Nausea is one of the more common complaints voiced by patients, whether acutely ill or dealing with chronic conditions such as cancer-related treatments and gastrointestinal disorders. Numerous medications are currently available for treating this uncomfortable situation, several of which are routinely utilized by advanced life support EMS personnel.
Promethazine (Phenergan)
Promethazine, commonly known as Phenergan, is one of the most popular anti-emetics (anti-nausea) medications currently utilized in both the emergency and non-emergency settings. It is most often given for nausea, but can be administered for sedation and motion sickness or to treat coughing and allergic reactions. For the latter indications, it is often given subsequent to other complaint-specific medications. Promethazine competitively blocks histamine H1 receptors, but doesn't decrease the secretion of histamine. As a prescription, it is often given as either a tablet or in suppository form, with usual dosing between 12.5 to 25mg. In the EMS setting, the dosing typically remains the same, but is administered either through an IV or as an injection directly into the muscle. Onset of relief is often within 15 to 20 minutes, depending on the route of administration. There are some side effects, the most common being extreme fatigue, drowsiness and dizziness. The potential for significant sedation, especially in the elderly, has promoted a recent move to other medications which produce much less sedation.
Odansteron (Zofran)
Odansteron, commonly called Zofran, is a drug for nausea that is relatively new to the EMS medication arsenal. Zofran was originally given in surgical and cancer treatment situations due to its rapid onset and few side effects. Today, Zofran is one of the preferred medications for nausea, although it does little for nausea caused by motion sickness due to the fact that it acts on the serotonin rather than histamine receptors. Zofran's most common side effects are constipation, headache and dizziness. Zofran can be given by injection or by mouth in an emergency situation. As the tablets dissolve within seconds of being placed in the mouth, there are fewer issues associated with swallowing and creating further nausea. The most common dose for Zofran is 4mg, and the onset of action is often within minutes of administration.
Metoclopramide (Reglan)
Reglan, although given by some EMS providers, is often administered only in the Emergency Department setting due to its significant side effects. Reglan facilitates gastric emptying (digestion) and functions to combat nausea and improve symptoms of migraine headaches. Reglan works within the central nervous system, affecting the dopamine receptors. Dosing is usually 10 to 15mg. There are numerous side effects, ranging from digestive to neurological conditions. Tardive dyskinesia, an often irreversible muscular movement disorder, has been the most common severe side effect after long-term usage and has been the basis for several lawsuits. Few EMS agencies currently utilize this drug in the pre-hospital setting.
Prochlorperazine (Compazine)
Compazine is another drug that successfully combats nausea, specifically in those situations involving chemotherapy, radiation therapy or surgical situations. As a neuroleptic or "nerve seizing" agent, Compazine actually has an almost paralyzing effect on parts of the nervous system, which accounts for its great success at preventing or halting nausea and vomiting. Though Compazine shares some of the same side effects as Reglan, the incidence and severity is typically noticeably lower. Dosing is often between 5 to 10mg, although this can be slightly lower or higher depending on the situation and route of administration.
Member Comments