Ondansetron vs Metoclopramide vs Promethazine: Which One to Order and When
Zofran is almost always the reflex order for nausea — but there are situations where it's the wrong call, and choosing it could mean a missed extrapyramidal reaction or a prolonged QTc you didn't see coming.
In this video, I break down the three antiemetics available in virtually every US hospital formulary — Ondansetron, Metoclopramide, and Promethazine — with exact dosing, side effects that actually matter at the bedside, and the clinical situations where each one wins.
What's covered: QT prolongation and when to pull Zofran, acute dystonia and akathisia (and how to treat them fast), why IV Promethazine is riskier than you think, and the one scenario where dopamine antagonists beat serotonin blockers every time.
This is part of the First Week of Residency Tips series — practical ward knowledge for incoming residents.
00:00 Introduction
00:35 Ondansetron (Zofran) and its side effects
02:15 Metoclopramide (Reglan) and Promethazine (Phenergan)
05:12 Antiemtic agent selection
06:11 Meclizine
06:15 Dronabinol
Link to "First week of residency tips": • Essential Tips for First-Week Residents
Link to dystonia and akathisia demonstration: • Dystonia, Akathisia, Parkinsonism, and Tar...
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