Ctrl

K

Promethazine

Oral
Intravenous
Intramuscular
Rectal
Class
Antihistamines
Subclass
First-generation H1-antihistamines
Generic name
Promethazine hydrochloride
Common formulations
Tablet, Syrup
Dosage and administration
Adults patients
Treatment
Allergic conjunctivitis • Caused by inhalant allergens and foods
•
25 mg PO daily
Alternative
•
6.25-12.5 mg PO TID
Allergic rhinitis • Seasonal or perennial
•
25 mg PO daily
Alternative
•
6.25-12.5 mg PO TID
Allergic transfusion reactions
•
25 mg PO once
Alternative
•
6.25-12.5 mg PO TID
Dermographism
•
25 mg PO daily
Motion sickness
•
25 mg PO BID
Urticaria • Mild, uncomplicated allergic skin manifestations
•
25 mg PO daily
Alternative
•
6.25-12.5 mg PO TID
Vasomotor rhinitis
•
25 mg PO daily
Alternative
•
6.25-12.5 mg PO TID
Adjunctive treatment
Adjunctive treatment for postoperative pain
•
25-50 mg PO once
Prevention
Prevention of motion sickness
•
25 mg PO BID starting one-half to 1 hour prior to travel
Consider a repeat dose 8 to 12 hours later if needed.
Symptomatic relief
Symptomatic relief of cyclic vomiting syndrome • Off-label
•
12.5-25 mg PO q4-6h
Indications for use
Labeled indications
Adults
•
Treatment of allergic conjunctivitis (caused by inhalant allergens and foods)
•
Treatment of allergic rhinitis (seasonal or perennial)
•
Treatment of allergic transfusion reactions
•
Treatment of anaphylactic reaction (in patients with post anaphylaxis-associated residual symptoms )
•
Treatment of dermographism
•
Treatment of motion sickness
•
Treatment of postoperative nausea and vomiting
•
Treatment of urticaria (mild, uncomplicated allergic skin manifestations)
•
Treatment of vasomotor rhinitis
•
Adjunctive treatment for postoperative pain
•
Facilitation of obstetric sedation in pregnant females
•
Facilitation of procedural sedation
•
Prevention of motion sickness
•
Prevention of postoperative nausea and vomiting
Off-label indications
Adults
•
Symptomatic relief of cyclic vomiting syndrome
Safety risks
Boxed warnings
Respiratory depression
Contraindications
Hypersensitivity to promethazine or any of its components or other phenothiazines
Comatose states
Lower respiratory tract symptoms including asthma
Warnings and precautions
Abnormal oral glucose tolerance test
•
Use caution in patients with diabetes mellitus.
Agranulocytosis
•
Use caution in patients with bone-marrow depression.
Cholestatic jaundice
•
Maintain a high level of suspicion as, administration of promethazine has been associated with reported cholestatic jaundice.
Dystonia
•
Use caution in acutely ill pediatric patients with dehydration.
Neuroleptic malignant syndrome
•
Maintain a high level of suspicion as, potentially fatal symptom complex has been reported in association with promethazine hydrochloride alone or in combination with antipsychotic drugs.
Respiratory depression
•
Use extreme caution in patients with compromised respiratory function.
Seizure
•
Use caution in patients with seizure disorders or in persons who are using concomitant medications, such as narcotics or local anesthetics.
Somnolence
•
Use extreme caution in patients performing activities requiring mental alertness, such as driving or operating machinery.
Urinary retention
•
Use extreme caution with a history of bladder obstruction, gastrointestinal obstruction, ileus, or benign prostatic hypertrophy.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Any modality
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
No guidance available. - Avoid use in pediatric patients whose signs and symptoms may suggest Reye's syndrome or other hepatic diseases.
Substantial chronic alcohol consumption
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Consider alternative agents that may be safer.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Unknown frequency
•
Agranulocytosis, angioedema, apnea, bowel obstruction, bradycardia, catatonia, choreoathetosis, cognitive impairment, ↓ WBC count, ↓ platelet count, drug-induced liver injury, dystonia, encephalopathy, extrapyramidal signs, hypertension, hypotension, jaundice, neuroleptic malignant syndrome, oculogyric crisis, photosensitivity of skin, ↑QT interval, blurred vision, diplopia, dizziness, dry mouth, euphoria, fatigue, fever, hallucinations, insomnia, nausea, nervousness, seizure, skin rash, somnolence, tinnitus, vomiting, respiratory depression, thrombotic thrombocytopenic purpura, tachycardia, thrombophlebitis, tremor
Interactions
Drug(s)
Check Interactions
Reset

What did you think about this content?

Create free account

Sign up for free to access the full drug resource