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?

[Twinmom06, ASN, APN]

I work on a chemo floor and rarely see phenergan ordered - when the Zofran doesn't work most of our docs write for Compazine which seems to provide much relief

[KelRN215, BSN, RN]

I think I can count on one hand the number of times I've given phenergan in pediatrics. Zofran is our go to antiemetic, followed by reglan (often in combination with benadryl), ativan and then marinol. Sometimes aprepitant for the kids who had really difficult to control nausea.

[VANurse2010]

From my own observational/anecdotal/personal experience opinion, Phenergan is much more effective once active vomiting is happening.

[Caffeine_IV]

Depends on the person. I've used both orally during pregnancy and preferred the zofran because I don't prefer meds that make me sleepy.

I think rotating them works well for patients and I've actually given the phenergan via suppository with good relief.

[applewhitern, BSN, RN]

My hospital's policy is that we have to give Zofran first; it Zofran doesn't work, we can give Phenergan. However, we have to mix it in a 50cc bag of NS and give it over 30 min! They will not let us push it, even though I have pushed it for many years at other facilities.

[sissiesmama, ASN, RN]

Zofran does squat for my nausea.

Me too. I have to go with Phenergan to get. Relief from n/v. Due to my medical Hx - s/p MI and stroke, multiple cardiac caths I have been in the hospital quite a few times.

Anne, RNC

[Kaltia]

Zofran as first line. it works for alot of people. Pherengan as back up, I find its more it or miss than zofran but for the few that zofran doesn't work for, phenergan usually works beautifully.

[NurseGirl525, ASN, RN]

As someone who has suffered from gastropariesis, I have a little experience with this. Zofran does absolutely nothing for me. Never has. I had a weird reaction with Reglan. Made me fall asleep almost immediately and then I was up for 72 hours straight. Phenergan did work for me a little when I had gastro. But I had to take a high dose and it did make me very sleepy. To me there is nothing worse than nausea and vomiting so having gastro was not fun for me. My gastro went away as mysteriously as it came on when I became pregnant with my son. I still to this day though get nausea very easily. I have gone to Benadryl. It has honestly worked the quickest and best. It usually works for me within 20 minutes and I do not build a tolerance to it. It also does not make me sleepy. Plus, I don't have to bug a doc when I am nauseated.

[ChristineN, BSN, RN]

My hospital's policy is that we have to give Zofran first; it Zofran doesn't work, we can give Phenergan. However, we have to mix it in a 50cc bag of NS and give it over 30 min! They will not let us push it, even though I have pushed it for many years at other facilities.

Yes, other facilities may allow it, but your current facility is obviously more concerned with the risk of extravasation from Phenergan which is definitely something to avoid

[SierraBravo]

I agree with what others have said, it is completely dependent on the patient. Some will respond to Zofran, some won't. Some will respond to Phenergan, some won't.

Phenergan and Compazine are in the same class of drugs, so you wouldn't want to give both as it can increase the odds of the patient having EPS. Plus, phenergan is definitely sedating.

Obviously Zofran and Phenergan work in completely different ways. One thing to keep in mind, Zofran can prolong the QT interval, so when was your patient's last EKG? And what was their QTC?

We use Zofran, Phenergan, and low dose Ativan for nausea. For intractable nausea, Marinol is also an option. I've also seen Kytril, dexamethasone, and Aprepitant used for nausea. Of course, Kytril and Zofran are in the same class of drugs, so you don't want to use both at the same time.

[Esme12, ASN, BSN, RN]

You are a teacher thinking about being a nurse...have you experienced the need for Zofran over phenergan?

When you become a nurse you will have little choice what antiemetic is administered and they are all not effective in controlling vomiting patients.

[klone, MSN, RN]

Zofran is no longer recommended as a first-line antiemetic in pregnancy, especially in the first trimester.

Our OB providers are getting away from using it, and instead recommend Vitamin B6 and Unisom. (which can also be found together as one medication under the trade name Diclegis). If that doesn't work, we will recommend compazine, Reglan, and/or phenergan PR.