zofran vs phenergan?

[Nursetobe25]

Which do you prefer to give/ take and what do you think work better?

From people I've talked to it seems zofran is either a hit or miss with nausea especially once theyes are actively vomiting. But phenergan always seems to work quite well despite having more side effects like sedation and what not.

What do you think?

[RN403, BSN, RN]

Our go to anti-emetic is zofran. Only if pt does not get relief from zofran do we get an order for Phenergan. As a PP stated - we cannot push Phenergan. It must be diluted and given via IV pump.

[Karou]

Depends on the physician, but it's common for me to see both zofran and phenergan ordered. I personally start with zofran first and use phenergan as a second option if that does not work. However, I personally think phenergan is more effective for most patients based off of my experience administering it.

When we do administer phenergan it has to be diluted in 10cc NS and flushed after with 20cc. Can't be administered via hand/wrist access. Must be pushed slowly. I avoid it when possible but administer it when necessary.

[TriciaJ, RN]

I much preferred giving Phenergan because it worked reliably and was cheap. Zofran was very expensive at one time and hit-and-miss. Of course, if the pt was already rather sedated I just went with Zofran (or Reglan). When I did push Phenergan, I diluted it with 10 ml NS, pushed it really slowly and flushed fore and aft.

[calivianya, BSN, RN]

Perfectly nice patient: Zofran

Confused, sundowning, screaming, or violent patient: Phenergan

Oh heck, who am I kidding - if I have a choice, I give everyone Phenergan because it works well and I work night shift. It is time for bed!

[wtbcrna, MSN, DNP, CRNA]

I generally use Phenergan for people that don't respond well to Zofran. Phenergan works on multiple receptors (H1, 5HT, alpha-adernergic, muscarinic, and dopamine) where Zofran is a specific 5HT3 antagonist.

In one study Zofran and Phenergan showed equal efficacy. Ondansetron versus promethazine to treat acute undifferentiated nau... - PubMed - NCBI

Zofran has a high association with headaches (9-27%), whereas Phenergan does not list headaches as a major side-effect. I don't know for sure, but I think the reason for the high occurrence headaches associated with Zofran is due to the potential for cerebral vasodilation where typically migraine medications (i.e. imitrex) will cause cerebral vasoconstriction.

Phenergan is also one of the few anti-emetics that do not cause prolonged QT intervals, and is generally considered safe to give someone with prolonged QT syndrome.

[Loo17]

In the ED we tend to use Zofran because it has less side effects including not being sedating and preventing patients from driving home. If after a couple doses it doesn't work the providers often go to Compazine. Rarely have I given Phenergan.

[imintrouble, BSN, RN]

I've had Zofran before, and it worked like magic. I've never had Phenergan. I remember one LOL I took care of when Phenergan was IV, who'd watch the clock for her "nausea medicine" just like a drug seeker watched the clock for their high. It's a miracle we didn't blow her arm off. I personally haven't given Phenergan in years. Our docs almost never order it.

[RNLeadSS]

Interesting I have never heard of Tigan. I like 8mg of zofran instead of 4mg.

[Graduatenurse14]

I gave Zofran, Phenergan and Compazine on my last night shift.

I had to give the Compazine since she had already started to vomit. Then later in the night, felt nauseous but hadn't yet vomited so I gave the Zofran.

I gave the Phenergan to a patient who develops N & V with all PO meds and only Phenergan works. I don't think I diluted it and/or pushed slowly enough the first time as he kept complaining of burning and eventually lost that IV. I diluted like crazy and pushed really slowly on the new IV but really think like the idea that it be diluted with 50cc and run over 30 minutes. I wonder if I could ask pharmacy if they could mix that for me next time I have to give it.

[SierraBravo]

I gave the Phenergan to a patient who develops N & V with all PO meds and only Phenergan works. I don't think I diluted it and/or pushed slowly enough the first time as he kept complaining of burning and eventually lost that IV. I diluted like crazy and pushed really slowly on the new IV but really think like the idea that it be diluted with 50cc and run over 30 minutes. I wonder if I could ask pharmacy if they could mix that for me next time I have to give it.

Exactly one of the reasons why promethazine should not be pushed. And that is not to mention the potential risk of hypotension or concerns about extravasation...

[Gooselady, BSN, RN]

In my experience, Zofran 'prevents' vomiting (very simplified here, I know). It doesn't seem to do as much as Phenergan for nausea or queasiness. If a patient is actively vomiting, I give Zofran. If they are nauseated and haven't vomited yet, I give (if ordered) Reglan or Phenergan or Compazine. Zofran given on a SCHEDULE seems to help reduce nausea and vomiting, though.