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IV Zantac in Anaphylaxis

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OK, How many of you are using IV Zantac in Anaphylaxis. I am going to be doing our proposal to add it to our protocol and am wondering who else is doing it and using what regimine. Also if you can post the costs per vial I appreciate it so I can compare it to our prices.

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Posted · Report post

Not me, just wondering though, what else is included in yours that your adding Zantac?

Do you already have steroids?

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Posted (edited) · Report post

No Zantac here...just diphenhydramine (in addition to epi, albuterol and solumedrol).

Since the Benadryl seems to be a standard in these parts, I'm curious to know what are you hoping to gain by going with this drug?

Are you looking at adding it to the Benadryl...or instead of?

Edited by tcripp
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Posted (edited) · Report post

Not me, just wondering though, what else is included in yours that your adding Zantac?

Do you already have steroids?

We already have Epi IM, Epi nebs, Benadryl, Solu-medrol.

No Zantac here...just diphenhydramine (in addition to epi, albuterol and solumedrol).

Since the Benadryl seems to be a standard in these parts, I'm curious to know what are you hoping to gain by going with this drug?

Are you looking at adding it to the Benadryl...or instead of?

Adding it to the existing protocol. Using both H1 and H2 inhibitors combined decreases severity, duration and incidence of multiphasic reactions when compared to H1 blockers alone. Locally it is standard treatment once they get in the ER to give Zantac IV even if they have had steroids and benadryl,

Edited by croaker260
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Posted · Report post

It has drug interactions with several common Rx'ed medications: Valium, Coumadin, Procardia Glipizide, Metoprolol. Just to name a few. I doubt you'll get it even in the conversation to be placed into Anaphylaxis. Since its not a life saving medication. Benadryl works well. However, good luck in your quest. All the best...

In Hospital Care and EMS Care are not same. What the ER does or doesn't do, can't be the only reason to place it into the EMS protocol. Why is it so important to be a medication for you to have? Asking for protocol change is like pulling teeth. Been there doing/done it. You'll get a lot of resistance. Be ready. Good luck...

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Posted (edited) · Report post

It has drug interactions with several common Rx'ed medications: Valium, Coumadin, Procardia Glipizide, Metoprolol. Just to name a few. I doubt you'll get it even in the conversation to be placed into Anaphylaxis. Since its not a life saving medication. Benadryl works well. However, good luck in your quest. All the best...

In Hospital Care and EMS Care are not same. What the ER does or doesn't do, can't be the only reason to place it into the EMS protocol. Why is it so important to be a medication for you to have? Asking for protocol change is like pulling teeth. Been there doing/done it. You'll get a lot of resistance. Be ready. Good luck...

Actually my experiance has been totally different, and my reasoning is different as well. We are an unusual mix of urban/sunburban/rural and frontier all in our county (1000 square miles). We have transport times ranging from 5 minutes to an hour, and thats not counting the rare BLS assists out of county and the wildland fire fighting standby's. So based on the research we are looking to sustain the anti-histamine effects over a longer period of time in addition to the broad spectrum shotgun effect of solumedrol. We are not looking to imitate the ER, but to incoperate a treatment of proven value that will have wide acceptance by the medical community we give our patients to.

As far as our protocols, we actually have very progressive protocols with a "standards of care committee" who is tasked with constant revision of our SWO's. I personally was responsible for our 2005 version of our SWO's major revision which included all the grunt work and research. So I am well used to the trials and tribulations involved.

We have already had the preliminary informal conversation about it, thats why I am doing the formal proposal. Fortunately our agency has a 20 year history of open interaction with out medical directors (we have two) and revisions, presentations, etc are well received. Our protocols are very provider driven.

Edited by croaker260
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Posted · Report post

It has drug interactions with several common Rx'ed medications: Valium, Coumadin, Procardia Glipizide, Metoprolol. Just to name a few. I doubt you'll get it even in the conversation to be placed into Anaphylaxis. Since its not a life saving medication. Benadryl works well. However, good luck in your quest. All the best...

In Hospital Care and EMS Care are not same. What the ER does or doesn't do, can't be the only reason to place it into the EMS protocol. Why is it so important to be a medication for you to have? Asking for protocol change is like pulling teeth. Been there doing/done it. You'll get a lot of resistance. Be ready. Good luck...

What's wrong with imitating hospital care?

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Posted · Report post

I used to carry Tagamet IV back in in early 2000s when I was on the ambo. It worked great in conjunction with the other therapies.

Do not overlook the use of Phenergan as well...Phenergan is H1 blocker and it is first line drug for allergic reactions in countries like Aus, NZ, etc...if you talk to an Aussie please pronounce it as Fuh-Nur-Gen (Gen said like hen) :)

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Posted (edited) · Report post

I used to carry Tagamet IV back in in early 2000s when I was on the ambo. It worked great in conjunction with the other therapies.

Do not overlook the use of Phenergan as well...Phenergan is H1 blocker and it is first line drug for allergic reactions in countries like Aus, NZ, etc...if you talk to an Aussie please pronounce it as Fuh-Nur-Gen (Gen said like hen) :)

We dropped phenergan 2 years ago and went straight Zofran, in large part to the increasing warnings from the FDA. 20 plus years of clinical experiance not withstanding of course. :)

Anyway, so prior to that, Phenergan was a second line H1 blocker for us in anaphylaxis.

HOWEVER, I am looking for a drug to augment our H1 blocker with an H2 blocker. Solumedrol has its own batch of issues and problems that are often overlooked. I am not saying we are looking to replace solumedrol, just looking to improve and expand out treatment. The research I have reviewed specifically list using an H1 blocker WITH an H2 blocker (i.e. Zantac). I am just curious who else is doing it out of hospital.

Edited by croaker260
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Just an update:

Presented Zantac IV today and was approved by our SOCC and Medical Directors. It goes to the system wide medical directorate next month and will likely be approved. Only debate was wich would be mosr ecost effective, IV Zantac or IV Pepcid. We will likely go with one or the other.

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Posted (edited) · Report post

It has drug interactions with several common Rx'ed medications: Valium, Coumadin, Procardia Glipizide, Metoprolol. Just to name a few. I doubt you'll get it even in the conversation to be placed into Anaphylaxis. Since its not a life saving medication. Benadryl works well. However, good luck in your quest. All the best...

In Hospital Care and EMS Care are not same. What the ER does or doesn't do, can't be the only reason to place it into the EMS protocol. Why is it so important to be a medication for you to have? Asking for protocol change is like pulling teeth. Been there doing/done it. You'll get a lot of resistance. Be ready. Good luck...

Just another follow up, the overwhelming majority of the side effects listed are seen with Tagamet, not Zantac (10% of the rate of SE compared to Tagamet)or Pepcid (even far less).

Tagamet inhibits the cytochrome P450 enzyme system in the liver, wich is responsible for the metabolism of many drugs. Therefore it prolongs the metabolism of b blockers and other drugs, which may interfere with treatment of epinephrine and prolong the halflife of the offending allergen.

As for comparing Pepcid and Zantac...We are actually pushing for Zantac because of the shorter time to effect when given IV.

Edited by croaker260
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Posted · Report post

Can't say anything about Zantac, but we've had very good results with famotidine here, the only difficulty for some services is the refrigeration issue (we have Engle coolers on our trucks, so it's a moot point for us).

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