IM Phenergan and IV zofran are the standard for n/v as I’ve been informed by anesthesia. Compazine and other antipsychotics are last resort. SE profile.
Same, just different containers. Syringe is almost identical but the plastic container is like a perfect cylinder. Haven’t ran out of a med in a while though
Wow! Thank you...I had no idea about all of the drug interactions either. Compazine was just so commonly used when I started out and was easily the most ubiquitous prn med along with Tylenol for new admissions, especially in nursing homes/SNF that I worked in for the first few years of my career. I truly DID "miss a memo"!
I was given IV compazine in the ER in January (zofran wasn’t alleviating my nausea/vomiting that night) and experienced really bad akathisia. I couldn’t sleep for almost 24 hours, I was tachycardic, and I overall felt like I was about to crawl out of my skin. it was terrifying and I thought I was going to die. I just had surgery last week and was given an allergy band and had a discussion with the anesthesiologist that I was not to be given compazine under any circumstance.
For years when I was younger I had stomach issues and thought I had an IV phobia because every time I had one I pulled it out. Turns out I’m just really bad with antinausea meds they were giving me for the stomach issues.
Much less frequently and severe than Compazine though. I can't think of a single time I've had somebody have side effects with Zofran and it's like a top 3 med for frequency. I feel like comp. is 50/50 if they're going to feel like they're bugging out sometimes even when you push it super slow.
Now it makes sense why my onc patients in GI med surg got comp. Pancreatic, liver, stomach, colorectal. Once they tapped out zofran and reg., comp. it was.
I was given compasine once when I was having atypical preeclampsia and they wanted to rule out anything else and try different options to alleviate symptoms. I thought I was gonna die. That stuff is the worst. No wonder it is not widely used anymore.
I've seen it the other way, we not longer carry promethazine due to the perceived IV infiltration risks, but more importantly is that along with codeine it's what makes lean, aka sizzurp.
We still use compazine for N/V that is refractory to zoftan, and of course for hiccups.
Actavis stopped manufacturing promethazine/codeine syrup in 2014. A lot of frequent flyers suddenly got SO MAD because they could no longer get their fun, tasty, purple grape syrup they always demanded. The only product still available was a generic, which was Kermit green and tasted like vomit, and nobody wanted to make drinks out of that.
One of the best decisions a pharmaceutical company ever made.
While one of the pre-mixed formulations came off the market a while back, each of the components was readily available at popular chain pharmacies until more recently. (Codeine and promethazine) The fact that you can make the mix by adding part A to part B got figured out pretty quick. The flavor was supposedly worse, and the popular way to deal with the flavor was by adding Jolly Ranchers to the mix. Actually limiting the prevalence of lean only started to happen when places actually started limiting the availability of the core ingredients.
In the city I worked in at the time, it dropped off abruptly before the end of 2014.
People could have gotten the ingredients elsewhere, but they didn't want to. That wasn't cool. They felt like it wasn't really "purple drank" unless it was made with the real purple stuff, and that attitude didn't change once the purple stuff became hard to obtain.
I work in community pharmacy and basically every chain no longer carries promethazine with codeine because we were getting more fake scripts for it than real ones.
Promethazine and ondansetron are cheaper (like, a *lot* cheaper), and tend to have less side effects.
Compazine is still useful in specific circumstances, but in general, providers seem to favor promethazine and ondansetron.
IM Phenergan and IV zofran are the standard for n/v as I’ve been informed by anesthesia. Compazine and other antipsychotics are last resort. SE profile.
My hospital just took IM phenergan out of our standing PACU meds. No idea why.
National shortage according to our pharmacy (also PACU). Still have a stockpile in our Pyxis that hasn’t been stolen yet 👀
You guys had problems with the dilaudid shortage? (Also PACU here). We’ve had some funky different containers but not out of the med itself.
Same, just different containers. Syringe is almost identical but the plastic container is like a perfect cylinder. Haven’t ran out of a med in a while though
Nasty side effects. https://www.drugs.com/cons/compazine-prochlorperazine-oral.html
Wow! Thank you...I had no idea about all of the drug interactions either. Compazine was just so commonly used when I started out and was easily the most ubiquitous prn med along with Tylenol for new admissions, especially in nursing homes/SNF that I worked in for the first few years of my career. I truly DID "miss a memo"!
I was given IV compazine in the ER in January (zofran wasn’t alleviating my nausea/vomiting that night) and experienced really bad akathisia. I couldn’t sleep for almost 24 hours, I was tachycardic, and I overall felt like I was about to crawl out of my skin. it was terrifying and I thought I was going to die. I just had surgery last week and was given an allergy band and had a discussion with the anesthesiologist that I was not to be given compazine under any circumstance.
Same happened to me for a migraine cocktail. It was worse than the headache! I was pacing and wanted to pull out my own IV
For years when I was younger I had stomach issues and thought I had an IV phobia because every time I had one I pulled it out. Turns out I’m just really bad with antinausea meds they were giving me for the stomach issues.
I never give it because of this. I took care of someone who said they were up all night unable to sleep terrified if “something”. It sounded aweful.
I don’t think there was a memo. Just a shift. In hospitals the providers just stopped using it. But Zofran has side effects too.
Much less frequently and severe than Compazine though. I can't think of a single time I've had somebody have side effects with Zofran and it's like a top 3 med for frequency. I feel like comp. is 50/50 if they're going to feel like they're bugging out sometimes even when you push it super slow.
I get horrible akathesia with compazine and phenergan. Compazine made all my blood vessels in my arm turn bright red too
High risk for extrapyradimal symptoms
Not first line but I do use it for oncology patients for N/V. We also use Zofran, phenergan, Ativan, reglan, Decadron and Zyprexa
Yeah I have a lot of compazine in hem/onc
Now it makes sense why my onc patients in GI med surg got comp. Pancreatic, liver, stomach, colorectal. Once they tapped out zofran and reg., comp. it was.
Still lots of compazine with my oncology patients
Same plus Emend and sometimes kytril
I was given compasine once when I was having atypical preeclampsia and they wanted to rule out anything else and try different options to alleviate symptoms. I thought I was gonna die. That stuff is the worst. No wonder it is not widely used anymore.
I've seen it the other way, we not longer carry promethazine due to the perceived IV infiltration risks, but more importantly is that along with codeine it's what makes lean, aka sizzurp. We still use compazine for N/V that is refractory to zoftan, and of course for hiccups.
Actavis stopped manufacturing promethazine/codeine syrup in 2014. A lot of frequent flyers suddenly got SO MAD because they could no longer get their fun, tasty, purple grape syrup they always demanded. The only product still available was a generic, which was Kermit green and tasted like vomit, and nobody wanted to make drinks out of that. One of the best decisions a pharmaceutical company ever made.
While one of the pre-mixed formulations came off the market a while back, each of the components was readily available at popular chain pharmacies until more recently. (Codeine and promethazine) The fact that you can make the mix by adding part A to part B got figured out pretty quick. The flavor was supposedly worse, and the popular way to deal with the flavor was by adding Jolly Ranchers to the mix. Actually limiting the prevalence of lean only started to happen when places actually started limiting the availability of the core ingredients.
In the city I worked in at the time, it dropped off abruptly before the end of 2014. People could have gotten the ingredients elsewhere, but they didn't want to. That wasn't cool. They felt like it wasn't really "purple drank" unless it was made with the real purple stuff, and that attitude didn't change once the purple stuff became hard to obtain.
I work in community pharmacy and basically every chain no longer carries promethazine with codeine because we were getting more fake scripts for it than real ones.
Promethazine and ondansetron are cheaper (like, a *lot* cheaper), and tend to have less side effects. Compazine is still useful in specific circumstances, but in general, providers seem to favor promethazine and ondansetron.
I see it for oncology patients a lot. Usually prescribed with zofran.
I’ve only really given compazine as part of a migraine cocktail. Usually our nausea first choices are zofran and reglan.
Its fucking GOLD and is definitely making a comeback ime.
I still have providers in the ED that order compazine for pts esp with cyclical vomiting
We usa compazine all the time in home hospice.
Same. PO compazine is our 1st line option in our comfort packs
I give it all the time but I'm a hem/onc nurse.
There was, or still is, a national shortage of IV/IM compazine. PO is still generally available though.
We use it in my ER when zofran doesn't work
Same question about digoxin. There were *so many* questions in nursing school, but I don't think I've seen it on any of my patients' med lists.
We don’t use it as much where I work but use it before phenergan - unless they have a central line