Interesting (alarming?) article on popular surgical anti-nausea drug

Most of us probably had promethazine (phenergan) either in pill or suppository form after our weight loss surgeries to prevent nausea. I know I did. I also know I had it in my IV during my plastics operations. And in the hospital before my blood transfusion. Doctors love to pu**** on WLS patients like crack dealers, because we're so notorious for having vomit issues (the reputation is deserved). I'm seriously wondering if the IV promethazine contributed to my thrombosis and phlebitis that I developed in the vein they used. It's EXTREMELY painful and I'm told will take months to fully resolve. And this drug has a reputation for being problematic. I've been doing some digging and have found various accounts of people having vein problems after getting it in their IV.

It's very acidic and can 'burn' your veins. I googled "IV promethazine" and found the following disturbing article (first result!):

"Preventing Serious Tissue Injury with Intravenous Promethazine (Phenergan)"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697094/

There were many other articles, and even a youtube video, about people having vein problems after getting this drug intravenously. Here's what I took away from my research:

-Lots of people have adverse reactions to it. Some hospitals simply don't use it anymore (the IV form, that is)
-It can be useful but only if used by someone who knows what they're doing, I.E:
-It needs to be used very sparingly
-It needs to be properly diluted
-It needs to be administered slowly
-It needs to be administered to the right type of vein


I know we all like to think that the professionals who are treating us are MORE educated and thorough than we are. But this can be a dangerous assumption. I know I'm the world's most annoying patient because I'm always looking up stuff like this and grilling my healthcare providers about it. Sometimes they get offended because they think I'm doubting their competency and trying to tell them how to do their job. But I find that it goes over smoother if I say things like "I read this article and it made me really concerned, can you address the points they bring up for me? How do you handle this drug?" That's certainly what I'll be saying to my anesthesiologist next time I go under for any type of surgery. I'm going to print out the article, explain about my previous vein injury, and refuse the IV promethazine. There are alternatives. I'm going to ask for those instead.

Food for thought!

As a nurse I've seen less and less of this drug used. And its not even for this reason. Its other side effects are pretty intense as well. The popular one that we use more frequently now is Zofran/Ondansetron.

I am a RN also and I second what Michelle says!!  We are using that MUCH less often and it is because of the other side effects.  I can't remember the last time I gave it...zofran is what is used most now in our hospital.

Patty

another RN joining in here.  Worked for the Cleveland Clinic and had my plastics there as well.  Used to give zofran as an RN and that is wht I recieved as a patient as well as a scopalamine patch that I kept on for 2 days after surgery

Scope patches are great!. I get sick every single time I have surgery and was never offered one. Working on the recovery side now, I know I'll demand one the next time I need surgery.

I actually can't take phenegran as it makes me throw up. I know its supposed to stop nausea but for me it doesn't work that way. My emergency room used to use it as part of the migraine ****tail and I always told the nurse I can't take it. They never listened to me and I ended up throwing up. They still tried to convince me it was the other meds and not the phenegren. Till my last hospital visit. They gave me something else that worked great. They listened when I told them about phenegren. Such a nice change to have them listen to me.

Thanks for this post. It gave me some things to discuss w/ my Dr. and Anesthesiologist.
Steve

Thank you so much for sharing this, and to the health care providers for offering their opinions! I am very worried about nausea for my Friday procedures, as it kept me in the hospital three times as long as expected after my RNY. I will definitely discuss this with the docs before my procedure. Thank you again!