There are many other anti-emetics that work as well as either Phenergan or Zofran. It's not an either/or proposition. How about Compazine or Reglan? In my practice, I personally don't find Zofran to be the wonder drug that some feel it to be. 

Toby S. Knight-Meigs, RN,BSN,EMT-P,RRT

Staff Nurse ED/ICU/Med-Surg

Lower Umpqua Hospital

Reedsport, OR

   We had our own problem here at U of L not to long ago.  A patient in the ER had an IV site in the right brachial vein in the bend of the arm (ER's favorite place to put um) that extravasated after a push of phenergan (diluted like it should be, not that it actually helps) and ate through the brachial artery at the same time.  We tried to save the arm, but she ended up losing it anyway.  The hospital is fianally listening to us, but that is what it took to make them listen.  The patient has become a great advocate for others. 

   We also just got rid of Dilantin.  It only took us 3 years and multiple law suites.  The patients want the phenergan, the doc's say it works so well, and it is cheap.  It's been a long battle, but I think it is FINALLY coming to an end.  Thank God!

Heather

Kathy Kokotis

Bard Access Systems

Zofran is now generic and its cost is almost equal to phenergan

Zofran was at almost $18.00 and phenergan at 1.00.  Now they are almost the same with the generic zofran.

One of my pharmacists informed me of this last week

Zofran has none of the issue of phenergan

kathy

Ann,

Would you mind sending me an email, I have another question for you about this. 

So good to hear from old aquaintances!!

Kathy Dodd, RN, BSN

kdodd@hhcs.org

One of our IV RNs testified as an expert for this case.  I am familiar with Diana -  through a close friend, and I sang in an a capella group with her sister.  It's had a big impact in our small Vermont communities.

I'm grateful not for her tragedy, but am grateful that it has gained national attention.  Because of it, it seems that all of the ISMP alerts about phenergan that I hand out to MDs and RNs are having more of an impact.  We may be able to remove the IV route from formulary.

I pray the Supreme Court does the right thing, and that the precedent that will be set by this decision will be on the side of the consumer - not the drug manufacturer.  Perhaps the labeling issues r/t heparin this year will help decide this case. 

Mari Cordes, BS RN 

Ann Zonderman, BSN, JD, CRNI, LHRM

 Court weighs amputee's case, limits on drug suitsBy MARK SHERMAN Associated Press Writer WASHINGTON (AP) - A Vermont musician who lost her arm because of a botched drug injection is squaring off against a drug maker and the Bush administration in one of the most closely watched business cases of the Supreme Court's term.At issue is whether the federal government can limit lawsuits by consumers like Diana Levine who have been harmed by prescription medications.The justices are hearing arguments in Levine's case Monday, shortly after the court announces whether it will accept other cases for argument sometime next year.The issue of limiting lawsuits arises in the heart-rending story of Levine, a guitarist and pianist who lost her right arm after an injection of the anti-nausea drug Phenergan, made by Wyeth Pharmaceuticals.A Vermont jury awarded Levine $6.7 million, agreeing that Wyeth should have been clearer in its warning label about the risks of improperly administering the drug.Wyeth and the administration, however, are asking the court to rule that drug makers may not make changes to labels without the approval of the Food and Drug Administration and that people cannot sue under state law for harm caused by an FDA-approved drug.In recent years, the administration and business groups have aggressively pushed limits on lawsuits through the doctrine of pre-emption - asserting the primacy of federal regulation over rules that might differ from state to state.

2008-11-03     12:42:28 GMT

I have heard a little about this but have not kept up closely with the details. Please keep us informed or give us a website where we can read more about it. Thanks, Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Ann Zonderman, BSN, JD, CRNI, LHRM

To anyone interested, the US Supreme Court held hearings last week regarding the damage  IV push phenegran has caused.  The manufacturer claims that FDA guidelines do not require additional warnings on the drug and they are not responsible as the     FDA approved the drug for use.  Hearing the Justices was great to show that they seem to think being responsible is a key ingredient to being accountable.  Their formal response usually follows – but will likely take a while… Ann Zonderman

The IV injection of promethazine has had reported risk documented as far back as the 1960's when accidental arterial injection was reported. My first case involving promethazine extravasation was in 1996 and I found this statement in the book Intravenous Medications, published annually be Mosby even back then - "Determine absolute patency of the vein. Extravasation will cause tissue necrosis." I also published articles in Nursing99 and Nursing2002 listing promethazine as a vesicant. 

In August of 2006, ISMP published their warning about this drug which was based on numerous lawsuits that had been published in regular newspapers. This was truly not the beginning of the problem. It was the first time that a nationally recognized organization published anything calling attention to this problem. 

It is my firm belief that each facility must take a hard look at all of their anti-emetic practices with a strong policy created.  Promethazine IV must be treated with the same high level of respect that all other antineoplastic agents receive. A literature search will produce numerous articles about the benefits of promethazine as an antiemetic, however there is almost nothing in the professional literature about the horrible outcomes with this drug when the correct nursing actions are not taken. 

When I look at a case, I consider what the nurses did to prevent the problem as outlined in the INS standards of practice, how quickly did they recognize that an infiltration/extravasation was happening, and what interventions did they use to mitigate the problem. 

The national standard has always been that the nurse must know the drugs they are giving and the possible problems and how to administer them safely. This is not anything new. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Kathy Dodd, RN, BSN

Infection Control

Hamilton Medical Center

Dalton, GA

706-272-6523

kdodd@hhcs.org