Zofran ODT in kids

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Specializes in OB, ER.

Does your ER give Zofran to young kids? We do all the time to as young as two year olds. Sometimes we cut them in half.

The reason I'm asking is that my four year old is sick and I called her Pediatrician to see if they would call in some Zofran for her. They refused. They said it is black boxed for kids and they would not do it. I got the good old fluids and rest speech. I know all of that but I also know zofran would allow her to drink fluids without puking every hour. The poor girl is miserable and they won't give me something to maker her feel better.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Zofran is not black-boxed. Phenergan is for children under two. In all likelihood they wouldn't prescribe it because insurance likely won't pay for it for an "off-label" use and it is really expensive.

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FlyingScot said:
Zofran is not black-boxed. Phenergan is for children under two. In all likelihood they wouldn't prescribe it because insurance likely won't pay for it for an "off-label" use and it is really expensive.

hmm isnt zofran an antiemetic? if so how is this off label....and giving liquids to an actively vomiting child???? isnt this asking for electolyte imbalance......???

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FlyingScot said:
Zofran is not black-boxed. Phenergan is for children under two. In all likelihood they wouldn't prescribe it because insurance likely won't pay for it for an "off-label" use and it is really expensive.

Zofran, ODT and other dosage forms, is available generically and is not very expensive.

IMHO, using Zofran for a child with a stomach virus is like using an elephant gun to swat a fly. If the child needs to go to the ER, that's another story.

And if what she has is actually food poisoning, antiemetics are the worst thing you can do because nasty as it is, there's a reason why she's vomiting - something's in there that shouldn't be.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
morte said:
hmm isnt zofran an antiemetic? if so how is this off label....and giving liquids to an actively vomiting child???? isnt this asking for electolyte imbalance......???

Zofran's official use is for nausea/vomiting related to chemotherapy. Using it as a general anti-emetic is considered "off-label" and many insurance companies will not pay for it. Of course we all know that it is frequently used in this manner because it has far fewer risks than Phenergan.

As far as fluids in an actively vomiting child as long as you aren't forcing them to chug a "Big Gulp" every hour there shouldn't be a problem. In our ER we recommend a half an ounce (adjust as needed for child's weight)every 10 to 15 minutes around the clock. If the child can keep it down for 5 minutes that half an ounce will have passed the Pylorus and whatever they are puking up is just stomach acid. That's just how we do it here. I'm sure there are many other ideas on what is the right way to hydrate a vomiting child.

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Specializes in OB, ER.

I don't understand why you are saying zofran for vomiting is off label?

She doesn't have food poisoning she is just sick with a fever and vomiting. I would love to give her something so she can drink, stay hydrated, and avoid the ER. She hasn't had anything to eat or drink in about 24 hours and she has vomited numerous times. She is miserable! I think a little zofran would prevent dehydration and would make her feel so much better!

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bjaeram said:
I don't understand why you are saying zofran for vomiting is off label?

She doesn't have food poisoning she is just sick with a fever and vomiting. I would love to give her something so she can drink, stay hydrated, and avoid the ER. She hasn't had anything to eat or drink in about 24 hours and she has vomited numerous times. She is miserable! I think a little zofran would prevent dehydration and would make her feel so much better!

reread , he/she stated "it is for N/V from CHEMO" anything else is off label....

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Specializes in OB, ER.
morte said:
reread , he/she stated "it is for N/V from CHEMO" anything else is off label....

I think she was posting the same time I was. Original post did not say that. I recieved it when I was pregnant and puking and it was not questioned then. I guess I didn't realize it was labeled for chemo only.

Still they didn't refuse because of insurance/payment they were saying it wasn't safe for young children. I'm just curious if other ERs prescribe it or if maybe we shouldn't be. Like I say we give it all the time to the little vomiters that come it.

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bjaeram said:
I think she was posting the same time I was. Original post did not say that. I recieved it when I was pregnant and puking and it was not questioned then. I guess I didn't realize it was labeled for chemo only.

Still they didn't refuse because of insurance/payment they were saying it wasn't safe for young children. I'm just curious if other ERs prescribe it or if maybe we shouldn't be. Like I say we give it all the time to the little vomiters that come it.

ahh, sorry about that, should have checked the times......instead of assuming....lol....it would seem they (your pedi office) needs some education.....good luck

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Your doctor's office is confused. It is Phenergan that is not safe for children. Your ER's use of it is just fine. Many pediatric hospitals are using it now.

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Specializes in Rural Health.

I think I would call the doctors office back and ask them just where exactly the literature came from saying it wasn't safe for children. Then I would ask them to call some in for me.

Zofran is great stuff for kids. They take it well, it usually works in 1-2 doses.

I hope your baby starts to feel better soon!!!

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Specializes in ED.

We give it to children probably more frequently than phenergan. If its a 4mg ODT I have cut it as far as 1/4 to give to a small child.

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