Zofran and our n/v protocol. Can someone explain?

[fiznat]

We recently got Zofran added to our nausea/vomiting protocol here. I will attach a copy of it below. Zofran seems to be restricted to last-line, only AFTER Phenergan (or Reglan, which my company does not stock) has already been attempted, or if the patient is allergic/reactive to Phenergan.

Everything I have heard and everything I read says that Phenergan is a dirty drug with lots of unwanted side effects, potential danger, etc etc. I know that Zofran is often used for prophylaxis against n/v only, but still I think it is pretty common for symptom relief as well. It seems odd to put Zofran all the way at the bottom, only after another (more dangerous?) drug has been tried or contraindicated.

I will of course ask our medcon docs when I get a chance, but can anyone offer any insight or idea as to why our protocol is written like this?

[ERDoc]

Phenergan is not as evil as it is made out to be. It has gotten a bad rap, just like droperidol. Sure it can cause problems but I think it has been overhyped. Zofran may be last resort because of the cost. IV Zofran can be pretty expensive.

[Doczilla]

IV Zofran is now generic, and is as cheap as Phenergan. We are replacing Phenergan entirely with Zofran in our drug bags.

'zilla

[ERDoc]

IV Zofran is now generic, and is as cheap as Phenergan. We are replacing Phenergan entirely with Zofran in our drug bags.

'zilla

Guess someone needs to let my hospital know this. We keep getting happy grams reminding us not to use IV Zofran due to the costs. Guess that's what happens when beancounters are allowed to get involved with pt care. Either that or maybe we are finishing up our supply of brand name Zofran and the hospital doesn't want to lose the money.

[AZCEP]

Could the cost issues be due to insurance companies not wanting to include Zofran in their formulary?

This is the message we've gotten several times as to why we do not have the option.

[JakeEMTP]

I'm not completely sure of the dates, next month I think, Zofran will be added to our protocols. I don't think Phenergan is being taken out completely, rather is being left in as an alternative. From what I understand, Zofran is to be a front line drug with Phenergan being secondary.

The Medical Director's update is in 2 weeks. I'll let you know what his plan is.

[Doczilla]

Whether formulary or not, the generic injectable form is just under $2 per 4mg vial retail. The oral dissolving tablets are still pretty pricey, even generic.

'zilla

[Spock]

Before Zofran went generic (ondansetron) we also got the happy grams reminding us of the cost when we used it in the OR. Now it is so cheap just about every patient getting a general anesthetic gets Zofran for nausea prophylaxis.

I can't see any reason why you would give phenergan before Zofran. Zofran is more effective and has fewer side effects. Maybe your command system is still paying the brand name cost.

Live long and prosper.

Spock

[fiznat]

I don't think it has very much to do with cost. The people who put together our protocols are entirely separate from the people who write the checks to pay for the drugs. Our protocols are designed by regional doctors for use by a large number of separate ambulance companies operating within a specific part of the state. Even still, the protocol only partially dictates what we must by- evidenced by the fact that we don't carry Reglan even though it is in the flowchart above.

[1EMT-P]

We shouldn't throw the baby ( Phenergan ) out with the bath water just because a few providers did not know how to properly administer the medication, instead we should educate providers on the medication and on the proper administration of the medication.

Zofran is a good medication, but is it going to work at preventing and/or treating motion sickness?