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For a while, I’d been running under EMS protocols that allowed promethazine (Phenergan) for nausea.  Then, someone got wind of all the bad things that could happen if the drug got injected into a bad IV, and it was heavily restricted before ultimately being pulled in favor of ondansetron (Zofran).

I’m pretty much in favor of the change, primarily because you’re less likely to see extrapyramidal twitching using ondansetron, which in turn was said to be less likely in promethazine than in droperidol, which was the first anti-nausea drug I’d been allowed to use.  (Admittedly, I never understood why skin necrosis seemed to be the reason for the switch, since D50 is actually even worse, and we haven’t replaced that with D10 yet.  It probably has more to do with the fact that the Zofran people’s patent expired in 2006.)

Of course, the ultimate question is:  does the newer stuff work as well as the older stuff?  Ondansetron was mostly studied in cancer patients, so its use in emergency settings was kind of an extrapolation from that data, but the good news is that 4mg of it seems to work just as well as 25mg of promethazine, with fewer side effects.  It’s still a bit more expensive ($15.50/dose vs. $2.67 for promethazine), but still much cheaper than just a few years ago–and probably cheaper overall than dealing with the effects of a single bad injection of phenergan.

Filed under: EMS Research