Promethazine

Promethazine is used for relieving allergy symptoms, including hives or runny nose.

Product dosage: 25mg
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Synonyms Phenergan plain

Promethazine is a versatile phenothiazine-derivative medication primarily indicated for the management of allergic conditions, nausea, vomiting, and as a sedative agent in certain clinical scenarios. It functions as a histamine H1 receptor antagonist, exerting potent antihistaminic, antiemetic, and sedative effects through central and peripheral mechanisms. Its efficacy and well-established pharmacological profile make it a valuable option in both acute and preventive therapeutic strategies under appropriate medical supervision.

Features

• Chemical class: Phenothiazine derivative
• Primary mechanism: Histamine H1 receptor antagonism
• Additional pharmacological actions: Anticholinergic, antidopaminergic, and local anesthetic properties
• Available formulations: Oral tablets, syrup, rectal suppositories, and injectable solutions
• Rapid onset of action, particularly with parenteral administration
• Demonstrated efficacy across multiple therapeutic indications

Benefits

• Provides rapid relief from symptoms of allergic reactions including urticaria, angioedema, and allergic rhinitis
• Effectively prevents and treats nausea and vomiting associated with various etiologies including motion sickness, postoperative recovery, and chemotherapy
• Offers sedative properties beneficial for preoperative preparation and anxiety reduction in specific clinical contexts
• Demonstrates anti-motion sickness effects through action on the vestibular system
• Cost-effective therapeutic option with extensive clinical experience supporting its use
• Multiple administration routes allow for tailored treatment approaches based on patient needs and clinical circumstances

Common use

Promethazine is commonly prescribed for the management of allergic conditions including seasonal and perennial allergic rhinitis, allergic conjunctivitis, and mild allergic skin reactions. It is frequently utilized as an antiemetic for preventing and treating nausea and vomiting associated with motion sickness, postoperative recovery, radiation therapy, and certain medications. Additionally, it serves as a sedative for preoperative and postoperative sedation, as well as for adjunctive therapy in pain management protocols. Some off-label uses include management of migraine-associated nausea and as an adjunct in the treatment of anaphylaxis when combined with epinephrine and other standard measures.

Dosage and direction

Dosage varies significantly based on indication, patient age, route of administration, and clinical context. For adults with allergies: 25 mg orally at bedtime, or 12.5 mg before meals and at bedtime. As an antiemetic: 25 mg orally or rectally, repeatable every 4-6 hours as needed. For sedation: 25-50 mg orally, intramuscularly, or rectally. Pediatric dosing must be carefully calculated based on weight and indication, typically 0.25-0.5 mg per pound of body weight, not to exceed adult doses. Injectable formulations should be administered by healthcare professionals. Always follow specific prescribing physician instructions and never exceed recommended dosages.

Precautions

Exercise caution in patients with respiratory compromise, including asthma, chronic obstructive pulmonary disease, or sleep apnea. Use cautiously in patients with cardiovascular disease, hypertension, or those taking other medications that prolong QT interval. Monitor for signs of neuroleptic malignant syndrome, particularly with high doses or prolonged use. Avoid activities requiring mental alertness until response to medication is established. Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, or bladder neck obstruction due to anticholinergic effects. Elderly patients may be more sensitive to sedative and hypotensive effects.

Contraindications

Absolute contraindications include known hypersensitivity to promethazine or other phenothiazines, coma states, and concomitant use with MAO inhibitors. Additional contraindications include suspected Reye’s syndrome in children and adolescents, severe CNS depression, and use in children under two years of age due to potential for fatal respiratory depression. Not recommended during pregnancy, particularly near term, due to potential effects on platelet aggregation in newborn. Avoid use in patients with bone marrow suppression or blood dyscrasias.

Possible side effect

Common side effects include drowsiness, dizziness, dry mouth, blurred vision, and constipation. More significant adverse reactions may include extrapyramidal symptoms (particularly at higher doses), orthostatic hypotension, tachycardia, and photosensitivity reactions. Rare but serious side effects include neuroleptic malignant syndrome, agranulocytosis, seizures, and paradoxical reactions including excitement and nightmares in children. Injection site reactions may occur with parenteral administration, including tissue damage if inadvertently administered intra-arterially or extravasated.

Drug interaction

Significant interactions occur with CNS depressants including alcohol, benzodiazepines, opioids, and sedative-hypnotics, potentially enhancing sedative effects. Concurrent use with MAO inhibitors may potentiate anticholinergic and sedative effects. May enhance effects of antihypertensive medications. QT-prolonging agents may increase risk of cardiac arrhythmias. Anticholinergic drugs may potentiate dry mouth, blurred vision, and other anticholinergic effects. Epinephrine effects may be reversed due to partial alpha-adrenergic blockade.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double doses to make up for a missed dose. For as-needed dosing, take when symptoms occur, following prescribed timing intervals. Maintain regular dosing schedule for chronic conditions to ensure consistent therapeutic effect. Consult healthcare provider if multiple doses are missed or if uncertain about dosing schedule.

Overdose

Overdose symptoms may include severe drowsiness, deep sleep, coma, convulsions, cardiorespiratory depression, and extrapyramidal symptoms. Massive overdose may lead to neuroleptic malignant syndrome, cardiac arrhythmias, and death. Treatment is supportive and symptomatic, including gastric lavage if presented early, activated charcoal, and appropriate monitoring of vital functions. There is no specific antidote; management should focus on maintaining airway, breathing, and circulation. Extrapyramidal symptoms may respond to anticholinergic agents. Contact poison control center immediately for guidance.

Storage

Store at controlled room temperature (20-25°C or 68-77°F), protected from light and moisture. Keep all medications in original container with child-resistant closure. Do not freeze liquid formulations. Properly discard expired or unused medication according to FDA guidelines or through medication take-back programs. Keep out of reach of children and pets. Do not transfer medications to unlabeled containers.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting, changing, or discontinuing any medication. The prescribing physician should be consulted for specific recommendations tailored to individual patient needs. This information may not include all possible uses, directions, precautions, or interactions. Healthcare providers should reference official prescribing information for complete details.

Reviews

Clinical studies demonstrate promethazine’s efficacy in managing allergic symptoms with response rates typically exceeding 70% in appropriately selected patients. Anti-emetic studies show significant reduction in nausea and vomiting compared to placebo across various clinical scenarios. Many clinicians report satisfactory results particularly in motion sickness prevention and postoperative nausea management. Some reviews note the sedative effects may be pronounced in certain patient populations, requiring careful dose titration. Long-term experience supports its overall safety profile when used appropriately, though monitoring for potential adverse effects remains important.