queston on zofran

[link51411]

I recently went from a level 1 neuro icu to a general icu in a midsized county hospital. the other day i gave my charge nurse an update on my pt that i was having to give zofran q3h today so doc told me to try phen and if that doesnt work place a ng and put it on suction. she said dont ever give zofran any quicker than q4h very seriously.

my queston comes to how often can you safely give zofran. in the NICU we used to drop 8mg on top of each other and i even saw 12mg given very close to each other. so i didnt think anything of giving 8mg in a 3hr time perioud as long as i let the md know so he/she could decide if there was anything else going on in the GI.

[caroladybelle, BSN, RN]

I work onco. Zofran 4mg Q4-6hrs PRN, or 8mg q8 - 12hrs PRN, is what we usually give. And during chemo it is given scheduled.

Zofran given in large frequent amts can cause cardiac issues/ekg changes , as well as occasionally HA.

And quite bluntly, if Q4 or Q6 hour dosing as listed above does not work, they need to try a different drug.. I've never seen it given Q3 in any reputable Onco center - they would change to another drug or add a different drug that can be combined.

[detroitdano]

Our standard is 4 mg IV Q6H PRN.

Zofran can cause the seizure threshold to drop, and it is capable of causing cardiac arrest.

[Perpetual Student]

I wouldn't hesitate to give a second 4mg shortly after a prior dose (assuming it's ordered), but if that's not really working it's time to switch to something else. It's not too uncommon for periop patients to get 8mg of Zofran in the space of an hour or two, but if the second dose doesn't work something else is tried (often Reglan or Inapsine).

[link51411]

thanks that answers my queston. its so interesting for me to see the way differant hospitals work. where i used to work an anesthesia resident told me that they used to give zofran vial after vial till it worked in the OR. but i guess they could be alot more agressive there because all of our pts were on invasive monitoring where here they arnt.

[MLB55]

Pt that came from the ED to our ICU coded three times after receiving high doses of zofran in a short time (per the cards note)

Like everybody else. After two doses, try something else.

[meandragonbrett]

You eventually reach a threshold with Zofran where giving more is not going to fix your problem. Zofran is a fantastic drug to use as prophylaxis for N/V but it is NOT a good rescue drug.

[CRNA1982]

thanks that answers my queston. its so interesting for me to see the way differant hospitals work. where i used to work an anesthesia resident told me that they used to give zofran vial after vial till it worked in the OR. but i guess they could be alot more agressive there because all of our pts were on invasive monitoring where here they arnt.

Hmm......This is not typical. No need to give vial after vial of zofran. For anti-emetic prophylaxis, we typically give a combination of 3 or more different drugs that each hit a different receptor in the chemotactic trigger zone of the brain. For example, zofran 4 mg (Seratonin), Benadryl 12-25 mg (H2), Droperidol 1.25 mg (D2) or Decadron 4-8 mg. Most anesthesia practitioners do not see pts. getting sick in the O.R....they usually get sick in PACU.

[rgroyer1RNBSN, BSN, RN]

We go with 4-8 mg q6-8h and if that doesnt work we usually end up giving compazine, phenergan, and or benadryl. Inapsine is wonderful to but it can cause pts. to get anxious and jumpy, we usually end up giving benadryl with inapsine.