Antiemetics

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Section 8 - MEDICATION GUIDELINES

8.09 ANTIEMETICS

Promethazine (PHENERGAN) / Antiemetic

DESCRIPTION:

  • Blocks cholinergic receptors in the vomiting center, which may mediate nausea and vomiting; competes with histamine for the H1 receptor site.

ACTION:

  • Blocks the effects of the hormone serotonin at the 5-HT3 -receptor sites (located in the vagal nerve terminals) that cause vomiting.
  • Half-life 3.5 - 5.5 hr

INDICATIONS:

  • Severe, persistent vomiting.

CONTRAINDICATIONS:

  • Coma, CNS depression, seizures, known hypersensitivity to drug

PRECAUTIONS:

  • Get as complete a history as possible before administering.
  • Using with epinephrine may result in further hypotension.
  • Using with barbiturates, tranquilizers, or alcohol may further CNS depression
  • FDA MANDATED BLACK BOX WARNING: If this medication is administered incorrectly it can cause severe skin damage up to and including gangrene. This damage may lead to amputation of the affected limb.

DOSAGE:

  • Currently supplied in 25 mg/ml vial
  • Adult (>13 y/o): 12.5 mg slow IVP, or IM.
    • Dilution is not necessary when given IM
    • IV site must be checked for patency before infusing the medication – document patent flow of the IV site on the patient care report
    • MUST be diluted in a minimum of 10 ml of normal saline when given IV
    • MUST be given through an IV line actively infusing fluids
  • Pediatric: .25-1mg/kg slow IVP, or IM.
    • Dilution is required as noted above.
    • The maximum single dose to be given must not exceed 12.5 mg
BLACK BOX WARNING

The IV (perenteral) administration of PHENERGAN (PROMETHAZINE) has a RELATIVE CONTRAINDICATION in children under 2 years of age. The provider must weigh the risk vs. benefit of PHENERGAN (PROMETHAZINE) administration based on the patient's condition.

Ondansetron Hydrochloride (ZOFRAN) / Antiemetic

DESCRIPTION:

  • This medication is used to prevent or decrease the severity of nausea and vomiting.

ACTION:

  • Blocks the effects of the hormone serotonin at the 5-HT3 -receptor sites (located in the vagal nerve terminals) that cause vomiting.
  • Half-life 3.5 - 5.5 hr

INDICATIONS:

  • Severe, persistent vomiting.

CONTRAINDICATIONS:

  • Known hypersensitivity.

PRECAUTIONS:

  • Patients with liver impairment
  • Pregnancy-Category B- Studies have revealed no evidence of impaired fertility or harm to the fetus.
  • May cause an extrapyramidal reaction.
  • Little information is available about dosage in pediatric patients under 2 years of age.

DOSAGE:

  • Currently supplied in 4mg/2ml vials and 4 mg oral disintegrating tablets (ODT)
  • Adult: 4mg slow IVP or 1 ODT tab.
    • When administering IV, consider diluting in 10-20 ml normal saline to aid in administering slowly or 4mg/2ml deep IM in a large muscle.
  • Pediatrics:
    • Premie - 8 years old - ADMINISTER 0.15 mg/kg slow IVP (mag of 4 mg)
    • 9 years and older - 4 mg slow IVP
    • For PO administration:
      • 1-3 year old – ADMINISTER ½ ODT tab
      • 4 years and older: ADMINISTER 1 ODT tab
  • NOTE: Use PO administration route for conscious patients ONLY.