too high to give to children, and that is why we use the IV form.

SpaceCoastRN · Feb 28, 2010

This is interesting. I was faced with this at about 0400 today. I just gave Decadron IM as the pharmacist is horrible to deal with and insisted I would need to give 50 ml of the oral suspension to my 8 month old patient. No thanks.

FlyingScot, RN · Feb 28, 2010

This is interesting. I was faced with this at about 0400 today. I just gave Decadron IM as the pharmacist is horrible to deal with and insisted I would need to give 50 ml of the oral suspension to my 8 month old patient. No thanks.

That's why using the IV form orally is so nice. A little dab will do you.

Footballnut · Feb 28, 2010

I give the IV/IM forms of the drugs IV/IM. And I give the po forms po. There's enough of the right form of the drugs to go around.

FlyingScot, RN · Feb 28, 2010

I give the IV/IM forms of the drugs IV/IM. And I give the po forms po. There's enough of the right form of the drugs to go around.

Not for kids. The volume of Decadron in suspension is too much for a ped's patient. The Orapred makes them puke. Why make a kid suffer through an IM injection if you don't have to? Now with adult patients it's an entirely different story.

Footballnut · Mar 1, 2010

I knew I would be in trouble with that last post. You are right, thanks! I was thinking of the Zofran tablets anyway. They have been really easy to dissolve under almost any kid's tongue.

rph3664 · Mar 1, 2010

Have any of you ever heard or worked in an ER where they gave the IV/IM form of Zofran or Decadron PO instead?

Before Zofran came out with oral dosage forms, the injectable liquid was given PO all the time, especially to children.

We use injectable Decadron the same way too, although I've been told it tastes nasty, because they don't make the Decadron oral concentrate any more and a baby is not going to swallow 40ml of anything but milk, because that's what it takes to get 4mg which is a loading dose for epiglottitis.

rph3664 · Mar 1, 2010

This is interesting. I was faced with this at about 0400 today. I just gave Decadron IM as the pharmacist is horrible to deal with and insisted I would need to give 50 ml of the oral suspension to my 8 month old patient. No thanks.

Didn't read the whole thread before I posted a few minutes ago, but yes, that's what would have to be done since there is no longer a Decadron Intensol or whatever that brand was called.