II. Indications
- Nausea or Vomiting
-
Motion Sickness or Vertigo
- Other agents are preferred (e.g. Dimenhydrinate)
III. Mechanism
- Phenothiazine Antiemetic
-
Dopamine 2 Antagonist
- Active at the ChemoreceptorTrigger Zone in the Medulla of the Brainstem
- Similar to other DopamineAntagonist Antipsychotic agents
IV. Contraindications
- Do not use under age 2 years
V. Adverse Effects
- Respiratory Depression
- Apnea and death have occurred in children
- Severe tissue injury risk on Parenteral Injection
- Do not use Subcutaneous Injection
- Hypotension with rapid IV injection
- Extrapyramidal Side Effects (with high IV dose)
- Anticholinergic effects (e.g. sedation, Dry Mouth)
VI. Safety
- Pregnancy Category C
- Avoid in Lactation
VII. Precautions
VIII. Dosing: Adults
-
Nausea or Vomiting
- PO/PR/IM: 12.5 to 25 mg PO/Deep IM/PR every 4 to 6 hours
- IV (not FDA labeled, see adverse effects): 12.5 to 25 mg IV every 4 hours as needed
-
Motion Sickness
- PO/PR: 25 mg orally or PR 30 to 60 minutes prior to departure and every 12 hours as needed
IX. Dosing: Children (over age 2 years only)
- Children
- PO/PR/IM: 0.25 to 0.5 mg/kg (up to 25 mg/dose) PO/deep IM/PR every 4 to 6 hours
- IV (not FDA labeled, see adverse effects): 0.25 mg/kg/dose (up to 25 mg) IV every 4 hours as needed
-
Motion Sickness
- PO/PR: 0.5 mg/kg (up to 25 mg/dose) PO/PR 30 to 60 minutes prior to departure and every 12 hours as needed
X. Efficacy
- Less effective Antiemetic than Prochlorperazine (Compazine) in ER patients
- Sedation may delay Emergency Department discharge
XI. Resources
XII. References
- Johnson (1993) Harriet Lane, Mosby, p. 521
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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promethazine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
PROMETHAZINE 12.5 MG SUPPOS | Generic | $3.85 each |
PROMETHAZINE 12.5 MG TABLET | Generic | $0.05 each |
PROMETHAZINE 25 MG SUPPOSITORY | Generic | $2.85 each |
PROMETHAZINE 25 MG TABLET | Generic | $0.05 each |
PROMETHAZINE 50 MG TABLET | Generic | $0.08 each |
PROMETHAZINE 6.25 MG/5 ML SOLN | Generic | $0.03 per ml |
PROMETHAZINE 6.25 MG/5 ML SYRP | Generic | $0.03 per ml |
PROMETHAZINE-CODEINE SOLUTION | Generic | $0.03 per ml |
PROMETHAZINE-CODEINE SYRUP | Generic | $0.03 per ml |
PROMETHAZINE-DM 6.25-15 MG/5 ML | Generic | $0.05 per ml |
Ontology: Promethazine (C0033405)
Definition (CHV) | a drug used to treat allergy symptoms |
Definition (CHV) | a drug used to treat allergy symptoms |
Definition (NCI) | A phenothiazine derivative with antiemetic and antihistaminic properties. Promethazine antagonizes the central and peripheral effects of histamine mediated by histamine H1 receptors. The effects include bronchoconstriction, vasodilation and spasmodic contractions of gastrointestinal smooth muscle. In addition, this agent binds to muscarinic receptors, resulting in anticholinergic and antiemetic activities. |
Definition (MSH) | A phenothiazine derivative with histamine H1-blocking, antimuscarinic, and sedative properties. It is used as an antiallergic, in pruritus, for motion sickness and sedation, and also in animals. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D011398 |
SnomedCT | 256051006, 322154000, 372871004, 8372007 |
LNC | LP15006-7, MTHU001492 |
English | Promethazine, 10H-Phenothiazine-10-ethanamine, N,N,alpha-trimethyl-, Promethazine [nausea], Promethazine [nausea] [see c8i..], Proazamine, Prometazin, Promethazine [Chemical/Ingredient], prometazin, Promethazine [nausea] [see c8i..] (product), promethazine, PROMETHAZINE, Diprazinum, Promethazine product, Promethazine (product), Promethazine (substance), Promethazine [dup] (substance), Promethazine [nausea] [see c8i..] (substance) |
Swedish | Prometazin |
Czech | promethazin |
Finnish | Prometatsiini |
Russian | PROZAMIN, PROMETAZIN, TIAZINAMII, METILPROMETAZIN, МЕТИЛПРОМЕТАЗИН, ПРОЗАМИН, ПРОМЕТАЗИН, ТИАЗИНАМИЙ |
Japanese | ヒベルナ, メチレンジサルチル酸プロメタジン, プロザミン, プロメタジン塩酸塩, ピレチア, フェネルガン, 塩酸プロメタジン, イソプロメタジン, プロメタジン |
Spanish | prometazina (sustancia), prometazina [náuseas] [ver c8i..] (producto), prometazina [náuseas] [ver c8i..], Fenergan, prometacina (sustancia), prometacina, prometazina (producto), prometazina, Proazamina, Prometazina |
Polish | Prometazyna, Difergan, Fenergan |
Portuguese | Fenergan, Proazamina, Prometazina |
French | Prométhazine |
German | Proazamin, Promethazin |
Italian | Prometazina |
Ontology: Phenergan (C0591971)
Definition (CHV) | brand name of an allergy medicine |
Definition (CHV) | brand name of an allergy medicine |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D011398 |
English | Phenargan, phenergan, phenergan [brand name], Phenergan |