Promethazine

Promethazine Brand Names

Anergan-50 | Pentazine | Phenadoz | Phenergan | Phenergan Fortis | Prometh Plain | Promethegan

What is Promethazine

Promethazine is an oral and parenteral medication that is structurally related to the phenothiazines; however, it is not used clinically as a neuroleptic.

It is a sedating antihistamine (H1-blocker) with considerable anticholinergic, sedative, and antiemetic effects and some local anesthetic properties. Promethazine has been used as an antihistamine in some prescription cough and cold products.

Promethazine is also used as an antiemetic in surgical care settings to treat or prevent or treat post-operative nausea/vomiting (PONV) and may be used to treat motion sickness.

In November 2004, the FDA directed manufacturers of promethazine-containing products to include a boxed warning contraindicating its use in children and infants less than 2 years of age due to an increased risk for fatal respiratory depression.

If parenteral use  of promethazine is necessary, the preferred route of administration is by deep intramuscular injection. Use of the intravenous route can be associated with significant adverse reactions such as severe tissue necrosis and gangrene.

In September 2009, the FDA required manufacturers of parenteral promethazine to include a boxed warning emphasizing the established risk of severe tissue damage associated with intravenous administration of promethazine.

Promethazine was first approved by the FDA in 1951.

Indications

1. anaphylaxis
2. hyperemesis gravidarum
3. motion sickness
4. nausea/vomiting
5. nystagmus
6. post-operative nausea/vomiting (PONV)
7. post-operative nausea/vomiting (PONV) prophylaxis
8. pregnancy-induced nausea/vomiting
9. procedural sedation
10. pruritus
11. sedation induction

Side Effects

1. agitation
2. agranulocytosis
3. akathisia
4. angioedema
5. aplastic anemia
6. apnea
7. blurred vision
8. bradycardia
9. cholestasis
10. confusion
11. constipation
12. contact dermatitis
13. corneal opacification
14. cyanosis
15. delirium
16. diplopia
17. dizziness
18. drowsiness
19. dyspnea
20. dystonic reaction
21. ejaculation dysfunction
22. eosinophilia
23. erythema
24. euphoria
25. excitability
26. fatigue
27. fever
28. galactorrhea
29. hallucinations
30. hemolytic anemia
31. hyperprolactinemia
32. hypertension
33. hyperthermia
34. hypotension
35. hypothermia
36. ileus
37. impotence (erectile dysfunction)
38. injection site reaction
39. insomnia
40. jaundice
41. leukopenia
42. libido decrease
43. mastalgia
44. menstrual irregularity
45. muscle paralysis
46. mydriasis
47. nasal congestion
48. neuroleptic malignant syndrome
49. neutropenia
50. nightmares
51. orthostatic hypotension
52. pancytopenia
53. phlebitis
54. photosensitivity
55. platelet dysfunction
56. priapism
57. pseudoparkinsonism
58. purpura
59. respiratory depression
60. retinopathy
61. seizures
62. sinus tachycardia
63. skin hyperpigmentation
64. skin irritation
65. syncope
66. tardive dyskinesia
67. thrombocytopenia
68. thrombosis
69. tinnitus
70. tissue necrosis
71. torticollis
72. tremor
73. urinary retention
74. urticaria
75. visual impairment
76. weight gain
77. xerophthalmia
78. xerostomia

Monitoring Parameters

• CBC with differential
• LFTs

Contraindications

• acute bronchospasm
• agranulocytosis
• alcoholism
• anticholinergic medications
• asthma
• bladder obstruction
• bone marrow suppression
• bradycardia
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• chronic obstructive pulmonary disease (COPD)
• CNS depression
• coma
• contact lenses
• coronary artery disease
• dehydration
• diabetes mellitus
• driving or operating machinery
• ethanol intoxication
• extravasation
• females
• geriatric
• GI obstruction
• glaucoma
• heart failure
• hepatic disease
• hepatic encephalopathy
• hypertension
• hypocalcemia
• hypokalemia
• hypomagnesemia
• ileus
• infants
• intraarterial administration
• intravenous administration
• jaundice
• labor
• long QT syndrome
• malnutrition
• myocardial infarction
• neonates
• obstetric delivery
• phenothiazine hypersensitivity
• pregnancy
• prostatic hypertrophy
• QT prolongation
• radiographic contrast administration
• respiratory depression
• Reye’s syndrome
• seizure disorder
• sleep apnea
• subcutaneous administration
• sulfite hypersensitivity
• thyroid disease
• tissue necrosis
• urinary retention

Interactions

• Abarelix
• Acarbose
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Diphenhydramine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Tramadol
• Acetohexamide
• Alfentanil
• Alfuzosin
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Alogliptin
• Alogliptin; Metformin
• Alogliptin; Pioglitazone
• Alosetron
• Alpha-glucosidase Inhibitors
• Alprazolam
• Amantadine
• Amifampridine
• Amikacin
• Amiloride; Hydrochlorothiazide, HCTZ
• Aminoglycosides
• Aminolevulinic Acid
• Amiodarone
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amobarbital
• Amoxapine
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Anagrelide
• Anticholinergics
• Anxiolytics; Sedatives; and Hypnotics
• Apomorphine
• Apraclonidine
• Aripiprazole
• Arsenic Trioxide
• Artemether; Lumefantrine
• Articaine; Epinephrine
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atazanavir; Cobicistat
• Atenolol; Chlorthalidone
• Atomoxetine
• Atropine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine
• Azelastine; Fluticasone
• Azilsartan; Chlorthalidone
• Azithromycin
• Baclofen
• Barbiturates
• Bedaquiline
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzhydrocodone; Acetaminophen
• Benzodiazepines
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benztropine
• Bepridil
• Bethanechol
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Brexpiprazole
• Brimonidine; Timolol
• Bromocriptine
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion
• Bupropion; Naltrexone
• Buspirone
• Butabarbital
• Butorphanol
• Cabergoline
• Canagliflozin
• Canagliflozin; Metformin
• Candesartan; Hydrochlorothiazide, HCTZ
• Cannabidiol
• Capsaicin; Metaxalone
• Captopril; Hydrochlorothiazide, HCTZ
• Carbamazepine
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Carisoprodol
• Carteolol
• Celecoxib
• Cenobamate
• Central-acting adrenergic agents
• Ceritinib
• Cetrorelix
• Cevimeline
• Charcoal
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlophedianol; Guaifenesin; Phenylephrine
• Chloral Hydrate
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chloroquine
• Chlorothiazide
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Chlorpropamide
• Chlorthalidone
• Chlorthalidone; Clonidine
• Chlorzoxazone
• Ciprofloxacin
• Cisapride
• Citalopram
• Clarithromycin
• Clemastine
• Clindamycin; Tretinoin
• Clobazam
• Clofazimine
• Clomipramine
• Clonazepam
• Clorazepate
• Clozapine
• Cobicistat
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• COMT inhibitors
• Crizotinib
• Cyclobenzaprine
• Dantrolene
• Dapagliflozin
• Dapagliflozin; Metformin
• Dapagliflozin; Saxagliptin
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasatinib
• Degarelix
• Desipramine
• Deutetrabenazine
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmedetomidine
• Dexmethylphenidate
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Quinidine
• Diazepam
• Dicyclomine
• Diethylpropion
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dimenhydrinate
• Dipeptidyl Peptidase-4 Inhibitors
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Disopyramide
• Dofetilide
• Dolasetron
• Dolutegravir; Rilpivirine
• Donepezil
• Donepezil; Memantine
• Dorzolamide; Timolol
• Doxepin
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Dronedarone
• Droperidol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Dutasteride; Tamsulosin
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Eliglustat
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Empagliflozin
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Enalapril; Hydrochlorothiazide, HCTZ
• Encorafenib
• Entrectinib
• Epinephrine
• Eprosartan; Hydrochlorothiazide, HCTZ
• Eribulin
• Ertugliflozin
• Ertugliflozin; Metformin
• Ertugliflozin; Sitagliptin
• Erythromycin
• Erythromycin; Sulfisoxazole
• Escitalopram
• Esketamine
• Estazolam
• Eszopiclone
• Ethanol
• Ethinyl Estradiol
• Ethinyl Estradiol; Desogestrel
• Ethinyl Estradiol; Ethynodiol Diacetate
• Ethinyl Estradiol; Etonogestrel
• Ethinyl Estradiol; Levonorgestrel
• Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
• Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
• Ethinyl Estradiol; Norelgestromin
• Ethinyl Estradiol; Norethindrone
• Ethinyl Estradiol; Norethindrone Acetate
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Ethinyl Estradiol; Norgestimate
• Ethinyl Estradiol; Norgestrel
• Ethosuximide
• Ethotoin
• Ezogabine
• Felbamate
• Fenfluramine
• Fentanyl
• Fingolimod
• Flavoxate
• Flecainide
• Flibanserin
• Fluconazole
• Flucytosine
• Fluocinolone; Hydroquinone; Tretinoin
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Fluvoxamine
• food
• Foscarnet
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fosphenytoin
• Fospropofol
• Gabapentin
• Galantamine
• Ganirelix
• Gemifloxacin
• Gemtuzumab Ozogamicin
• Gentamicin
• Gilteritinib
• Glasdegib
• Glimepiride
• Glimepiride; Pioglitazone
• Glimepiride; Rosiglitazone
• Glipizide
• Glipizide; Metformin
• Glyburide
• Glyburide; Metformin
• Glycopyrrolate
• Glycopyrrolate; Formoterol
• Goserelin
• Granisetron
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Guanidine
• Halobetasol; Tazarotene
• Halofantrine
• Halogenated Anesthetics
• Haloperidol
• Histrelin
• Homatropine; Hydrocodone
• Hydantoins
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxychloroquine
• Hydroxyzine
• Hyoscyamine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Ibutilide
• Iloperidone
• Imipramine
• Incretin Mimetics
• Indacaterol; Glycopyrrolate
• Indapamide
• Inotuzumab Ozogamicin
• Insulins
• Iohexol
• Iopamidol
• Iopromide
• Ioversol
• Ipecac
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Isosulfan Blue
• Itraconazole
• Ivosidenib
• Kanamycin
• Ketoconazole
• Lamotrigine
• Lapatinib
• Lefamulin
• Lemborexant
• Lenvatinib
• Leuprolide
• Leuprolide; Norethindrone
• Levetiracetam
• Levodopa
• Levofloxacin
• Levomethadyl
• Levorphanol
• Linagliptin
• Linagliptin; Metformin
• Lithium
• Lofexidine
• Lomefloxacin
• Long-acting beta-agonists
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Lorazepam
• Loxapine
• Lumateperone
• Lurasidone
• Macimorelin
• Magnesium Salts
• Maprotiline
• Meclizine
• Mefloquine
• Meglitinides
• Melatonin
• Mepenzolate
• Mephobarbital
• Meprobamate
• Mequinol; Tretinoin
• Mestranol; Norethindrone
• Metaxalone
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methadone
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methocarbamol
• Methohexital
• Methoxsalen
• Methscopolamine
• Methsuximide
• Methyclothiazide
• Methylphenidate
• Metoclopramide
• Metolazone
• Metoprolol
• Metronidazole
• Metyrapone
• Metyrosine
• Midazolam
• Midostaurin
• Mifepristone
• Miglitol
• Minocycline
• Mirabegron
• Mirtazapine
• Mitotane
• Molindone
• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Moxifloxacin
• Nabilone
• Nadolol
• Nafarelin
• Nalbuphine
• Naltrexone
• Nebivolol
• Nebivolol; Valsartan
• Nilotinib
• Nitroglycerin
• Non-Ionic Contrast Media
• Norepinephrine
• Norfloxacin
• Nortriptyline
• Octreotide
• Ofloxacin
• Olanzapine
• Omeprazole; Amoxicillin; Rifabutin
• Ondansetron
• Oritavancin
• Orphenadrine
• Osilodrostat
• Osimertinib
• Oxaliplatin
• Oxazepam
• Oxybutynin
• Oxycodone
• Oxymorphone
• Ozanimod
• Paliperidone
• Panobinostat
• Paromomycin
• Paroxetine
• Pasireotide
• Pazopanib
• Peginterferon Alfa-2b
• Pemoline
• Pentamidine
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Perampanel
• Pergolide
• Perphenazine
• Perphenazine; Amitriptyline
• Phenobarbital
• Phentermine; Topiramate
• Phenylephrine
• Phenylephrine; Promethazine
• Phenytoin
• Photosensitizing agents (topical)
• Pilocarpine
• Pimavanserin
• Pimozide
• Pioglitazone
• Pitolisant
• Plazomicin
• Porfimer
• Posaconazole
• Pramipexole
• Pramlintide
• Pregabalin
• Prilocaine; Epinephrine
• Primaquine
• Primidone
• Procainamide
• Procarbazine
• Prochlorperazine
• Propafenone
• Propantheline
• Propoxyphene
• Protriptyline
• Quazepam
• Quetiapine
• Quinidine
• Ranolazine
• Rasagiline
• Remifentanil
• Ribociclib
• Ribociclib; Letrozole
• Rifabutin
• Rifampin
• Rifamycins
• Rifapentine
• Rilpivirine
• Risperidone
• Rivastigmine
• Rolapitant
• Romidepsin
• Ropinirole
• Rosiglitazone
• Rotigotine
• Safinamide
• Saquinavir
• Saxagliptin
• Scopolamine
• Secobarbital
• Segesterone Acetate; Ethinyl Estradiol
• Selpercatinib
• Sertraline
• SGLT2 Inhibitors
• Short-acting beta-agonists
• Sibutramine
• Simvastatin; Sitagliptin
• Siponimod
• Sitagliptin
• Sodium Oxybate
• Solifenacin
• Sorafenib
• Sotalol
• Sparfloxacin
• St. John’s Wort, Hypericum perforatum
• Streptomycin
• Sufentanil
• Sulfonylureas
• Sunitinib
• Tacrolimus
• Tamoxifen
• Tamsulosin
• Tapentadol
• Tazarotene
• Telavancin
• Telithromycin
• Temazepam
• Teniposide
• Tetrabenazine
• Thalidomide
• Thiazide diuretics
• Thiazolidinediones
• Thiopental
• Thioridazine
• Thiothixene
• Tiagabine
• Timolol
• tobacco
• Tobramycin
• Tolazamide
• Tolbutamide
• Tolterodine
• Topiramate
• Toremifene
• Tramadol
• Trazodone
• Tretinoin, ATRA
• Triazolam
• Tricyclic antidepressants
• Trifluoperazine
• Trihexyphenidyl
• Trimethobenzamide
• Trimipramine
• Triprolidine
• Triptorelin
• Trospium
• Valproic Acid, Divalproex Sodium
• Vandetanib
• Vardenafil
• Vemurafenib
• Venlafaxine
• Verteporfin
• Vigabatrin
• Voriconazole
• Vorinostat
• Zaleplon
• Ziconotide
• Ziprasidone
• Zolpidem
• Zonisamide