Using Zofran preventively

In the past, I've only used Zofran once my son has started vomiting. A couple of days ago, my nonD son was up all night vomiting...and my thoughts, as always, turned to Daniel and worried about him catching it. So, for the past two days, I've given him a Zofran. His BG has been a little weird...lows not responding to treatment as if the carbs are not absorbing...and he did complain about his tummy hurting a couple of times...which prompted my giving him the Zofran.

My older son is doing much better today, and has not vomited since Friday morning. My question is...if you give Zofran preventively...how long do you continue doing it? I know with stomach viruses you can still be contagious after you recover...but I really don't want to give the Zofran unnecessarily. Daniel still seems fine...but I really want to avoid the vomiting if we can.

Also, if you have given Zofran to avoid vomiting, have you ever still seen weird BGs...like carbs are not absorbing? I don't know exactly how Zofran works in the body...is it just preventing the vomiting, but not all the digestion issues caused by a virus?

 

I've never heard of using Zofran when someone isn't ill. Like all prescription medications, I would try to use it only if necessary, and if someone isn't ill, it's not necessary.

In our experience, it's always been used when someone is ill, and as such BG values can be impacted by the underlying illness.

 

I know that vomiting and diabetes is a frightening combination, but I also think that generally speaking one is vomiting for a reason and stamping that down preventively might not be the best move.

Both our ped and endo are very hesitant to prescribe Zofran, so that may be coloring my view, but I would be disinclined to use it "preventively" in a child.

 

My DS is just now getting over the flu. His doc prescribed the zofran as a preemptive strike. He had stomach cramps and wasn't eating so she had me give it to him so he wouldn't start vomiting. He made it through, ketones and all, without a hospital stay because of the precautionary zofran. She advised me to keep it on hand as a precaution for the future. I'm very happy we didn't wait til he started throwing up, he definitely would've ended up in the ER!

 

The problem is, once he starts throwing up, lately the Zofran only works in a very limited way...and sometimes not at all. It was my understanding that Zofran (or something similar) is used to prevent nausea/vomiting when one is undergoing chemotherapy, and it was best used before the person feels ill. Obviously, this is not the same situation...but that's why I tried it this way this time. As I mentioned, he was expressing feelings of tummy upset, and coupled with his weird BGs (before and after the Zofran) and his brother's illness, I thought it might be prudent to give him a pill. Every time he has thrown up lately, we have ended up in the ER. With so many flu cases lately, and the fact that the ER is just not the place we want to be, I tried a preventive tact this time.

Won't give him a pill today. Hope I (and he) won't regret it.

 

I think using it if your kid already has the flu to prevent vomiting is one thing - but I don't know that I'd do it just because someone else in the house was sick.

Of course watching someone throw up can make me throw up - he could be having sympathy pains. Or he could be so worried about throwing up that he feels queasy. William can get this way if someone around him is sick and throwing up.

Giving it before chemo is a different situation also.

Zofran did not work for William last time -at first. I took him to the doctor after he kept throwing up and it turns out the dose I was giving him was way less than what she gave him. It could be that didn't work well last time because the dose was too low - but you'd have the ask the doctor about that. The zofran worked like a charm - our doctor was hesitant about using it at all.

 

Just wondering if you are using Zofran ODT (orally disintegrating tablet). If not, you might want to get those - they dissolve very easily so that they get into the system quickly. The regular tablets take longer to act, and sometimes it isn't in time, and you don't know if it actually went into their system or not. That said, we only use it once DS has vomited, or feels like he is about to, and then only sparingly. I will say that it is definitely a great tool to have, though.

 

You can't be so certain about that, and I hope you haven't been lulled into a possibly false sense of security. Please take each illness on a case-by-case basis.

 

I have used it before vommiting when she had a site failure during the night and woke with a tummy ache and high bg with Ketones over 1.5.

I have also used it like you described when I asssumed that vommitting might occur and bgs where low already and not responding to fast carbs, assuming impending stomach bug. used it just to be able to get her number cloder to 200 so that I would not be behind the 8ball with her having low bg's and ketones and vommiting.

WARNING continued use of zofran can dehydrate the body and be VERY constipating. a week later after the use of Zofran under doctors orders she became impacted and was vommitting from the constipation. We now include the use of Miralax if we use Zofran multiple times.

 

Fwiw, while a hospital visit is possible with a Type 1 kid with stomach virus (flu is a respiratory virus which doesn't often cause gastric issues) it is by no means a presumed outcome.

 

When I have been in the hospital, I've been given IV zofran at the same time as IV painkillers, to prevent me from throwing up, when me throwing up would have been a disaster (because I was having surgery and/or had acute pancreatitis).

But zofran is hundreds of dollars per dose. There's no way I'd use it at home to prevent somebody from throwing up who probably wasn't going to throw up anyways. And zofran can cause side effects, including a whole bunch that mimic a cold- a fever, headache, diarrhea, drowsiness. So if you have somebody who's not sick and you want to know whether or not he's getting sick, it's a bad idea to give him this medication.

And BTW, the only time I've gone to the hospital because I vomitted, it would not have been helpful if I had not vomitted and stayed home- the bigger issue was what made me vomit (pancreatitis) and not the fact that I vomited. I have sucessfully dealt with having vomited at home at least a dozen times (and yes, I know, I'm an adult).

 

Thank you for posting this. It is important for newly dx'd parents to know this. My son has had a stomach virus twice since dx and while they weren't a walk in the park, it wasn't necessary to go to the ER, even though I had D people telling me to rush him there ASAP.

 

The other thing to keep in mind is that none of these drugs are without risk. The high, single-dose Zofran given by IV has been pulled from the market due to causing potentially-fatal issues with heart rhythm. I know that a lower, oral dose is not the same, but why give a drug when you really can't fully understand what it's doing when it can be avoided?

 

Just some added experience. In over 40 years of dealing with T1 I have never had an Endo give me a prescription for an anti-"throw-up" drug. I have only had two Docs who would even prescribe one for me without a visit (after I started getting sick at home). As a grown up once I start throwing up I have to go in to the ER. But I do not have someone tending to me!!! Not a complaint just a big kudos to you parents. Plus I am one of those people who once the upset starts I can not stop it. I have never gone into the hospital for the flu, and I did not get a flu shot till close to 50. The killer for me is the stomach issues-virus or bacteria. If I just can not keep stuff down (which is always with a stomach bug) it means I also just feel too awful to be wanting to check by BG every 30 minutes or change out pump sites or change out CGMS sites or try and sip a bit of ginger ale, and my BG is going wild. So when the bugs are going around, I am pretty extreme on sanitizing wipes for my whole family, healthy eating, lots of water and lots of sleep, and it does help. I find stomach issues and T1 a real bear, and 95 percent of the time if I get the bug, we end up in the ER, I just get too dehydrated and end up with too many ketones.:cwds::cwds:ali

 

Well...I didn't...and I regretted it. He started throwing up around 1:30 am this morning (and so did I) and was at it at least once or twice an hour until a little before noon. I managed to keep his BGs in a good place, mostly because he had no IOB when he started vomiting...and I ran him a little high. But no sleep for either of us all night. Luckily, no ER visit, and he is feeling better now and has eaten a couple of times already (I did manage to get a pill into him around 1:30 pm....the one I gave him after the intitial throw up came up 10 minutes later.)

I understand people have different opinions on this, but I wish I would've listened to my gut. He complained of tummy upset after dinner yesterday, and I just gave him kids' Pepto.

 

Get him the ODT for next time (see previous post) - it will work better. Glad he is on the road to recovery!

 

Yes...I meant to respond to your post. Am working on 2 hours sleep. The first time we were prescribed Zofran, it was that dissolving stuff...and I think that's why it was successful then and not so much now. I will definitely ask for that again. Thanks!

 

The kid I have the zofran script for is actually my non-d 12yo. She was dxd with a condition called cyclical vomiting syndrome when she was in preschool. She has been happily episode free(knock wood) for a couple years. The last time she started what I was pretty sure was an episode I gave her the zofran and it headed it off. It's the only time I have used it. At the time I talked about it with my ped and using it for Hanna, she warned me to be careful as there is a purpose to vomiting when you have a stomach flu as miserable as it is.

Luckily in almost 5 yrs since diabetes reared its ugly head, Hanna has almost never been sick. (Knocking wood again!). She does seem to have a really fantastic immune system.

 

I have used it when I had severe nausea but no vomiting yet (only because the vomiting is always inevitable at that point), but I wouldn't in a million years use it "just in case" I were to get sick because someone else in the family was throwing up. My kids throw up all the time for all kinds of reasons.. it doesn't mean I will.. sometimes I catch something they didn't get (I work with kids, so it happens). I normally have hours of feeling "off" before it hits me... it's usually the same with my kids, they'll complain of tummy aches for a while before they actually get sick... but sometimes they have tummy aches and don't get sick, so you never really know for sure.

That said, like Ali posted, usually when I start throwing up it sets up a pattern (involving starvation ketones and dehydration more vomiting from that) that is VERY hard for me to break without IV fluids.. and of course IV fluids can fix everything really fast which is why I never hesitate to go to the ER - it's no fun but I feel SO much better so much faster when I do. Having D with any stomach virus just complicates things.. we can't clear the ketones without insulin and we can't take more insulin if we can't keep food down and we're already running low, and if we can't keep anything down the dehydration just gets worse and worse, ketones build up even more and cause vomiting on their own. Zofran (and I prefer the ODT kind) can usually help me avoid the need for IV fluids... but it really isn't a failsafe and taking it without severe nausea would basically be pointless because there would be nothing for it to do. It's not a prophylactic drug and it won't stop someone from getting sick, and it can't fully prevent vomiting.

Hindsight is always 20/20 though.. obviously now you can see now that it probably would have helped if you'd given it with the pepto, but it's always a hard call to make. I think you handled it fine.

 

We can't even get a script for zofran or the like. The stomach flu was going through our house last year so I called the endo's office and asked about getting a script called in just in case Sloan got it. (His BGs at the time were acting like he may be getting it.) His endo said they would not prescribe it because if he started thriwing up they would not treat it until he had blood work done to make sure everything was ok and that it true ky was a stomach bug and not DKA, since the symptoms can be the same.