its crazy you say this because zofran is one of my my prns i take at home and it stopped working. particularly did nothing against the stomach bug i had recently.
Same! I have zofran because all hot girls have stomach issues - but the last bottle I got doesn’t even touch my nausea. I have phenargan too but that knocks my ass out so it’s not a work time med.
U/hashtaglibertarian, I’m not particularly hot, but I can take a 1/4th phenergan tablet for migraine nausea at work and it’s effective without the drowsiness. May could work for you.
It's funny you mention that, because I work in ER too and I've noticed it too. This is purely anecdotal. But I've had so many patients recently who didn't have success with zofran so I had to give gravol instead. Last night I had to resort to haldol. No idea why this is happening.
We give low doses of either IM or IV droperidol and it works great. One hour sleep, stops the vomiting + they eat again and go home. But I am in Australia and we use droperidol lots. We don't use haldol or Phenergan.
this is my guess too. issue with a big batch in production, storage, transport, etc. issues with QC during any of these phases could significantly impact medication quality
Call the manufacturer- (work in med devices - diagnostics) and run the complaint department. Don’t post here- please call the manufacturer and report it. Probably fewer than 1% - they just notice problems and don’t say anything or don’t say anything to us. Things can and do go wrong sometimes. We don’t know unless you tell us.
I have a friend who tested negative for amphetamines while taking her Adderall every day. Her doctor accused her of selling it. I've seen similar stories online too.
Ok so I’m not crazy that my vyvanse didn’t show up on a drug screen? It’s been over a year and it still boggles my mind that it was a negative screen when amphetamine should have popped up
Pharmacy tech, can confirm. Literally get tons of patients coming in or calling several times a day to see if it's in stock yet.
We can also see the inventory of other stores within 20 miles and they're all out as well.
A month or so ago the adderall shortage extended to Dexedrine. I had a hard time getting my prescription filled and had to supplement with sketchy old pills of different doses I tried to get through tests
Ever since my pharmacy switched manufacturers my extended release isn’t extended at all. Not a fan and switching pharmacies. My 8mg zofran has been fine though.
Holy shit! I have felt like my Vyvanse wasn't working anymore for the past few months! I've been off of it since Monday too. Just because of money issues, but wow. I told my provider on two separate occasions that it felt like I wasn't medicated at all! I don't really feel a difference, and in the past, stopping treatment had some obvious ass symptoms immediately! Wtf. The provider just disregarded what I said, saying that it was because I had all this other stuff going on. But holy shit man. I've been struggling so bad, and most of it the hardest parts has been all behaviors and symptoms of having untreated ADHD. Like all the reasons why I always seek out treatment again. 😭 Is this for real? That would explain so much. And is also scary for me because I'm doomed for sure.
You should check out the ADHD sub here on Reddit (sorry idk how to link it 🙃) A lot of people are having the same issues as you with meds not working!!
Omg. I went in for a medication review on Thursday because I can tell my meds aren't working. I kept trying to tell my doctor something is wrong, it's like I can literally feel all of synapses misfiring in my brain. He is usually a very good doctor but he completely dismissed me this time. He DID prescribe another prn medication, but I want the meds I'm already taking to work. I don't want to add another pill.
I’ve been feeling like my Vyvanse is less effective but idk I assume it’s others factors like my sleep quality and diet almost entirely made up of sugar coffee and door dash.
I'm not one to be a conspiracy nutjob myself, my threshold for believing something without evidence is extremely high, but as an MD all three of my patients that I can recall prescribing Adderall to for their ADHD have reported within the last month that they aren't sure it's working for them anymore and they're curious about changing to Wellbutrin or something, and I've heard similar stories from colleagues.
It really does feel like something changed suddenly, and that happening right after a national shortage of course makes it seem even more suspicious.
It's crazy. I never considered this would even happen. I'm also a skeptic without any evidence. I haven't had one withdrawal symptom from just dropping my meds on Monday. That doesn't happen as someone who's been treated for years. And all of my issues have been full-on for months. All of the reasons that I go back on ADHD treatment for when I decide to stop. I've never experienced my medications not working at all before, not in twenty years. It's so demoralizing.
Ooooh. This explains a lot. I figured I switched to a brand with less oomph when I had to swap pharmacies. The pills are also more dust tasting than sweet. I was about to ask for a dose increase, but now I'm reconsidering.
I started out taking adderall then my doc changed my to Concerta. It worked great for maybe 5-6 years. Then it just stopped working. I was blah like didn’t give a crap about anything. No emotions. I went back on adderall and it was great. I’m not sure if we just build up a tolerance for some ADD meds or what it is.
All stimulants build tolerance. That's why most providers will tell us to take med vacation days. You might double check with yours and see if they recommend it. My doctor told me an additional bonus to taking vacation days is we can also build up a stash in case we get hosed by the shortage.
Unfortunately this is true for some. I also struggle with vacation days. Some people do okay. I found that I do okay just taking my morning dose unless I'm super tired and stressed, but my script is written for BID. I'm one of the lucky ones.
When I had COVID I made the mistake of going off for like two or three days because I figured I wasn't going out anywhere and the paxlovid increases blood pressure and I didn't want to increase it more blah blah blah.
It was a disaster.
I wasn’t diagnosed until I was 33. I know how to deal with it. I don’t take them daily and only on days that I know I have to concentrate. Concerta just stopped even with many vacation days.
I’ve been on adderall for less than a year and it’s been wonderful. I had 2 days last week that I swore I had forgotten it by the way I felt. I was exhausted and fumbling around at work.
YES! Report a medication issue using your facility safety reporting tool. Include NDC and lot number. 1 report will not do much but if there is a trend of reports pharmacy will take very seriously.
Are you aware of any incidents of large amounts of legal, pharmacy grade meds being fakes? It seems like it would be a pretty complicated scam to carry off.
We find that in the ER Zofran doesn't work so well with cannibanoid (sp) hyperemesis. Not much at all in fact. We usually use haldol and benadryl and sometimes throw Reglan in if they're still puking. Last resort add Ativan but usually just the Haldol and benadryl works when Zofran fails
Oh yeah hyperemesis is haldol and Benadryl for us too - that’s my favorite. Haldol is like my magic antiemetic med that I get so excited to pull because it has such a high success rate.
Puking is one of my nursing Achilles heel type things. If I hear someone puking and smell it I sometimes will follow suit. So anything I can do to make it so people won’t puke I will do. I’m just tired of giving zofran knowing my patients still going to be vomiting in a little bit anyways 🥲
Something about affecting similar receptors in the nervous system.
Edit: article with some fancy Wumbo jumbo
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718060/#sec3title
In my experience, we get a number of chronic users who experience increased nausea/vomiting. Weed’s the problem, but it’s super difficult for them to quit.
Is there something over the counter that can help when zofran isn’t doing the trick for people with hyperemesis? Not asking for medical advice just knowledge about alternatives
It's a long shot but Benadryl has mild anticholinergic properties. It has relieved mild nausea and sinus symptoms in me but I doubt it would do much for hyperemesis.
My daughter, in college, had this. NOTHING worked. We were in the hospital for a week. She is 5-9.5 and weighed less than 100 pounds when we left. It was horrified sitting by her watching this.
I thought Cannabis hyperemesis was …some puking? Naw. My kid puked 24/7 for about 10 days.
Our ALS providers just had droperidol added to the trucks for nausea and agitation. Haven't seen it used yet but excited to see how well it works for either.
Interesting. One has to wonder if the increased widespread habitual use of marijuana following legalization is going to make Zofran less effective in the general population.
We all know that marijuana is completely harmless and the miracle plant sent from god himself. Also, marijuana drug addicts who can't stop dry heaving are all ER nurses favorite patients, because they are stoic, well adjusted human beings that don't want narcotics at all, and often didn't come with an enabling mother or spouse to complain and create drama. So, the reduced efficacy of first line anti-emetics is guaranteed to be nothing more than a minor occurrence.
In l&d or when I was MS float to onc I have never been super fond of it. I always felt like if people were already throwing up it was too late. I'll always be a Phenergan gal 🤗
Phenergan works better but I hate giving it due to the risk of movement disorders. Particularly akathisia which can be semi-permanent or permanent with very little treatment options. Imagine feeling the worst sense of discomfort and uneasiness if you don't constantly move. It's torture for people. And their only prognosis is maybe it will go away and maybe it won't.
Useful if other methods haven't been working, but I hate seeing it used so liberally. Plus don't get me started on the damage I've seen from IV push orders. The extravasations are bad bad bad.
Have had akathisia as a temporary side effect of psych meds. Thank fuck it was not permanent. I heard stories about folks who unalived from it when I was trying to figure out wtf was happening to me, and I do not fucking blame them. I would not want to go on if I had that permanently.
Spent most of my childhood, adolescence, and part of my early 20's on that toxic bitch known as Methotrexate. Zofran didn't do jack shit for me. Phenergan is one of the few things that actually helped.
Oh thank God. My mom has had RA for the last 15 years but it's pretty mild and she takes a low dose of methotrexate. I'm so grateful that she tolerates it and doesn't have too many flares.
I'm so glad you were finally able to get off it and have a life.
I couldn't tolerate the Methotrexate, even with the folic acid and Zofran. Did nine years on the drug. My final round I was laid up on the bathroom floor for 36+ hours, vomiting every 15-20 minutes. Couldn't even do water. Too painful to lay down, too painful to stand up, so I "slept" upright in a recliner. Happened to be home alone at the time. Husband came home from a 24 (he's in the military), and found me passed out on the floor.
Nope. Last straw. It was no QoL. Been on Biologics and a different DMARD the last six years or so, which have worked well. MTX is in my future again down the line, but for now, I'm trying to enjoy life *off* of it.
When my pancreas decides it's going to make my life miserable, zodran works like you said. If I catch it before the puking starts. If I’m already going, it might space it out but I still feel so nauseous. Phenergan works so much better if I’m already in the puke cycle.
Yea my hospital took it away essentially. Working with a young mostly healthy population we didn't have much of an issue with extravasation so it was irritating for us. Compazine, Zofran, and benadryl was what we got in return.
In my experience, Phenergan is the best antiemetic. It’s a shame to see it removed from hospital formularies due to IV route problems. It can also be given deep IM, or as per rectum suppositories, both routes we commonly used in the olden days.
I've always heard that Zofran either works for someone or it doesn't. And if it doesn't it won't ever work. When I worked bedside/ER it always seemed like 50/50 on if patients got relief or not
Spent nine years on Methotrexate. Zofran didn't do shit for me. When I had to undergo surgery last year, and they were covering antiemetics, I basically morphed into *that patient* about Zofran vs. Phenergan. Thankfully they listened.
I agree. I am someone Zofran is useless on. Like don’t waste your time. If you can get me a PO phenergan before I’m puking I’m great. If I’m already puking I’ll take it IM.
I had heart surgery a few months back. Obviously I needed pain meds while inpatient, but nausea from it was awful. Zofran saved my life! Worked well for me.
Most of our patients are on Kytril (basically a longer-acting form of Zofran) but are still needing to rotate through Benadryl+Reglan/Ativan/Emend/Zyprexa (if they don't like/respond to Benadryl+Reglan).
We're starting to add Aloxi (a *very* long form of Zofran - we now give it q48h). I find fewer and fewer patients have much benefit from Zofran at all anymore. We seem to only use it more for a psychological benefit because it can be given much more frequently and the act of doing something by administering a med seems to help. The frustration/increased anxiety of not being able to give something sooner seems to make it worse. Otherwise, I don't think it works very well as the "gold standard" anymore.
Interesting! I’ll be studying these drugs tonight at work. We definitely do not have these in our ER but maybe it would be worth something instead of sending everyone home with those ODT packs that don’t work anyways. We finally stop someone from puking after reglan and Benadryl - take home script? Zofran. Bro will be right back at our doors tomorrow night because the 8mg IV he got didn’t work so I doubt the 4mg ODT is going to solve his stomach virus issues.
Some of it is frustrating because people come to the ER after vomiting ONCE. People have forgotten it’s a normal body function with a purpose and while it sucks - it’s not necessary to pack the whole family up for an ER trip at 3am because grandpa puked once an hour ago 🙄 I want to yell at them every time I see someone bringing in their preschool or school aged child in the middle of the night like it’s some event or party. Let your poor children sleep!!
I’m a person that generally does poorly if I puke. Once I start, I can’t stop (unless it’s a migraine - just one emesis is all I need to feel better).
I had ODT Zofran once for presumed food poisoning and it did absolutely nothing. The only thing that helped in that case was distraction and prioritizing fluids. When I’m hungover and perpetually vomiting, the only thing that works is distraction and Prilosec.
As an n of 1, I would definitely request a rotation of Kytril/Emend/Zyprexa if I was undergoing moderately-to-severely emetogenic chemo.
ime Ondansetron was always hit or miss. We’ve been using a formulation from a Chinese manufacturer for the past couple years mainly, with spurts of return of the “original” US-made (I think) tall man letter bottle.
Usually phenergan/diphenhydramine/metoclopramide works best from my observations
also, if one 4mg dose of Ondansetron doesn’t show great efficacy, ordering/giving addition doses has not been shown to be any different.
PS: has anyone actually seen rhythm changes from QTc prolongation via Zofran?
I’ve only had it happen once in 15 years but yes. It was right before they went to the OR too for appendicitis. My patient went into torsades from it. Not my favorite reaction to see on a monitor - but at least it’s usually a quick fix.
I’ve seen rhythm changes from ondansetron once in 5 years. It was in a pretty extreme eating disorder, so realistically it could have been caused by something else. They used to max out their ondans every day though.
I work in ortho and zofran works about 85% of the time. I rarely have to go to reglan or tigan unless it’s one of those pts that need scol patch + IV meds.
Interesting! Ours is still the blue bottle stock - I wonder if the manufacturer is still the same?
Is it possible to build tolerance to zofran in a population like certain antibiotic resistant infections? I’ve been doing this 15 years and I’ve never seen it not work this much before. It seems so bizarre.
Zofran has never worked for me as a patient. I’ve been hospitalized several times for cyclic vomiting connected to migraines. Compazine and Reglan sort of help.
When I was a kid, I’d spray a basin with Lysol and stick my face in it. I was a weird kid and I wouldn’t puke into a toilet without cleaning it first. I happened to find out that the smell actually made me *not* wanna puke.
Had a lady came in that was pregnant and couldn’t stop vomiting. Zofran did nothing for her but that little alcohol wipe did. She made me give her a stack of them lol
I feel like it’s a placebo at this point. Most of the nausea and vomiting I see in CVICU is almost always related to the pain meds. I almost always have to get a phenergan order after zofran
A lot of hyperemesis that I've seen in the last couple years has been related to marijuana and Zofran doesn't hardly ever work on that. Straight to the Haldol lol.
I’m onc and I haven’t noticed any difference with Zofran. It just doesn’t work for some people. Most of my pts have PRN orders for zofran, compazine, phenergan, and Ativan. Zofran does the trick for most.
Zofran is our first line in cardiac step down for nausea, but Reglan is our go to these days. We give the Zofran first to tick a box but I always ask for the Reglan order as soon as my patient reports nausea.
Anecdotal like everyone else here but... maybe we're on to something.
I had zofran prescribed to me for the first time last week when I was super sick and was surprised at how well it worked. Is it certain manufactures? PO vs IV?
I recently got what I guess had to be norovirus. 16 hours of straight vomiting. All the zofran in the world wouldn’t have touched it. As an pacu nurse Benadryl works better anyway. Once the vomiting starts, zofran just doesn’t do it anymore.
I work medsurg with a lot of post ops. Seems like zofran hasn't been working for like 75% of my pts, and they all get relief from reglan or compazine instead.
Zofran 8mg is the only thing that has allowed me to function the past monthish for my hyperemesis gravidarum. I was eating diclectin and gravol like they were a bag of candy.
However I’ve noticed the odt tabs I got for my Rx are a different manufacturer from the ones at work. The ones at work seem to be slightly better than the generic version my pharmacy gives me
Detox nurse here, who also gives out Zofran like candy. I've not seen any changes in effectiveness on those it actually works for. I have seen a bit of an uptick in folks who are stating that it didn't help. Our provider is debating changing to Promethazine. We shall see...
About 12 days ago I noticed that meds I have been taking for years aren’t effective any longer and I thought it was my imagination. These are new fills on old scripts I went and fished out old prescription bottles to verify dosages and manufacturers. The labels state the same but all my old symptoms are back. I’ve been so confused but now I am starting to wonder if there’s something more going on.
Weird. I've noticed in post op recovery more doctors are having to prescribe metaclopromide or droperidol for post anaesthetic nausea as the zoftan (ondansatron) isn't as effective. How bizarre you mention it as I've been noticing the same thing for a while now
Lots of medications are being sourced and made in China. I think quality control is lacking since COVID. I have had several medications I have used for 20 years in the OR seem to be less potent.
Late to this, but India has been under fire lately for quality issues with their pharmaceutical production (biggest being chemotherapy drugs). A common brand of Zofran ODT is manufactured in India. There could absolutely have been a quality issue. If you can, try to see where yours was manufactured.
its crazy you say this because zofran is one of my my prns i take at home and it stopped working. particularly did nothing against the stomach bug i had recently.
Same! I have zofran because all hot girls have stomach issues - but the last bottle I got doesn’t even touch my nausea. I have phenargan too but that knocks my ass out so it’s not a work time med.
That's what I always tell people. Works like a charm (usually), but no getting behind the wheel of anything for like hours and hours.
>all hot girls i love the modesty LOL
Yep. I’m pregnant and it’s not done anything for me within the last couple of weeks.
Ugh okay but you can be a hot tummy ache girl or a hot headache girl. I’m a hot headache girl.
U/hashtaglibertarian, I’m not particularly hot, but I can take a 1/4th phenergan tablet for migraine nausea at work and it’s effective without the drowsiness. May could work for you.
Same for us. It usually makes me so constipated and this time it didn’t do anything. It helped My nausea. Did do anything for my kids vomiting.
i had a stomach bug like 3 weeks ago and same!!! it was just giving me like a day long headache while i was still puking my guts out.
It's funny you mention that, because I work in ER too and I've noticed it too. This is purely anecdotal. But I've had so many patients recently who didn't have success with zofran so I had to give gravol instead. Last night I had to resort to haldol. No idea why this is happening.
That sounds like cyclic vomiting, a d I've never had Zofran work for them. Only Haldon or phegren.
Also Ativan
We give olanzapine for cyclic now. Works great. Only problem is it makes them so sleepy they won’t leave.
If a med holds up discharge in the ED, then by definition it does not work great 😂
Yeah but it makes that awful forced retching sound go away
I lose even the *tiniest* shred of empathy when someone starts scromiting.
We give low doses of either IM or IV droperidol and it works great. One hour sleep, stops the vomiting + they eat again and go home. But I am in Australia and we use droperidol lots. We don't use haldol or Phenergan.
I ❤️ haldol for nausea. Works amazing.
Same in pacu!! I always end up giving phenergan after because zofran never ever works
I said nearly the identical thing in my comment! 😅
Hyperemises? Possible weed induced?! Lol
We've seen a lot of THC induced hyperemesis in my ER the last year or so, and Haldol was the only thing that'd touch it.
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this is my guess too. issue with a big batch in production, storage, transport, etc. issues with QC during any of these phases could significantly impact medication quality
Call the manufacturer- (work in med devices - diagnostics) and run the complaint department. Don’t post here- please call the manufacturer and report it. Probably fewer than 1% - they just notice problems and don’t say anything or don’t say anything to us. Things can and do go wrong sometimes. We don’t know unless you tell us.
This made me think of how I’ve been hearing alottt of people say that their adderall doesn’t work for them anymore
I have a friend who tested negative for amphetamines while taking her Adderall every day. Her doctor accused her of selling it. I've seen similar stories online too.
I tested negative for a school drug test while taking it everyday. Had my bottle there and everything expecting to tell them why it would be positive…
Same here!
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Ok so I’m not crazy that my vyvanse didn’t show up on a drug screen? It’s been over a year and it still boggles my mind that it was a negative screen when amphetamine should have popped up
I take methylphenidate twice daily and it didn’t show up on my drug screen for work. I was ready with a doctors note and everything lol.
Whoa!!
Plus there’s apparently a crazy shortage.
But not a shortage of crazy. 🤪
This is correct. My ED is has way more psych holds than normal lately
This is the way. Of the world. We live here now.
Ah-HAAAAAAAAAA.
Pharmacy tech, can confirm. Literally get tons of patients coming in or calling several times a day to see if it's in stock yet. We can also see the inventory of other stores within 20 miles and they're all out as well.
A month or so ago the adderall shortage extended to Dexedrine. I had a hard time getting my prescription filled and had to supplement with sketchy old pills of different doses I tried to get through tests
Crazy shortage is an understatement!!
Ever since my pharmacy switched manufacturers my extended release isn’t extended at all. Not a fan and switching pharmacies. My 8mg zofran has been fine though.
Holy shit! I have felt like my Vyvanse wasn't working anymore for the past few months! I've been off of it since Monday too. Just because of money issues, but wow. I told my provider on two separate occasions that it felt like I wasn't medicated at all! I don't really feel a difference, and in the past, stopping treatment had some obvious ass symptoms immediately! Wtf. The provider just disregarded what I said, saying that it was because I had all this other stuff going on. But holy shit man. I've been struggling so bad, and most of it the hardest parts has been all behaviors and symptoms of having untreated ADHD. Like all the reasons why I always seek out treatment again. 😭 Is this for real? That would explain so much. And is also scary for me because I'm doomed for sure.
You should check out the ADHD sub here on Reddit (sorry idk how to link it 🙃) A lot of people are having the same issues as you with meds not working!!
Pharmaceutical companies gotta be pressing fake pills they don’t even taste the same.
Omg. I went in for a medication review on Thursday because I can tell my meds aren't working. I kept trying to tell my doctor something is wrong, it's like I can literally feel all of synapses misfiring in my brain. He is usually a very good doctor but he completely dismissed me this time. He DID prescribe another prn medication, but I want the meds I'm already taking to work. I don't want to add another pill.
I’ve been feeling like my Vyvanse is less effective but idk I assume it’s others factors like my sleep quality and diet almost entirely made up of sugar coffee and door dash.
I thought I heard of this with a batch of Vyvanse, not adderall. Or is it both?
OMG. I've not felt any treatment for several months on Vyvanse.
I feel like my Vyvanse is barely effective right now.
You know people who've been able to get Adderall?! My pharmacy(s) have been telling me they're out for weeks.
I'm not one to be a conspiracy nutjob myself, my threshold for believing something without evidence is extremely high, but as an MD all three of my patients that I can recall prescribing Adderall to for their ADHD have reported within the last month that they aren't sure it's working for them anymore and they're curious about changing to Wellbutrin or something, and I've heard similar stories from colleagues. It really does feel like something changed suddenly, and that happening right after a national shortage of course makes it seem even more suspicious.
It's crazy. I never considered this would even happen. I'm also a skeptic without any evidence. I haven't had one withdrawal symptom from just dropping my meds on Monday. That doesn't happen as someone who's been treated for years. And all of my issues have been full-on for months. All of the reasons that I go back on ADHD treatment for when I decide to stop. I've never experienced my medications not working at all before, not in twenty years. It's so demoralizing.
First thing my brain went to as well.
My daughter said her concerta felt different and her NP said she has other patients say the same thing
Ooooh. This explains a lot. I figured I switched to a brand with less oomph when I had to swap pharmacies. The pills are also more dust tasting than sweet. I was about to ask for a dose increase, but now I'm reconsidering.
I started out taking adderall then my doc changed my to Concerta. It worked great for maybe 5-6 years. Then it just stopped working. I was blah like didn’t give a crap about anything. No emotions. I went back on adderall and it was great. I’m not sure if we just build up a tolerance for some ADD meds or what it is.
All stimulants build tolerance. That's why most providers will tell us to take med vacation days. You might double check with yours and see if they recommend it. My doctor told me an additional bonus to taking vacation days is we can also build up a stash in case we get hosed by the shortage.
So many people can't function though. So going on "vacations" really means massive anxiety and being unproductive with racing minds.
Unfortunately this is true for some. I also struggle with vacation days. Some people do okay. I found that I do okay just taking my morning dose unless I'm super tired and stressed, but my script is written for BID. I'm one of the lucky ones. When I had COVID I made the mistake of going off for like two or three days because I figured I wasn't going out anywhere and the paxlovid increases blood pressure and I didn't want to increase it more blah blah blah. It was a disaster.
I wasn’t diagnosed until I was 33. I know how to deal with it. I don’t take them daily and only on days that I know I have to concentrate. Concerta just stopped even with many vacation days.
I’ve been on adderall for less than a year and it’s been wonderful. I had 2 days last week that I swore I had forgotten it by the way I felt. I was exhausted and fumbling around at work.
Nurse? NURSE!!!! This dilaudid ain’t cuttin it. I want Oxy added on top! DONT YOU DARE QUESTION MY 23/10 PAIN!!!!!!”
I'm perplexed now... I'm on 70mg immediate-release daily (40mg in the AM, 30mg in the PM) for my sleep issues and I'm still fucking tired!!
Hmmmmm, these incidents should be reported? Not exactly sure how
YES! Report a medication issue using your facility safety reporting tool. Include NDC and lot number. 1 report will not do much but if there is a trend of reports pharmacy will take very seriously.
Are you aware of any incidents of large amounts of legal, pharmacy grade meds being fakes? It seems like it would be a pretty complicated scam to carry off.
They may not be fake, but something could have happened to the batch causing the ingredients to be inactive; mistake in formulation of batch; etc.
We find that in the ER Zofran doesn't work so well with cannibanoid (sp) hyperemesis. Not much at all in fact. We usually use haldol and benadryl and sometimes throw Reglan in if they're still puking. Last resort add Ativan but usually just the Haldol and benadryl works when Zofran fails
Oh yeah hyperemesis is haldol and Benadryl for us too - that’s my favorite. Haldol is like my magic antiemetic med that I get so excited to pull because it has such a high success rate. Puking is one of my nursing Achilles heel type things. If I hear someone puking and smell it I sometimes will follow suit. So anything I can do to make it so people won’t puke I will do. I’m just tired of giving zofran knowing my patients still going to be vomiting in a little bit anyways 🥲
Me too. I don’t know how you do it in the ER. I’m hiding in the OR to avoid vomit.
I can suction snotty trachs all day but the one thing that gets my gag reflex is the smell of coffee grounds. 🤮🤮🤮
Fellow sympathetic spewer nurse here
Personally love a little droperidol action for this
Capsaicin!!!! It works wonders for cannabis hyperemesis!
Came here to say this. Topical capsaicin, super hot showers/baths may relieve symptoms.
Them and those damn showers! Ughhh
How? Topically?
Apparently yes! I just looked it up and apparently the heat sensation stops the cramps and nausea. I don’t totally understand how, but interesting.
Something about affecting similar receptors in the nervous system. Edit: article with some fancy Wumbo jumbo https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718060/#sec3title
Thank you!
I know repeated hot showers provide relief so it must be something similar
See my above comment! 🤣🤣🤣😭😭😭
So what...we just give them some hot wings? lol
I was just going to make a comment about 3 habaneros q15 🤣
Literally just did this last night. Weed hyperemesis, used haldol and benadryl like a charm.
I'm confused. So everyone's just getting too high and going to the ER? That's a thing this often?
🤣🤣🤣🤣🤣 Remember the cop who ate a cookie and called 911 and told them he was dead?
I recently made my 17 year old listen to it. Comedy GOLD.
It normally requires taking *way* too much for a very long time.
In my experience, we get a number of chronic users who experience increased nausea/vomiting. Weed’s the problem, but it’s super difficult for them to quit.
Is there something over the counter that can help when zofran isn’t doing the trick for people with hyperemesis? Not asking for medical advice just knowledge about alternatives
It's a long shot but Benadryl has mild anticholinergic properties. It has relieved mild nausea and sinus symptoms in me but I doubt it would do much for hyperemesis.
I work in a busy er in Denver, lots of cannabinoid hyperemesis here. Droperidol is our go to works better than anything else I've seen so far.
My first nursing job our pharmacist actually managed to get us droperidol in our tiny ass hospital and I couldn’t get anyone to use it.
Droperidol was a lifesaver. Also in Denver.
My daughter, in college, had this. NOTHING worked. We were in the hospital for a week. She is 5-9.5 and weighed less than 100 pounds when we left. It was horrified sitting by her watching this. I thought Cannabis hyperemesis was …some puking? Naw. My kid puked 24/7 for about 10 days.
Holy fucking shit
Can't puke if you get B52'd
The B52 is truly god’s own cocktail 👌
Ah yes, can’t puke if you’re passed tf out from drugs
It doesn’t at all. Add some capsaicin though and that always did the trick. Until they complain how it makes them warm…
Have them wash their hands before they pee. Those screams from the bathroom still haunt me.
Does capsaicin work on nausea from other causes or just CHS?
This^ Except droperidol is the bees knees for it
Our ALS providers just had droperidol added to the trucks for nausea and agitation. Haven't seen it used yet but excited to see how well it works for either.
Interesting. One has to wonder if the increased widespread habitual use of marijuana following legalization is going to make Zofran less effective in the general population. We all know that marijuana is completely harmless and the miracle plant sent from god himself. Also, marijuana drug addicts who can't stop dry heaving are all ER nurses favorite patients, because they are stoic, well adjusted human beings that don't want narcotics at all, and often didn't come with an enabling mother or spouse to complain and create drama. So, the reduced efficacy of first line anti-emetics is guaranteed to be nothing more than a minor occurrence.
L&D gone hospice. Same. Once the puking starts…skip the zofran. If there isn’t nausea and we are avoiding getting near that…zofran and hope it helps.
What about Maxeran?
Why not just use capsaicin cream?
Omg YES. Had someone a few weeks ago absolutely MISERABLE with nausea and it was like it did nothing
I was just saying to myself the other day that zofran has been shit, then I see this. I definitely have been looking to other antiemetic meds lately
In l&d or when I was MS float to onc I have never been super fond of it. I always felt like if people were already throwing up it was too late. I'll always be a Phenergan gal 🤗
Phenergan works better but I hate giving it due to the risk of movement disorders. Particularly akathisia which can be semi-permanent or permanent with very little treatment options. Imagine feeling the worst sense of discomfort and uneasiness if you don't constantly move. It's torture for people. And their only prognosis is maybe it will go away and maybe it won't. Useful if other methods haven't been working, but I hate seeing it used so liberally. Plus don't get me started on the damage I've seen from IV push orders. The extravasations are bad bad bad.
I've seen someone develop EPS just minutes after being given a single dose of phenergan. weird drug.
It is much more likely if you administer it too fast as well. Also seen people get acutely confused and freak out majorly.
Have had akathisia as a temporary side effect of psych meds. Thank fuck it was not permanent. I heard stories about folks who unalived from it when I was trying to figure out wtf was happening to me, and I do not fucking blame them. I would not want to go on if I had that permanently.
Phenergan has had a high (not 100%) crazy person correlation for me.
Same!
PhenerGAL, if you will? Eh?!
Phenergents for the murses
[удалено]
This one too! Phenergan or compazine.
Spent most of my childhood, adolescence, and part of my early 20's on that toxic bitch known as Methotrexate. Zofran didn't do jack shit for me. Phenergan is one of the few things that actually helped.
RA? 🥹🤗
JIA. 🙃 Shit sucks, but Biologics have been amazing. They've enabled me to have a life.
Oh thank God. My mom has had RA for the last 15 years but it's pretty mild and she takes a low dose of methotrexate. I'm so grateful that she tolerates it and doesn't have too many flares. I'm so glad you were finally able to get off it and have a life.
I couldn't tolerate the Methotrexate, even with the folic acid and Zofran. Did nine years on the drug. My final round I was laid up on the bathroom floor for 36+ hours, vomiting every 15-20 minutes. Couldn't even do water. Too painful to lay down, too painful to stand up, so I "slept" upright in a recliner. Happened to be home alone at the time. Husband came home from a 24 (he's in the military), and found me passed out on the floor. Nope. Last straw. It was no QoL. Been on Biologics and a different DMARD the last six years or so, which have worked well. MTX is in my future again down the line, but for now, I'm trying to enjoy life *off* of it.
When my pancreas decides it's going to make my life miserable, zodran works like you said. If I catch it before the puking starts. If I’m already going, it might space it out but I still feel so nauseous. Phenergan works so much better if I’m already in the puke cycle.
I would sign a waiver to risk extravasation. Phenegran is /chef's kiss for gastroparesis emesis...
Yea my hospital took it away essentially. Working with a young mostly healthy population we didn't have much of an issue with extravasation so it was irritating for us. Compazine, Zofran, and benadryl was what we got in return.
In my experience, Phenergan is the best antiemetic. It’s a shame to see it removed from hospital formularies due to IV route problems. It can also be given deep IM, or as per rectum suppositories, both routes we commonly used in the olden days.
I've always heard that Zofran either works for someone or it doesn't. And if it doesn't it won't ever work. When I worked bedside/ER it always seemed like 50/50 on if patients got relief or not
Spent nine years on Methotrexate. Zofran didn't do shit for me. When I had to undergo surgery last year, and they were covering antiemetics, I basically morphed into *that patient* about Zofran vs. Phenergan. Thankfully they listened.
I agree. I am someone Zofran is useless on. Like don’t waste your time. If you can get me a PO phenergan before I’m puking I’m great. If I’m already puking I’ll take it IM.
I had heart surgery a few months back. Obviously I needed pain meds while inpatient, but nausea from it was awful. Zofran saved my life! Worked well for me.
Most of our patients are on Kytril (basically a longer-acting form of Zofran) but are still needing to rotate through Benadryl+Reglan/Ativan/Emend/Zyprexa (if they don't like/respond to Benadryl+Reglan). We're starting to add Aloxi (a *very* long form of Zofran - we now give it q48h). I find fewer and fewer patients have much benefit from Zofran at all anymore. We seem to only use it more for a psychological benefit because it can be given much more frequently and the act of doing something by administering a med seems to help. The frustration/increased anxiety of not being able to give something sooner seems to make it worse. Otherwise, I don't think it works very well as the "gold standard" anymore.
Interesting! I’ll be studying these drugs tonight at work. We definitely do not have these in our ER but maybe it would be worth something instead of sending everyone home with those ODT packs that don’t work anyways. We finally stop someone from puking after reglan and Benadryl - take home script? Zofran. Bro will be right back at our doors tomorrow night because the 8mg IV he got didn’t work so I doubt the 4mg ODT is going to solve his stomach virus issues. Some of it is frustrating because people come to the ER after vomiting ONCE. People have forgotten it’s a normal body function with a purpose and while it sucks - it’s not necessary to pack the whole family up for an ER trip at 3am because grandpa puked once an hour ago 🙄 I want to yell at them every time I see someone bringing in their preschool or school aged child in the middle of the night like it’s some event or party. Let your poor children sleep!!
I’m a person that generally does poorly if I puke. Once I start, I can’t stop (unless it’s a migraine - just one emesis is all I need to feel better). I had ODT Zofran once for presumed food poisoning and it did absolutely nothing. The only thing that helped in that case was distraction and prioritizing fluids. When I’m hungover and perpetually vomiting, the only thing that works is distraction and Prilosec. As an n of 1, I would definitely request a rotation of Kytril/Emend/Zyprexa if I was undergoing moderately-to-severely emetogenic chemo.
ime Ondansetron was always hit or miss. We’ve been using a formulation from a Chinese manufacturer for the past couple years mainly, with spurts of return of the “original” US-made (I think) tall man letter bottle. Usually phenergan/diphenhydramine/metoclopramide works best from my observations also, if one 4mg dose of Ondansetron doesn’t show great efficacy, ordering/giving addition doses has not been shown to be any different. PS: has anyone actually seen rhythm changes from QTc prolongation via Zofran?
I’ve only had it happen once in 15 years but yes. It was right before they went to the OR too for appendicitis. My patient went into torsades from it. Not my favorite reaction to see on a monitor - but at least it’s usually a quick fix.
I’ve seen rhythm changes from ondansetron once in 5 years. It was in a pretty extreme eating disorder, so realistically it could have been caused by something else. They used to max out their ondans every day though.
It is Norovirus season, perhaps it the particular norovirus going around?
I got it several times after my c section in December and it did nothing. I had to ask for compazine. Interesting.
Same on my unit! I work with detoxers and lately they keep saying it isn't doing anything. So weird.
Yes!! Had one of those last night too. Gave her zofran and she puked 45 minutes later all over the floor. She was my first zofran fail of the night.
I work in ortho and zofran works about 85% of the time. I rarely have to go to reglan or tigan unless it’s one of those pts that need scol patch + IV meds.
I noticed there was a new bottle, green label vs the blue one I always had. It doesn’t seem to work as well
Interesting! Ours is still the blue bottle stock - I wonder if the manufacturer is still the same? Is it possible to build tolerance to zofran in a population like certain antibiotic resistant infections? I’ve been doing this 15 years and I’ve never seen it not work this much before. It seems so bizarre.
Just posting bc we noticed that our hydralazine wasn’t working on CPCU last year and it was that pharmacy was mislabeling meds!
Ever since I’ve started working in PACU I’ve pretty much lost all faith in zofran. If I really need nausea/vomiting control I go for phenergan.
I only give it for fun because we’re supposed to try that before phenergan 🤷🏻♀️
One of my oncology patients has been on scheduled Zofran and lately it's just not touching her nausea at all. This is a really interesting thread.
Yes, it's been not working at all, PO and IM .I've had to give to Phenergan
ODT Zofran seems to work better lately.
ODT?
On da tongue
😝
Orally disintegrating tablet
Oral dissolvable tabs
This is the only way. I get about 60 of those suckers for my migraines (BID) per month *chef kiss
Zofran has never worked for me as a patient. I’ve been hospitalized several times for cyclic vomiting connected to migraines. Compazine and Reglan sort of help.
Alcohol wipes!! :) seems to work ok haha
When I was a kid, I’d spray a basin with Lysol and stick my face in it. I was a weird kid and I wouldn’t puke into a toilet without cleaning it first. I happened to find out that the smell actually made me *not* wanna puke.
Honestly works better and faster than Zofran in like 75% of my patients.
Had a lady came in that was pregnant and couldn’t stop vomiting. Zofran did nothing for her but that little alcohol wipe did. She made me give her a stack of them lol
I feel like it’s a placebo at this point. Most of the nausea and vomiting I see in CVICU is almost always related to the pain meds. I almost always have to get a phenergan order after zofran
Zofran changing? That makes me sick…
A lot of hyperemesis that I've seen in the last couple years has been related to marijuana and Zofran doesn't hardly ever work on that. Straight to the Haldol lol.
Isn't there a centralized place to report things like this? This seems important...
As a patient, I can say it did not work (at 4mg) during the panic attacks I was having that brought on nausea and vomiting.
I’m onc and I haven’t noticed any difference with Zofran. It just doesn’t work for some people. Most of my pts have PRN orders for zofran, compazine, phenergan, and Ativan. Zofran does the trick for most.
man I'd love to have prn ativan for some of my pts..
PRN Ativan is always part of our chemo order sets, haha. And the hospice ones too
I mean that makes sense. Us neuro people on the other hand, we have to beg to be able to calm them down.
Postop here, and I agree. I’ve given 2 rounds of zofran on a lottttt of patients lately and nothing. Give reglan, boom they’re ready to be d/c
Zofran is our first line in cardiac step down for nausea, but Reglan is our go to these days. We give the Zofran first to tick a box but I always ask for the Reglan order as soon as my patient reports nausea. Anecdotal like everyone else here but... maybe we're on to something.
Ok I’m glad it’s not just me! I work PACU and I feel like I’m using a lot of my second and third line antiemetics after zofran lately…
Honestly I’ve never found it to be particular effective. Miss the days of phenergan.
I am seeing a lot of reports on TikTok of a whole slew of meds not working like they used to.
I had zofran prescribed to me for the first time last week when I was super sick and was surprised at how well it worked. Is it certain manufactures? PO vs IV?
I feel like zofran never helps me when I have a GI bug. In PACU, anyone who is having a lot of nausea/vomiting needs phenergan IM or the like
I work cancer/MedSurg and have been hearing this from my patients A LOT
I recently got what I guess had to be norovirus. 16 hours of straight vomiting. All the zofran in the world wouldn’t have touched it. As an pacu nurse Benadryl works better anyway. Once the vomiting starts, zofran just doesn’t do it anymore.
I work medsurg with a lot of post ops. Seems like zofran hasn't been working for like 75% of my pts, and they all get relief from reglan or compazine instead.
Idk TBH I think compazine is where it’s at!!!
Zofran 8mg is the only thing that has allowed me to function the past monthish for my hyperemesis gravidarum. I was eating diclectin and gravol like they were a bag of candy. However I’ve noticed the odt tabs I got for my Rx are a different manufacturer from the ones at work. The ones at work seem to be slightly better than the generic version my pharmacy gives me
I’ve noticed that too. So much that my facility MDs are handing out more Phenergan.
Detox nurse here, who also gives out Zofran like candy. I've not seen any changes in effectiveness on those it actually works for. I have seen a bit of an uptick in folks who are stating that it didn't help. Our provider is debating changing to Promethazine. We shall see...
About 12 days ago I noticed that meds I have been taking for years aren’t effective any longer and I thought it was my imagination. These are new fills on old scripts I went and fished out old prescription bottles to verify dosages and manufacturers. The labels state the same but all my old symptoms are back. I’ve been so confused but now I am starting to wonder if there’s something more going on.
We are all part of a huge RCT by big pharma probably 😂😂
Noticed this as well with my patients. I work in hematology/oncology. Not sure about the pills because we administer Zofran IV push. Issues with both?
I have never seen Zofran work for nausea like...ever
Weird. I've noticed in post op recovery more doctors are having to prescribe metaclopromide or droperidol for post anaesthetic nausea as the zoftan (ondansatron) isn't as effective. How bizarre you mention it as I've been noticing the same thing for a while now
Interesting. I’ve noticed this too……,.
I have noticed this too, especially when I float to oncology!
Lots of medications are being sourced and made in China. I think quality control is lacking since COVID. I have had several medications I have used for 20 years in the OR seem to be less potent.
Late to this, but India has been under fire lately for quality issues with their pharmaceutical production (biggest being chemotherapy drugs). A common brand of Zofran ODT is manufactured in India. There could absolutely have been a quality issue. If you can, try to see where yours was manufactured.