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Zofran (ondansetron Hydrochloride). North Country EMS Protocol Option July 2010. Brand versus Generic. Brand- Zofran Cost- ~$66.00 for 4 mg Generic – Ondansetron Hydrochloride Cost- ~ $5.00 for 4mg.

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zofran ondansetron hydrochloride

Zofran (ondansetron Hydrochloride)

North Country EMS Protocol Option

July 2010

brand versus generic
Brand versus Generic
  • Brand- Zofran
    • Cost- ~$66.00 for 4 mg
  • Generic – Ondansetron Hydrochloride
    • Cost- ~ $5.00 for 4mg
slide3

Zofran (ondansetron hydrochloride) can be used instead of Reglan (metoclopramide)as an antiemetic.

    • North Country EMS 2007 Protocols
      • Acute Coronary Syndrome (page 18)
      • Nausea/Vomiting (page 35)
zofran ondansetron hydrochloride4
Zofran (ondansetron hydrochloride)
  • This is approved for use in adult protocols.
  • Not approved for use in pediatric protocols.
  • Medical control order would be needed for Pediatric patient and dose is 0.1 mg/kg for children 2-12 y/o, if under 40 kg (88lbs)
  • Optional for agencies to carry.
slide5

OLD

  • CARDIAC – ACUTE CORONARY SYNDROME (ACS)
  • (Suspected Cardiac Chest Pain)
  • Routine Medical Care
  • Chewable Aspirin 162 mg total
  • EMT-CC / EMT-P
  • If SBP >100 Nitroglycerine 0.4 mg SL*
  • May repeat every 3-5 min. x 2
  • Transport patient as soon as feasible. Obtain 12 Lead ECG (if available)
  • Do not delay transport
  • Nausea/Vomiting present - Metoclopramide (Reglan) 10 mg IV/IM
  • If chest pain persists and SBP >100
  • Morphine 2 mg IV
  • May repeat every 5 min. up to 20 mg
  • If heart rate >75 and SBP >100
  • Metoprolol (Lopressor) 5 mg IV slow

May repeat X 2 every 5 min.

  • Complete fibrinolytic checklist (Pg. 81, if transport time allows)
  • Do not delay initial Nitroglycerin therapy to establish IV access.
  • Nitroglycerine is contraindicated in patients who have taken
  • Erectile Dysfunction medication within 24 hours.
  • If SBP <100 without Altered Mental Status; consider Medical Control consultation for Nitroglycerine administration.

NEW

  • CARDIAC – ACUTE CORONARY SYNDROME (ACS)
  • (Suspected Cardiac Chest Pain)
  • Routine Medical Care 
  • Chewable Aspirin 162 mg total
  • EMT-CC / EMT-P
  • If SBP >100 Nitroglycerine 0.4 mg SL*
  • May repeat every 3-5 min. x 2 
  • Transport patient as soon as feasible. Obtain 12 Lead ECG (if available) 
  • Do not delay transport 
  • Nausea/Vomiting present –

Metoclopramide (Reglan) 10 mg IV/IM

or

  • Ondansetron (Zofran) 4 mg IV/IM

(may repeat X 1 after 5 minutes if no relief)

  • If chest pain persists and SBP >100
  • Morphine 2 mg IV
  • May repeat every 5 min. up to 20 mg
  • If heart rate >75 and SBP >100 
  • Metoprolol (Lopressor) 5 mg IV slow

May repeat X 2 every 5 min.

 Complete fibrinolytic checklist (Pg. 81, if transport time allows)

  • Do not delay initial Nitroglycerin therapy to establish IV access.
  •  Nitroglycerine is contraindicated in patients who have taken
  • Erectile Dysfunction medication within 24 hours.
  • If SBP <100 without Altered Mental Status; Control consultation for Nitroglycerine administration.
nausea vomiting
NAUSEA / VOMITING

Indicated for patients experiencing nausea and/or vomiting as a result

of disease, medications or acute motion sickness.

EMT-CC / EMT-P

Routine Medical Care

Consider Fluid Challenge

(Pg. 26)

Metoclopramide (Reglan) 10 mg IV/IM

Or

Ondansetron (Zofran) 4 mg IV/ IM

(Slow IV Push 2-5 minutes)

(May repeat x 1 if no relief after 5 minutes)

zofran ondansetron hydrochloride7
Zofran (Ondansetron Hydrochloride)
  • Class-Antiemetic
  • Description –Serotonin (5-HT₃) receptor antagonist-Blocking action may take place in CNS at area postema (chemoreceptor trigger zone) and in peripheral nervous system on terminals of vagus nerve
  • Indications- nausea and vomiting
  • Contra Indications – Hypersensitive to drug
  • Precautions-In pregnant and breast-feeding women use cautiously, may be excreted in breast milk, may cause syncope if pushed to fast
  • Dosage- 4 mg slow IV push (over 2-5 minutes) or 4 mg IM
zofran ondansetron hydrochloride pharmacokinetics
Zofran (ondansetron Hydrochloride)Pharmacokinetics
  • Absorption: Variable; bioavailability is 50% to 60%
  • Distribution: 70% to 76% is protein bound
  • Metabolism: Extensively metabolized.
  • Excretion: Primarily excreted in urine, can be excreted in feces or breast milk.
  • Half-life : 4 hours
zofran ondansetron hydrochloride adverse reactions
Zofran (ondansetron Hydrochloride)Adverse Reactions
  • CNS: - Headache
  • GI: Diarrhea, Constipation
  • Skin: Rash

Side effects may include: constipation, diarrhea, drowsiness, dizziness, fatigue, headache, impaired wound healing, itch, decreased heart rate, fever, anxiety/agitation

slide11

Any questions please contact North Country EMS at 315-379-3977.

  • You must complete training program and quiz prior to using medication.
  • Agencies must keep copy of providers completed quiz on file, provider must obtain 80% or better on quiz.
  • Documented remediation from training officer or medical director required if score is 80% or less
works sited
Works Sited
  • Springhouse Nurses Drug Guide 2005, pg 942.
  • North Country EMS 2007 Protocol Book
  • Physician Desk Reference Health (pdrhealth.com)