Question about Anti-Nausea Meds

[Sally Girl]

My daughter takes Zofran, but she doesn't get nearly enough from our insurance company (they denied an increase). Her doctor has also prescribed Tigan and Compazine supps.

Can she take the Zofran with the Tigan or Compazine in the same day?

She needs to ask him this when she sees him, but I thought I would ask it here also.

Cheryl

[Pharmacist.steve]

According to my drug interaction database ... "... no significant interactions known or found for these drugs...."

[Sally Girl]

Thank you for your response!

Cheryl

[Kira]

My current plan (worked out with my GI) is like this:

If I start having significant nausea/vomiting, I take a Zofran ODT. (BTW, my insurance will only give me 9 Zofran at a time, but I can get it refilled again after I use up my 9 tablets).

If the Zofran doesn't work, I take Phenergan (pill or suppository, depending on how bad the vomiting is).

If the combo of Zofran and Phenergan doesn't work, then I'm supposed to call my GI or PCP and go in to get IV fluids (D10) and IV antiemetics (infusion center, ER, or hospital stay, depending on how bad I let it get).

For me, it is REALLY important to get the nausea/vomiting controlled quickly, because I can't tolerate missing meals due to my mitochondrial disorder. If I let it go for too long before controlling the vomiting with meds and/or getting a bunch of IV glucose and hydration... then I end up in this endless cycle of nausea/vomiting, which makes eating/drinkng nearly impossible, which causes a bunch of metabolic decompensation, which triggers even more vomiting (along with all of the other "fun" things my various organ systems do when I'm having a metabolic crash). And on and on it goes.

Between my gastroparesis/slow motiliy, my cyclic vomiting syndrome, and my mom's two cycles of chemotherapy, I have really gotten familiar with the different anti-emetics available.

I have tried zofran, anzimet (a cousin of zofran), droperidol, compazine, tigan, phenergan, reglan... my mom has tried zofran, compazine, emend, ativan, dexamethasone (helps with the nausea from some of the chemo she had), and droperidol.

For me, the tigan didn't do much... the compazine gave me bad side effects... the reglan didn't' work AND gave me bad side effects... the anzimet and zofran worked somewhat and were about equal... and the phenergan and droperidol worked okay but they both knock me out.

My mom did best with emend in the morning before chemo and then for three more days, a big IV dose of zofran and dexamethasone during with the chemo infusion, ativan before chemo to help with anticipatory nausea, and then zofran as-needed at home. She had the same compazine side effects as me (akathesia... this horrible sensation of being really drowsy but simultaneously being really restless and agitated). She has only had the anzimet and droperidol in the hospital, after her colon cancer surgery... both worked okay, but the droperidol did make her sleepy (which wasn't such a bad thing, since she was just resting in bed in the hospital anyhow).

I don't know the cause of your daughter's nausea/vomiting, so I'm not sure if any of this would help her... but some of the things that have really helped for me are eating small, frequent meals (because of my gastroparesis)... avoiding foods that slow stomach emptying even more (fat, fiber, etc) and eating softer food that is easier for my stomach to empty (liquids, sherbet, cream of wheat... rather than a big ol' steak or something).

Also, it always works out better when I go in for IV fluids/sugar/meds early on, to prevent it from turing into that vicious cycle. I have had so many bad experiences with the ER/hospital in the past couple of years, though, that I tend to procrastinate and make excuses until things are really bad.

Anyway... I hope you & your daughter are able to find a combination of nausea meds that works well for her. While I still get nausea/vomiting, it has definitely been easier to manage at home lately, once we came up with a regimen that works for me.

[Gymnast_Navy_Wife]

I have no experience with Tigan or compazine; but I do with Zofran and Phenergan (one Kira mentioned).

I take anti nausea meds on a fairly regular basis due to side effects from meds and/or any other type of thing (such as just a bug) that might cause nausea as soon as I feel it coming on it; and when I am nauseas I am usually unable to eat/drink much or take my "must take" meds -- such as my anti seizure meds and certain vitamins. Due to my low weight, history of malnutrition/FTT (failure to thrive), vitamin deficiencies and other reasons, its vitally important & essential for me to be able to keep eating/drinking/taking meds.

My "first line of defense" is Zofran ODT (disolves when put on your tongue/mouth--doesn't have to be swallowed). 4-8 mg of it usually does the trick and either totally resolves it or minimizes the severity to the extent I can keep hydrated and take meds.

However, when Zofran doesn't help and the nausea/vomiting continues to the extent where I can't take clear liquids or is just unbearable; I take a combination of Zofran and Phenergan (the oral/pill form)-- alternating them every 4-6 hrs. I always take the Zofran first-- even if I am alternating the two meds; because my body can't tolerate phenergan suppositories and I have side effects from both the suppository and pill form.


I have never had any problems or medical contradictions when I've alternated them. In fact, I first came to know about Zofran-- my wonder drug when I was in the ER for the stomache flu and the ER doctor was the 2 drugs to try to get the nausea/vomiting under better control.

As for the insurance thing, my insurance/pharmacy will only allow up to 15 tablets at a time. 15 tablets can last me anywhere from as long as 2 months if my meds aren't causing nausea on a consistent basis and haven't had any other GI issues; or they can last as little as 2-3 days if things are really bad on a regular basis or I've had other GI problems too--- this happend this past week when I developed a nasty strain of the GI bug which kept me nausea and unable to eat for almost a week. So, what my doctor does, like Kira's, prescribes several refills so that when I run out or am close to running out, I can just call it to the refill pharmacy.

Good Luck and I hope your daughter starts to feel better soon !

:) GNW

[Peter B]

Kira,
Not only is your plate full, it's overflowing. I sure hope you find an answer to any or all of your issues, that are at least tolerable.
The reason I'm posting is, after going back up to my room following my amputation I was nauseous as all get out. The doc had the nurses put something in th IV and WHAM, no more pukey feeling.
Upon release from the hospital I was prescribed an anti nausea med in case I had any more probs. I inquired how much the med cost at the drug store I go to and was informed that a months supply would cost me in the neighborhood of $3,000. I was floored, to say the least. I can't remember the name of the med. but was curious; Do all anti-nausea meds cost big bucks?

Pete

[Sally Girl]

Thank you for the responses. Her problem is that she doesn't respond really to any of the anti-nausea meds really, except for Zofran. She has tried everything that is reasonably priced in both oral and in suppository form. I know there are some really spendy and powerful anti-nausea meds for cancer patients (like Kytril), but our insurance won't cover them.

I called a patient assistance program for Zofran, and it sounds like my daughter is going to qualify for it because she is on SSI.

My daughter is in such terrible shape, and it isn't getting any better. She has some perplexing neurological conditions (Chiari/Syringomyelia/Pseudotumor). We're in the middle of getting her shunt evaluated, but it has turned out to be a very frustrating process (thanks to big "M" Clinic).

We have an appointment at our university medical center in one month. Before that appointment, I am taking her to a new neurologist in Chicago to get some sound advice. Several of my friends see him, and he has offered to look at the big picture for her. He is pretty brilliant.

My daughter has a fabulous G.P. who manages her care (pain meds and such). But when you go to "M" Clinic to get some help, and their specialists don't understand, it is so frustrating.

M Clinic is big time into going into detox/pain rehab and bite on a bullet the rest of your life.

Lyrica has put some pounds on my daughter, and she won't starve to death anytime soon. But she can barely eat, she has given up on being vertical, she is in very severe pain 24/7 despite being on a very high dose of Duragesic.

I know what I am seeking--a neurosurgeon who can get a working shunt for her ICP issues. Then we can work on the rest of her problems one at a time.

Thanks for listening.

[Peter B]

Sally,
Is the big "M" clinic the Mayo? I've heard nothing good about their attitude with regard to Scheduled meds. For such an esteemed medical facility to be so backward is a real shame.

Pete

[Sally Girl]

Yes, it is. And it is so darn sad! You go to them to get help, but if you are on narcotics, it puts a big wall between you and them. They just can't see past it. It affects how they look at you and what they offer for treatment.

My daughter has been in severe pain since 2000. She has had very excellent neurologists who believe in pain management--places as prestigious as Mayo Clinic.

We went to Mayo Clinic because we live close to Mayo Clinic, and we are seeking a local neurosurgeon, rather than our current neurosurgeon who is nine hours away.

The Mayo neuro was with her for twenty minutes and then declared she was addicted to narcotics and needed detox and pain rehab.

Forget about the specialists throughout the years who have spent countless hours managing her care and prescribing narcotics. Just throw that all out the window and come down on her with such arrogance.

It really makes me sick, but we are actually going back there next week for a couple of appointments. I canceled the appointments the neuro made for detox and pain rehab. I'm sure he is going to royally chew me out for that.

There are new studies coming out of Northwestern University in Chicago how chronic pain changes the brain (not in a good way).

Isn't Mayo behind the times in their views on pain management?

Cheryl

[gambles]

As for the meds, I can't figure out why some months I get 9 Zofran 8 mg and some months I get 12. There is no pattern. I use both Phenergan and Phenergan suppositories with the Zofran.

I didn't see anyone mention ice bags for nausea in the responses. I use them constantly. I have no idea why they work or when I started, but somehow I naturally starting packing my abdomen with the blue ice bags to try to stop from vomitting - along with meds of course. Every now and then I come across someone else who does the same thing. I felt particularly validated for my bizarre nausea treatment when a talk show host in the 90's mentioned doing the same thing. It might be worth a try while waiting for meds to kick in.

Also, you have probably thought of this, but is your daughter on the 8 mg Zofran?? If by some chance she takes 4 mg, you can get the 8 and cut them and end up with double. It's a long shot, but I wanted to ask just in case.

One last thing, your daughter is very lucky to have you! :)

Suzanne