Phenergan....good or bad?

[vs-eh?]

WHAT!? and HUH!? I have zero idea what your argument is here, and judging by the fact you refer to this drug as "HCL" in your opening sentences you don't know much about pharmacology either. PSSSSST.....A lot of drugs have HCL in their names....you can look it up.

You are questioning a doctor about various medical things and you are an EFR... And discussing the "poison" in this persons body...

I could go on...

Perhaps you could describe more about your friend and their current medical condition and give your reasons why you think this drug (which to the best of my knowledge isn't used in EMS in Canada) is rigt for them...

[NREMT-Basic]

The following is from the website rxlist.com concerning phenergan/promethiazine hcl"

DRUG INTERACTIONS

Injection:

Narcotics And Barbiturates: The CNS-depressant effects of narcotics are additive with promethazine hydrochloride.

After reading this extra long post about Phenergan, which is really quite interesting, I spoke with a friend of mine who is a extremely knowledgeable and experienced pharmacist. His experience would indicate that EXTREME caution must be taken when administering Phenergan with morphine and other opiates/opioids as well as drugs in the benzodiazapine class since both phenergan and these classes of medication can have a HIGHLY suppressive effect on the CNS. In addition, Phenergan on its own, let alone combined with other narcotics/benzos, etc has the effect of producing extraordinarily soporific effects, disorientation, loss of memory, hallucinations (both auditory and visual) disorientation as to person, place and time, suppression of respiratory function, decreased cardiac efficiency as well as hypertensive crises.

Having had personal experience with nausea meds since an auto accident in 2004, I can say that there is little else on the market that is as effective an anti-nauseant/emetic. However, I have also landed in the hospital due to a poor combination of drugs prescribed by my physician after taking phenergan for the nausea associated with vicodan. My respriatory function was supressed to the point that the ER staff had intubation tray standing by, and would not let me move and had the room darkened as my B/P was 210/100. The reason I ended up in the ER with this was that my roomates found my in a sleep from which I could not easily be awakened, extraordinarily labored respiratory effort, LOC as well as a host of other emergent medical concerns.

All of that being said, I have found phenergan superior to both compazine and zofram, but there is a spate of literature cautioning its use with other CNS function drugs.

Being only a Basic, I full well expect to get bashed for having done some research and daring to post it. Thats ok though. I know what my own research and personal experience have shown and am confident in the information provided to me by my pharmacist friend.

[BushyFromOz]

You know it was quite an informative read until you posted this BS line at the end

Being only a Basic, I full well expect to get bashed for having done some research and daring to post it. Thats ok though. I know what my own research and personal experience have shown and am confident in the information provided to me by my pharmacist friend.

What do you think you are some kind of pioneer for doing this? Irony is if you do get bashed, it wont be because you are a basic, but because you threw in a whining whinging little tantrum comment at the end.

Personal experience and expert opinion though valid, are the lowest form of evidence in EBM. What you refferred to as a "spate" of literature is what you should be referring to. Personal opinion and expert opinion are not research, so in fact you really did nothing except have a phone call with your pal and post it here.

You seem surprised that adminsitration of one CNS depressent with another CNS depressent may in fact....wait for it.....depress the CNS?

[NREMT-Basic]

Bushy-

had you read my post instead of scimming it, you would have been privy to the fact that I was agreeing that Phenergan suppresses the CNS and in conjunction with other CNS depressants can make for a potentially lethal cocktail. And, if you are or have been schooled in research methodologies you would know that the opinions of experts are VALID forms of research Perhaps you havent gotten that far in Uni so far.

As far as my comment about being a Basic and expecting to get slammed, well once again, experience on this forum and all others in the City has proven to be true. On many, MANY occassions, Basics who might have some knowledge even though he is not yet a Paragod, have been bashed, insulted, slandered and otherwise abused. The proof is in the forums for you to read.

Read carefully and you will see that I was contributing to the conversation about Phenergan and other CNS depressants with the information readily at hand. You and I have always gotten on well, so this little attack coming from you is quite a surprise, especially since you have been known to whine from time to time yourself.

[NREMT-Basic]

PS Bushy-

For an example of the bashing of Basics, you need only to actually READ Dust's posting about Basics not knowing NC's for extension tubing. Nuff said?

[Ridryder 911]

Bottom line everyone needs to be cautious on all medications given....

Phenergran is usually a benign drug which is probably one of the most administered medications and is commonly administered with analgesics to decrease the s/e of nausea.

There are way much more dangerous medications that ALS personnel comes into contact with.

I know in the U.S. that as year ago, my insurance was paying $42.00 a capsule for Zofran, and $1150.00 for ready-dissolve tabs (box of 10) ... when my wife was on chemo...

R/r 911

[ERDoc]

Let's face it. Every medication has lots of side effects listed. how many do we really see? How many serious side effects do we really see? The way a side effect gets put on the box is a problem at times. During clinical trials, pts are asked to report any symptoms that they develop. So a huge list of side effects is created, including the ones that were not related to the medication. Let's say that drug X is in phase 3 trials. You are part of this study and happen to develop diarrhea from the native water you drank on your trip to Mexico. If you report that you developed diarrhea, even though it had nothing to do with the med, it will be listed as a side effect. The more serious side effects are very rare, and yes you should think about them when you give a med, but they should not interfere with proper pt care. There is no way to predict who will develop certain side effects. Don't live in fear of the meds or you will not give them when needed.

Someone had mentioned that Zofran was not designed to treat nausea, but only prevent it when given prior to chemo/surg. Funny thing is, it works great even after a pt develops nausea. I've seen it work in pts who had no effect from phenergan. It works great in pregnant women with hyperemsis gravidarum. There are lots of meds out there that were not designed to do certain things, but we use them to do other things. Phenergan (and most of the antiemetics for that matter) were never designed to treat migraines, but they sure are efficient at it. You will never see trials for FDA approval for things like this because it is costly and most physicians know about it already.

Windsong, I'm not usre what exactly you are getting at with the story, but it was a little confusing. Obesity is not caused by "poisons." Just like VS said, there are a few other issues with this story. If you want some intelligent conversation, please reprint it and clear up some of the vague parts and let us know what exactly it is you want to know.

NREMT-Basic, you show that you are not "schooled in research methodologies." NO ONES opinion is considered a valid form a research. They are only what you said they are, opinions. As we all know, opinions are like arseholes, everyone has them. Most experts base their opinions on solid research (maybe this is what you were getting at). Research involves carrying out an unbiased study and examining the data to come to a conclusion. The whole idea of research is to avoid people's opinions and biases (including the so-called experts). Before you attack someone, make sure that your facts are correct. I have gotten far enough in Uni to know plenty about research methodologies, including designing and carrying out a study or two of my own. If you want to have an intelligent conversation about research methodologies, let me know, I will be more than happy to go over the topic a little (although, I think someone may have discussed the different types of studies on another threat). As Bushy said, case studies are the least useful form of study.

As Rid said, there are much worse drugs in your bags that you should be concerned with. Adenosine comes to mind. ANy drug that stops someones heart for a period of time tends to tighten the sphincter a little.

[NREMT-Basic]

If interviews with experts in the field are not valid research options, why do academic groups like the Modern Language Association continually update there methods for documenting these sources in research articles, papers, etc.

But, Doc, thanks for hijacking the thread.

[ERDoc]

If interviews with experts in the field are not valid research options, why do academic groups like the Modern Language Association continually update there methods for documenting these sources in research articles, papers, etc.

But, Doc, thanks for hijacking the thread.

As I said previously, opinions are not research. I don't know what is so difficult to understand about that. So what if some group updates the way they document the source. Evidence Based Medicine is based on research, not what someone thinks. Do a little internet search and look up what evidence based medicine involves, there is nothing about opinions. I can say whatever I want, doesn't mean it's research. Research involves doing a study, interpreting the data and coming to a conclusion. Again, which part of this do you have trouble with. An opinion is just that and doesn't mean a thing, now back it up with scientific data and it has some value. If you ever have to defend something you do, I hope you won't reply with, "Well Dr. so and so said to." It will carry very little weight and in the scientific community it will get you laughed at. If you say, "The ABC study published in XYZ journal showed blah blah blah," then your statement will carry some merit. Learn the difference between fact and opinion and their significance in a scientific conversation.

Sorry about hijacking the thread, I just wanted to correct your inaccuracies (it is nothing personal). If anyone else has a problem with me trying to correct errors and do a little educating in the mean time, please let me know publicly or via PM and I will not do so again.

[BushyFromOz]

You should pay more attention to my post Basic...

I said you seemed surprised it suprresses the CNS, i didn't say you denied it.

I also said that opinions are valid evidence BUT they are the lowest form of evidence. I paid attention to your post, you just didn't pay attention to mine

ERDoc - Public announcement, keep edjucating and posting my friend