Inapsine
In honor of the full moon tonight, I would like to pay tribute to a pharmacological legend. Historically one of the all-time great emergency department drugs, our use of this product has unfortunately been sharply curtailed by the FDA black box warning. While its precise mechanism of action may be unclear, the fact is that this medication is an outstanding treatment for migraine headaches, nausea, agitation, psychosis, and all varieties of annoying drunks. Its most distinguishing feature?
It makes crazy people normal, and it makes normal people crazy.
At least for a little while.
I miss it.
Labels: drunks, ER, full moon, nightshifts, nighty night, reactions
posted by scalpel at 9:38 AM
14 Comments:
Ahhhh...full moon nights in the ER..memories...feeling sentimental about my job.
There does seem to be something to that - the full moon - we did get busy, CRAZY stuff but then there were sometimes full moon shifts that were average. :) I know staff always commented about the full moon and I think kind of psychologically braced themselves. :)
I don't think I saw droperidol prescribed even once in residency.
But now as an attending the other docs in the group, all out at least 10 years, apparently routinely prescribe it.
How exactly does a black box warning curtail prescribing practices? It's not illegal, right? Wikipedia says coumadin has a black box warning too. If you like it so much (as clearly the other docs in my group do) why not just go ahead and prescribe it? Does it make you nervous? Or administration?
I think I might need to lay off the coffee for the next few hours.
The black box diminishes my enthusiasm for administering that medication (we can't prescribe it because its only available in parenteral form). I'm not going to get an ECG before, during, and three hours after administering any medication for which there are alternatives. Too much hassle.
Despite the fact that the doses which have (exceedingly rarely) caused problems are exponentially higher than the doses I routinely have used (1.25 mg-5 mg), that black box gives the potential victim of an adverse effect an automatic position of strength in a lawsuit which I am not willing to concede to anyone.
Plus, since Compazine became available again I just don't need to use Inapsine as much.
The difference with Coumadin is that there is no reasonable alternative to Coumadin, and Coumadin is essentially required for certain life-threatening conditions.
Many hospitals just simply took it off formulary so you can't prescribe even if you wanted to.
I miss it so much. It got the batshit crazy people back home into their own bed not really realizing they had went to the emergency department
Oh man, you and me both!!! I love that drug. Best thing for nausea this side of...well, anything! I actually had it IM for sudden onset of nausea/vomiting and it worked like a freaking dream. It only took a tiny amount to relieve nause, too. Never had a patient with an adverse reaction and I was giving it many, many times a night. All it takes in one too many lawsuits and you can kiss your meds goodbye. They stopped making Tigan suppositories, too. So no Phenergan for kids and no Tigan for anyone. I wonder if the Zofran folks had anything to do with this.
"I wonder if the Zofran folks had anything to do with this."
Outstanding point. Follow the money.
Having been a PACU nurse for many years, I LOVED Inapsine. Even the small doses worked very well. The only problems I ever saw with it were the same as with any other drug in the class - i.e. Haldol. In high doses or when given too rapidly, EPS sometimes occurred. But then, I have also seen EPS with rapid administration of Reglan.
EVERY med is fatal for someone, somewhere. I agree, though. Why set yourself up for a lawsuit when there are viable alternatives available?
We have resumed using Droperidol as part of our PONV preventitive regimen, using only 625 mcg intraoperatively. Still an effective drug at an effective dose, with zero untoward or adverse effects.
I was seen in the ER as a patient and givin Inapsine. I was seen for minor Abdominal pain. This crap made me nuts for about 2 weeks afterward. Everyone says the effects wear off in 2 days. I was not monitored or even givin fluids as some nurses have told me they do. I suffered an electrolite imbalance, I've nearly lost my job over it. If there was an alternative I wish it had been considered. If it does to everyone else what it did to me I wish it was off the market!!!!!
Inapsine was administered to my 17 year old son for non existant naseau "just in case" without my permission. He reacted with such severity that it was as though he was having a stroke, paralysis, eyes rolled back and his heart rate was dangerously increased. He had several long term complications from it as well. I found out from my cousin, a nurse in Colorado, that they haven't been allowed to use it for years. It is disallowed in the UK as well. Why do you all seem to think it is so harmless? It nearly killed my son.
I'm a neurologist with extensive ICU and ER experience. I've used the drug > 100 times since 1990, without any untoward effects, largely for the purpose of enabling IV starts or lab draws in patents with hard-to-stick veins. I learned the trick from an anesthesiologist. The drug has muscle relaxant properties -- both skeletal and smooth muscle -- hence permitting the veins to become engorged, thereby facilitating the stick. The caveat is to make sure the patient hasn't any significant dysrhythmia and has a systolic BP of >100 mm Hg. Give 2.5 mg IM and attempt the labdraw or IV start exactly 20-30 minutes later. It works like a charm for almost everyone and helps avoid repetitive futile/painful sticks.
I was given inapsin in er, even after I told them all medications I am on. Almost immidiately I felt suffocated, confused, agitated, I felt like I was dyeing.:( just wanted to run. They said they had notheing to reverse the side efect, n it would wear off in a few hrs. They offered to add Ativan or Valium to calm me down. I asked to be realeased. They sent a second dr in that talked me into Valium. Made it worse.
This is two days later, I'm still having hard time breathing, n having pain in my chest. I researched this, have found it is deadly to give this drug to those who r on the meds I'm on. I'm furrious. Still don't know if I can die from this. Why black box a drug when drs ignore warnings. I know I have enough proof to sue. But right now I just want to live...
I was given inapsine along with propofol and rapifen for a colonoscopy. Doctor said I would only be partialy sedated but was immeditaely out like a rock and didn't wake up until I was already in recovery. When I woke up I felt horrible, like someone was pushing the gas and brakes at the same time. I couldn't sit still but felt exhausted. My heart was racing, and I felt like I couldn't catch my breath. I also couldn't focus on anything. I thought it would wear off but it didn't. I went home, no one checked my vitals once I was in recovery, was just sent home. I returned to the ER several hours later and told my reaction shouldn't be from any of the anesthesia, but that maybe I was having a panic attack. They gave me benzodiazapem which only slowed my heart rate but I was still short of breath. I was allowed to be admitted over night. I went home the next morning but I still felt like I was having a major anxiety attack. Finally about 24 hours after the procedure, the racing heart/ anxiety feelings went away but then I felt NOTHING. I was like zombie for the next two days, no motivation, no desire, no connection to anything just completely empty like my soul was gone. Finally I felt better except for the next 5 days I was very tired. I am healthy normally but my bp is often on the low side and after the colonoscopy prep. maybe it was too low and that has something to do with my reaction, don't know, only know I NEVER want to go through that again and am very afraid to have any kind of procedure done now.
I went into anaphylactic shock after receiving this drug in the ER for nausea prevention due to pain meds I was taking. The nurse initially wouldn't believe me and insisted I was panicking. I was rapidly losing the ability to take a breathe. Thank the Lord my Mom was in the room and saw the look in my eyes and insisted I was NOT panicking. Finally the nurse gave me a good look over & realized what was going on. I always list it as an allergy & few nurses even know what it is. On one occasion a nurse knew exactly what it was and she also experience anaphylaxis. This drug scares the crap out of me and I've been told it was completely off the market. I'm guessing that it's actually that hospitals have stopped using it. That being said, Zofran is essentially worthless in my experience.
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