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promethazine (Rx)Brand and Other Names:Phenergan, Phenadoz

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 12.5mg
  • 25mg
  • 50mg

suppository

  • 12.5mg
  • 25mg
  • 50mg

injectable solution

  • 25mg/mL
  • 50 mg/mL

syrup

  • 6.25mg/5mL
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Allergic Conditions

PO/PR: 25 mg at bedtime or 12.5 mg before meals and at bedtime (dosage range, 6.25-12.5 mg q8hr)

IV/IM: 25 mg; may be repeated in 2 hours when necessary; switch to PO as soon as possible

Nausea & Vomiting

PO/PR: 12.5-25 mg q4-6hr PRN

IV/IM: 12.5-25 mg q4-6hr PRN

Motion Sickness

25 mg PO/PR 30-60 minutes before departure and q8-12hr PRN; on succeeding travel days, 25 mg PO/PR every morning and every evening

Preoperative Sedation

50 mg PO/PR on night before procedure or 25-50 mg IV/IM combined with reduced doses of analgesics and atropinelike drugs

Postoperative Sedation

25-50 mg IV/IM/PO/PR combined with reduced doses of analgesics and atropinelike drugs

Obstetric Sedation

25-50 mg IV/IM in early labor; may be increased to 25-75 mg q2-4hr after labor established; not to exceed two doses or up to 100 mg/day during labor

Dosage Forms & Strengths

tablet

  • 12.5mg
  • 25mg
  • 50mg

suppository

  • 12.5mg
  • 25mg
  • 50mg

injectable solution

  • 25mg/mL

syrup

  • 6.25mg/5mL
more...

Allergic Conditions (Off-label)

<2 years old: Contraindicated

≥2 years old: 25 mg PO/PR at bedtime or 12.5 mg q6hr; alternatively, 6.25-12.5 mg PO/PR q8hr

Nausea & Vomiting

<2 years old: Contraindicated

≥2 years old: 0.25-1 mg/kg PO/PR q4-6hr PRN; not to exceed 25 mg 

Motion Sickness

<2 years: Contraindicated

≥2 years: 12.5-25 mg PO/PR administered 30-60 minutes before departure and q8-12hr PRN or 0.5 mg/kg PO q12hr PRN 

Succeeding days of travel: 12.5-25 mg twice daily (upon arising or before evening meals)

Sedation

<2 years: Contraindicated

≥2 years: 12.5-25 mg PO/IM/PR at bedtime

Preoperative Sedation

<2 years: Contraindicated

≥2 years: 1 mg/kg PO/PR with reduced dose of analgesic and appropriate dose of atropinelike drug  

Postoperative Sedation

<2 years: Contraindicated

≥2 years: 12.5-25 mg with reduced dose of analgesic and appropriate dose of atropinelike drug

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Interactions

Interaction Checker

promethazine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Sedation

            Confusion

            Disorientation

            Blurred vision

            Hallucinations

            Dystonias

            Catatonic states

            Euphoria

            Excitation

            Extrapyramidal symptoms

            Tachycardia

            Bradycardia

            Leukopenia (rare)

            Agranulocytosis (rare)

            Obstructive jaundice

            Photosensitivity

            Dry mouth

            Angioneurotic edema

            Tardive dyskinesia

            Urticaria

            Xerostomia

            Impotence

            Urinary retention

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            Warnings

            Black Box Warnings

            IV administration can cause severe tissue injury, including burning, gangrene, or thrombophlebitis, necessitating fasciotomy, skin graft, or amputation

            Severe tissue injury can occur from perivascular extravasation, unintentional intra-arterial injection, and intraneuronal or perineuronal infiltration

            Deep IM injection is preferred method of administration

            Intra-arterial and SC administration are contraindicated

            25 mg/mL product may be administered by deep IM injection or IV infusion (at rate not to exceed 25 mg/min through flowing IV tubing)

            Monitor for signs and symptoms of potential tissue injury including burning or pain at site of injection, phlebitis, swelling, and blistering

            Discontinue IV infusion immediately if patient complains of pain during injection

            Respiratory fatalities reported with use in children <2 years (use contraindicated); use lowest effective dose in children >2 years; avoid other drugs with respiratory depressant effects

            Contraindications

            Hypersensitivity

            Newborn/premature infants <2 years old (risk of potentially fatal respiratory depression)

            SC or intra-arterial administration

            Coma

            Treatment of lower respiratory tract symptoms, including asthma

            Cautions

            Use caution in asthma, hepatic impairment, peptic ulcer disease, respiratory impairment, bone marrow suppression, anaphylaxis in susceptible individuals

            May impair ability to drive or perform hazardous tasks

            May impair core body temperature regulation; caution when taking medications with anticholinergic effects, heat exposure, or strenuous exercise

            Depresses hypothalamic thermoregulatory mechanism; exposure to extreme temperatures may cause hypo- or hyperthermia

            May alter cardiac conduction (life-threatening arrhythmias reported)

            Antiemetic effect may obscure toxicity of chemotherapeutic drugs

            Monitor closely in patients with cardiovascular disease, hepatic impairment, Reye syndrome, or history of sleep apnea

            Has anticholinergic effects; use with caution in patients with decreased gastrointestinal motility or obstructions (partial or comlete), urinary retention, urinary obstructions, xerostomia, BPH, or visual problems

            May cause extrapyramidal symptoms including pseudoparkinsonism, acute dystonic reactions, tardive dyskinesia, and akathisia

            Neuroleptic malignant syndrome reported with use; monitor for fever, muscle rigidity and/or autonomic instability, or mental status changes

            May cause orthostatic hypotension; use caution in patients at risk of experiencing hypotensive episodes (cardiovascular disease, cerebrovascular disease, hypovolemia or taking medications that may predispose to bradycardia or hypotension)

            May cause photosensitivity

            Pyloroduodenal obstruction, stenosing peptic ulcer disease, bladder neck obstruction

            Anticholinergic effects of promethazine may exacerbate condition in patients with narrow-angle glaucoma or myasthenia gravis

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Not known whether drug crosses into breast milk; discontinue drug, or do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Phenothiazine derivative with antidopaminergic effect: Blocker of mesolimbic dopamine receptors and alpha-adrenergic receptors in brain

            Antihistaminic effect: H1-receptor blocker

            Absorption

            Bioavailability: 25% (PO/PR)

            Onset (antihistaminic effect): 3-5 min (IV); 20 min (IM/PO/PR)

            Peak serum time: 6.7-8.6 hr (suppositories); 4.4 hr (syrup)

            Duration: PO (motion sickness), 4-6 hr; IV (nausea and vomiting), 4-6 hr; up to 12 hr

            Distribution

            Protein bound: 93%

            Vd: 98 L/kg (syrup); 17-277 L/kg (range)

            Metabolism

            Metabolized by hepatic P450 enzyme CYP2D6

            Metabolites: Promethazine sulfoxide and glucuronides (inactive)

            Elimination

            Dialyzable: No

            Half-life: 10 hr (IM); 9-16 hr (IV); 16-19 hr (syrup)

            Excretion: Urine (major), feces (minor)

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            Administration

            SC and intra-arterial injection contraindicated

            IV Compatibilities

            Solution: Compatible with most common solvents

            Additive: Amikacin, ascorbic acid injection, chloroquine, hydromorphone, netilmicin, vitamins B and C

            Syringe (partial list): Atropine, diphenhydramine, fentanyl, meperidine, morphine sulfate(?)

            Y-site (partial list): Ciprofloxacin, cisplatin, cladribine, cyclophosphamide, cytarabine, fluconazole, gemcitabine, linezolid, teniposide

            IV Incompatibilities

            Additive: Aminophylline, chloramphenicol, chlorothiazide, floxacillin, furosemide, heparin, hydrocortisone sodium succinate, methohexital, penicillin G potassium (incompatible at promethazine 250 mg/L and penicillin 20 million units/L; may be compatible at lower concentrations), penicillin G sodium, pentobarbital, phenobarbital, thiopental

            Syringe: Cefotetan, chloroquine, diatrizoate sodium 75%, diatrizoate meglumine/diatrizoate sodium, dimenhydrinate, heparin, iodipamide, iothalamate, ketorolac tromethamine, nalbuphine(?), pentobarbital, thiopental

            Y-site: Aldesleukin, allopurinol, amphotericin B cholesteryl sulfate, cefazolin(?), cefepime, cefoperazone, cefotetan, ceftizoxime(?), doxorubicin liposomal, foscarnet, heparin(?), hydrocortisone sodium succinate(?), methotrexate, piperacillin/tazobactam, potassium chloride(?), vitamins B and C(?)

            IV/IM Administration

            Administer by deep IM injection or by injection into tubing of running IV infusion solution

            IV: Concentration <25 mg/mL; infusion rate not to exceed 25 mg/min

            Avoid extravasation

            Storage

            Store at controlled room temperature; protect from freezing

            Protect from light

            Discard if particulate matter formation or discoloration occurs

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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