Comments on: No more Tigan suppositories

By: Paul Miller

Paul Miller — Sun, 30 Mar 2008 16:16:36 +0000

What about Prochlorperazine (i.e., Compazine) as an antiemetic? I’m new to this site so forgive me if it’s already been mentioned before. I’ve been given an injection of it in the past for nausea (though they wouldn’t let me drive home!). But I also have Compazine suppositories (25 mg.), which I use a few times per year (if I’m exceedingly nauseated and am afraid for example that taking Phenergan or Tigan orally will take too long to work if I’ve recently eaten a meal).
Is either Tigan or Phenergan effective (somewhat) for anxiety as well as nausea?
Would appreciate any advice.
Paul (forlino@ca.rr.com)

P.S.: Are there any websites or blogs such as this whereby one can ask a question of a doctor who specializes in inner ear problems? I’m having a frightening problem (which I hope isn’t permanent) after taking the cough syrup Hydromet (hydrocodone + homatropine) which sent me to the E.R. with pressure in one ear that continued to worsen and the fluid never drained.

By: tennisdoc

tennisdoc — Sun, 22 Apr 2007 03:02:52 +0000

I have been using tigan supps for about 15 years. A few years back medicaid said they weren’t effective. Like darvocet, there are a people who do respond.
Most of our mothers are in the business of instant gratification.
Can’t use phenergan, Zofran works, but too expensive. Maybe we can be like the pediatricians, give topical phenergan and tell them to see a different doctor if it doesn’t work.

By: TheNewGuy

TheNewGuy — Sat, 14 Apr 2007 12:25:48 +0000

Listen to the research. If it doesn’t work, it doesn’t work, no matter how much you want it to or think it does

Are you sure about that? Beware… be careful basing your practice on one study or one opinion. The FDA has made some sketchy decisions before, and I’m fairly skeptical that tigan “doesn’t work.” They may have to cone down their study groups a bit, but I’m not buying that it doesn’t work at all. Even if the pharmacological effect is minimal and there’s a big chunk of placebo effect, that’s true for plenty of other medications, and if it helps, it helps. People talk about the placebo effect like it’s some great evil, but it helps your patient, and in that sense, the placebo effect is good.

Also, I’m aware of the data that shows tylenol#3 and Darvocet are indistinguishable from plain tylenol in blinded studies, and most of the time I’d agree… but I’ve seen clinical situations and patient populations that seem to benefit from those drugs more than you’d think… two examples off the top of my head are tooth pain and little old ladies, respectively.

Evidence-based medicine is great, but be careful that you don’t worship at that altar so much that you discount the art that only comes from clinical experience.

But maybe that’s just me getting older and crustier.

By: Trenchy

Trenchy — Fri, 13 Apr 2007 10:15:09 +0000

Now let’s watch one of the big drug companies announce a new anti-emetic in the next 6 months… since when does the FDA give a rat’s ass if something is effective?

By: just the ER doc

just the ER doc — Fri, 13 Apr 2007 04:03:38 +0000

Listen to the research. If it doesn’t work, it doesn’t work, no matter how much you want it to or think it does. It is placebo effect (which in and of itself is not bad as long as you do not cause side effects). It is like codeine, for which there is ample evidence that it is not more effective than plain tylenol or ibuprofen for pain, and we certainly know that it causes nausea. Darvocet is a similar med, clearly not superior to plain tylenol or ibuprofen. I can’t understand why any doctor would still prescribe these meds unless there is a significant placebo effect in the patient’s mind from previous use of the meds. Dangerous to prescribe meds that don’t work any better than safer and equally effective alternatives.
That’s my two cents anyway. I’m a young doc, 2 years out of residency, and I’ve never prescribed a tigan suppository in my life. No need to really.

By: Kim

Kim — Thu, 12 Apr 2007 23:30:55 +0000

Gee, it’s always worked in the pediatric population. Now what do we do since Phenergan is no longer an option?

Granted, not all kids need an antiemetic but how can they say it doesn’t work?

Not happy at all to read this!

By: John J. Coupal

John J. Coupal — Tue, 10 Apr 2007 21:53:05 +0000

Dear Dr. [fill in the name]:

Tigan suppositories have been prescribed for decades. Many doctors have been satisfied with the product’s performance.

We have just decided that the suppositories don’t work. We are ordering them off the market.

Sincerely,
The FDA
“Your Tax Dollars at Work!”
Have a nice day.

By: PaedsRN

PaedsRN — Mon, 09 Apr 2007 20:04:10 +0000

Zofran went generic? Cool! Sorry, OT but I hope that’s going to make a real difference to the way it’s prescribed… how often, at least.

We have a hospital policy to try certain other drugs first (including metaclopramide) and finishing with ondansetron if the others don’t do the trick. There’s often a certain amount of gentle nudging from the nursing staff in the direction of prescribing ondansetron first, since it’s so effective and we see relatively few adverse effects.

Haven’t seen or worked with Tigran in this neck of the woods.

By: Ten out of Ten

Ten out of Ten — Mon, 09 Apr 2007 12:58:30 +0000

I too have been using oral zofran since the NEJM study came out about a year ago. I have the nurses put 2mg in the nipple of a pedialyte bottle, and have them take it with 2oz of pedialyte. It’s a one time dose thing.

Also, zofran went generic earlier this year.

By: scalpel

scalpel — Mon, 09 Apr 2007 05:16:57 +0000

I just give them one dose to get them out of the ER and through the night; then they can followup with their own doc in the morning.