Zofran ODT in kids

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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.

Specializes in Emergency, outpatient.

In Hawaii, we use it in our ED constantly, both for adults and children. Our docs also work the regional childrens hospital, and they prescribe it routinely. We break ODT tabs all the time.

As for "off-label" usage, it is very definitely not a problem with our physicians or our insurance companies. I have not had a call from a pt re high cost of Zofran here in the last year. When I worked in SC, occasionally we would get a call from pts and pharmacies complaining about the cost. Maybe the insurance companies got over it. Personally I would much rather use and administer Zofran.

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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.

I am an Maternal-Child Health home care nurse, and I frequently have seen Zofran (usually generic) used with young children-the youngest is 7 months old. I've been seeing it used in my area in children for about a year, I'd say. If the child is a toddler, they get 2 mg (1/2 a pill). My 7 month old client actually has it in liquid form. Out of the *currently* 6 children I have right now in my caseload, only one of them is on a chemotherapeutic drug-and she's actually on it for a clinical trial for a heart condition, not cancer.

I can't speak for what your pediatrician will or won't do-sometimes they have a reason, and sometimes it's because they aren't comfrotable with it because of the fairly new status of it's use with children.

Good luck! I hope she feels better soon-it's so hard to watch them suffer.

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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.

I also forgot to mention in my previous post, I also take Zofran ODT myself, and have never had it questioned by my insurance. I have many mendical issues, but thankfully cancer is not one of them, and I am not on chemo. I was actually initially prescribed Zofran because I have multiple kidney stones and when they occur (way to often!) I vomit uncontrollably. I also have CRPS, and sometimes the pain from this will make me vomit.

Rather than vomiting every day, my nephrologist ordered Zofran. Compazine orally was a waste of time-I threw it up. Compazine and Tigan suppositories, the indignity aside, burned dreadfully, so it only added another discomfort. My doc told me that the ODT was actually the most effective because even swallowing a pill can induce vomiting in someone very nauseated. I also have Zofran in it's regular form-I much prefer the ODT.

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Specializes in Pediatrics, Nursing Education.

Phenergan is black boxed, not zofran.

We gave it in peds all the time.

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Specializes in Pediatrics, Nursing Education.

i also took zofran "off label" from the chemo association. i took it for hyperemesis during my pregnancy. it worked wonderfully, but it was very expensive. finally i got an override from my insurance company, because they only allowed 8-10 pills a month. i finally got it so i could take it daily, as i was loosing so much weight and it was the ONLY thing that would allow me to function or get out of bed without puking up my guts!!

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Specializes in Emergency.

Zofran does not carry a black-box warning for children. It is approved for use in children as young as 2 yrs old and we snap the ODT in half to give to the child - it also comes in a strawberrry-flavored liquid.

Lots of medications are being used off-label. Why should the makers of zofran pay for more research studies when their patent is now expired? It is approved for chemotherapy-induced nausea/vomiting and post-op nausea/vomiting. Its also being studied as a treatment for alcoholics.

Despite zofran not being indicated for general nausea/vomiting, we often premedicate all our pts with zofran prior to giving strong IV pain meds. From experience, I've seen patients tolerate zofran very well.

Most docs want to see a sick child prior to giving antiemetics because they can dehydrate quickly, or there could also be another reason for their nausea/vomiting. Zofran ODT and po fluid challenge in peds is a great alternative to placing an IV and running fluids- but that's if the child is stable enough (hypotensive, dry tears, decreased urine output, lethargic, etc need more aggressive treatment and zofran ODT won't cut it).

Generic zofran ODT runs around $20 per tablet.

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Food "poisoning" is an infectious process. I agree that Zofran should not be used routinely for gastrointestinal illness, most cases are self limiting--vomiting for 8-12 hours then symptoms begin to resolve.

If the child truly has not had anything to drink for 24 hours, has continued to vomit and is also running a fever then they probably need medical evaluation for dehydration and also the illness involved.

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Specializes in ER.

I work in a Peds ER and we give it. I would not have survived my forst trimester of pregnancy without zofran ODT, it worked quik and I was not sleepy liek with phenergan. We do break them in half alot.

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Specializes in ER/EHR Trainer.

Insurance companies know exactly what zofran does...we use it all the time. I am sorry but any pediatrician that would make a child suffer when there was a solution would not be my pediatrician any longer.

The patent was released during the past year, and this wonderful medicine has been made available for general use. Adults, pregnant hyperemesis, whatever....why should anyone feel miserable?

The only off label use we get is for adults using the disintegrating tabs....pharmacy and pediatrics are constantly saying we shouldn't be using in our adult patients-no evidence that they work...sorry, if it works, it works. I don't care if the tab is $8, we are going to charge them a fortune for using the ER, the least we can do is make them feel better.

Maisy

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We very seldom give phenergan anymore for nausea, way to many side effects. Yes, we do give zofran po to small children. We also cut it in half. It works great, no needles for the little ones and frequently they can hold down popsicles within 30 minutes of recieving the med!! It is expensive, but if you can afford it why not!

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Specializes in ED, Tele, Med/surg, Psych, correctional.

The following study appeared in the Annals of Emergency Medicine:

    The Role of Oral Ondansetron in Children With Vomiting as a Result of Acute Gastritis/Gastroenteritis Who Have Failed Oral Rehydration Therapy: A Randomized Controlled Trial . Annals of Emergency Medicine , Volume 52 , Issue 1 , Pages 22 - 29.e6G . Roslund , T . Hepps , K . McQuillen
    In subjects with acute gastritis/acute gastroenteritis and mild to moderate dehydration who failed initial oral rehydration therapy, the proportion of children who received intravenous hydration was smaller in the ondansetron group than in the placebo group.

    As a result, the recommendation was to give Zofran ODT and slowly rehydrate with po fluids.

    You should show this to your pediatrician who clearly needs to read up on the most-up-to-date studies and recommendations.
    Evidence based practice!!!!


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Specializes in OB, ER.

Thank you so much for the article, that is perfect. I will definatly show that to my doctor. Thanks a lot!!

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