From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... ELDERLY PATIENTS In general, dosages in the lower range are sufficient for most elderly patients. ... TO CONTROL SEVERE NAUSEA AND VOMITING Adjust dosage to the response of the individual. Begin with lowest recommended dosage IM Dosage Initially 5 mg to 10 mg (1 to 2 mL) injected deeply into the upper, outer quadrant of the buttock. The recommended intramuscular (IM) antiemetic medication for an elderly male in long-term care is prochlorperazine (IM), with a dosage of 5 mg to 10 mg initially, which can be repeated every 3 or 4 hours if necessary, with a total IM dosage not exceeding 40 mg per day 1.
From the Research
For an elderly male in long-term care experiencing nausea requiring intramuscular administration, ondansetron (Zofran) 4 mg IM every 8 hours as needed is the recommended first-line option due to its better safety profile and fewer anticholinergic side effects compared to other alternatives. When considering the management of nausea in elderly patients, it's crucial to prioritize medications with the least potential for adverse effects, given the vulnerability of this population to drug side effects.
Key Considerations
- Ondansetron has been shown to be effective in managing nausea with a favorable side effect profile, making it a preferable choice for elderly patients [ 2 ].
- Promethazine, although sometimes used, carries anticholinergic effects that may be problematic in elderly patients, increasing the risk of confusion, dry mouth, and urinary retention [ 2 ].
- Prochlorperazine may also be considered but carries a risk of extrapyramidal symptoms, which can be distressing for patients [ 2 ].
- The most recent and highest quality study [ 3 ] comparing ondansetron, metoclopramide, and placebo for nausea and vomiting in adult emergency department patients found similar efficacy among the groups but highlighted the importance of considering the side effect profile in choosing an antiemetic.
Administration and Monitoring
- Start with the lowest effective dose and titrate as needed, considering the altered pharmacokinetics, reduced renal and hepatic function, and increased sensitivity to medication side effects in elderly patients.
- Monitor for sedation, orthostatic hypotension, and extrapyramidal symptoms when administering any of these medications.
- Investigate and address the underlying cause of nausea whenever possible to ensure comprehensive management.
Evidence Summary
The recommendation for ondansetron is based on its efficacy, safety profile, and the results from studies such as [ 2 ] and [ 3 ], which support its use as a first-line antiemetic in various settings, including emergency departments and potentially in long-term care facilities for elderly patients.