Promethazine

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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
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  • 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
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  • 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
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  • 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
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  • Isoniazid, INH; Rifampin
  • Isosulfan Blue
  • Itraconazole
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  • Kanamycin
  • Ketoconazole
  • Lamotrigine
  • Lapatinib
  • Lefamulin
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  • Leuprolide
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  • Levetiracetam
  • Levodopa
  • Levofloxacin
  • Levomethadyl
  • Levorphanol
  • Linagliptin
  • Linagliptin; Metformin
  • Lithium
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  • Lomefloxacin
  • Long-acting beta-agonists
  • Loperamide
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  • Metformin; Sitagliptin
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