What is the better antiemetic zofran or phenergan?

[Infofreak411]

It seems Zofran is the standard antiemetic choice these days for multiple implications (ie post op nausea, opioid administration etc) and while it seems to work amazingly for some people it seems to be a hit or miss for others. Sometimes it works others it doesn't.

Phenergan on the other hand despite issues with it causes intense sedation, mild akathisia and burning on injection seems to be the "golden ticket" in terms of anti-emetics and rarely seems to fail to do its job unless the etiology of vomiting is unknown and requires multiple antiemetics that hit multiple targets in the brain.

What is your opinion?

[loriangel14, RN]

I find it depends on the patient. What works well for one may not work for another.I don't think there is a "best" medication.

[Whispera, MSN, RN]

I object to Phenergan, since the akathisia and other EPS symptoms can be more than mild... It's fine unless those symptoms develop. Then something else should be used.

[iheartnursingu]

I think it's pretty patient dependent. I know personally, Phenergan does nothing but make me tired, where as Zofran gives me relief from nausea really quickly. Phenergan is a lot cheaper than Zofran though (which may matter for some).

[~PedsRN~, BSN, RN]

I took zofran back in the olden days before it's patent ran out and the generic became available. :) My OB gave it to me for hyperemesis when I was pregnant with my first daughter (who is now 15 years old!) - back then it's uses outside of the cancer/chemo world were still experimental. Back then my doc told me that the more you used it, the less it worked. It turned out to be true.... the first pregnancy it was a life saver, the second not so much, the third hospitalized me three times.

I see this is true in some of my patients... the more chronic kids that use zofran repeatedly often get stuck in vomit mode and it takes a good dose of phenergan to knock it off. But those kids that are there post lap appy that feel a little sick from the anesthesia? Works like a charm.

[scottaprn]

Evidence shows that the outcome at 30 minutes after administration the outcome between zofran and phenergan are equal for relief of nausea.

For prophylactic administration zofran has better numbers.

Zofran has safer side effect profile.

Since they have the same efficacy I write more zofran unless I think that the sedation that phenergan provides would be therapeutic.

[T-Bird78]

They both help me, but I'll opt for zofran if I have to function and get out of bed that day, phenergan if I need sleep too. I was on both plus reglan around the clock with my pregnancy (orally) and that round-the-clock regimen still didn't help the hyperemesis, but the zofran subuc pump finally got it under control (with oral meclazine added). After the pump was d/c I was oral zofran daily until the day after I delivered my baby. I've noticed more MDs are rx zofran for a stomach virus, including the pediatrician, especially the ODT zofran.

[~PedsRN~, BSN, RN]

They both help me, but I'll opt for zofran if I have to function and get out of bed that day, phenergan if I need sleep too. I was on both plus reglan around the clock with my pregnancy (orally) and that round-the-clock regimen still didn't help the hyperemesis, but the zofran subuc pump finally got it under control (with oral meclazine added). After the pump was d/c I was oral zofran daily until the day after I delivered my baby. I've noticed more MDs are rx zofran for a stomach virus, including the pediatrician, especially the ODT zofran.

I have BTDT with the pump. It was the only thing that made my third pregnancy survivable. :)

I often wonder if we don't *think* phenergan works better because it just knocks people the hell out.

[RunBabyRN]

In my limited experience, I've seen better relief with phenergan, and I've never seen any SEs except for sedation (not that I don't think they can happen). I've had to give more repeat doses of Zofran to patients than phenergan. When I was in the Navy, we always gave phenergan, never Zofran. But then, we also did Toradol injections all the time as well.

My husband and father-in-law both have medical conditions that require antiemetics be kept on-hand, and we prefer phenergan for this. We actually were able to get a transdermal gel compounded, which is certainly less invasive than an injection or suppository (since it's not like they're SL all the time), and is less likely to come back up than a PO version.

[TheGooch]

Zofran does squat for my nausea.

[annie.rn]

Professionally I give lots of Zofran and it seems to work just as well as Phenergan (obviously not scientific evidence so don't base your practice off of that :-) ). Personally, I dislike Phenergan for it's pain in the butt administration (I.V. is most often how I have given it) and it's SE profile (especially in elderly population). One of the worst nursing shifts of my career which I still remember twenty years later like it was yesterday was a not too old LOL who went absolutely bonkers after 12.5mg I.V. Found her butt naked, completely disoriented and hallucinating. I try not to give it to the elderly if I can help it unless they've had it before and know how they react.

Personally, I've only taken Phenergan once or twice and can't remember too much how it worked but I have had great relief from Zofran when I have taken it.

[Karou]

My patients seem to get better, more consistent relief with phenergan. That being said, I avoid it when possible. As a once or twice time order it seems fine but many of my patients come in with chronic abdominal pain + nausea and the repeated administrations make me nervous. We are not allowed to give it via hand or wrist access, must dilute with 10cc NS and follow with 20cc flush. Our providers prefer to order zofran unless there is an allergy. We have had so many chronic pain/nausea patients with chronic blowing IV's that require midlines\PICCS after their veins are ruined by phenergan. Also has one awful case of infiltration where we had the patient years later with the scars.