Drug Data Generic Name Promethazine HCl Trade Name Phenergan Minimum Dose 25 mg 1 tab q 4-6, Maximum Dose

50 mg 1 tab q 4 Contents Promethazine HCl Availability and color - Tablets: 12.5, 25, 50 mg - Syrup: 6.25, 25 mg/5mL - Suppositories: 12.5, 25, 50 mg - Injection: 25, 50 mg/mL Routes of administration Oral Intramuscular Intravenous

Classification Pharmacologic Class Phenothiazine Therapeutic Class Antiemetic, Antihistamine, Sedative, Hypnotic Pregnancy Risk Factor C

Mechanism of Action Selectively blocks the H1 receptors, diminishing the effects of histamine on cells of the upper respiratory tract and eyes and decreasing the sneezing, mucus production, itching and tearing that accompany allergic reactions in sensitized people exposed to antigens; blocks cholinergic receptors in the vomiting centre that are believed to mediate the nausea and vomiting caused by gastric irritation, by input from the vestibular apparatus, and by input from the chemoreceptor trigger zone; depresses the RAS, including the parts of the brain involved with wakefulness. Pharmacokinetics A: Well absorbed (Oral, IM); peak plasma concentrations after 2-3 hr. D: Widely distributed: Brain, crosses the placenta, enters breast milk. Protein-binding: 76-93%. M: Extensive hepatic 1st-pass metabolism; converted to promethazine sulfoxide, Ndesmethylpromethazine. E: Via urine and bile (as metabolites) Drug Half Life 9-16 hr

Indication General Indications - Prevention and treatment of nausea and vomiting associated with labyrinthitis - Prevention of motion sickness - Short-term management of insomnia - Symptomatic relief of perennial and seasonal allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria and angioedema - Amelioration of allergic reactions to blood or plasma - Dermatographism, adjunctive therapy in anaphylactic reactions - Preoperative, postoperative, or obstetric sedation - Adjunct to analgesics to control postoperative pain - Adjunctive IV therapy with reduced amounts of meperidine or other opioid analgesics in special surgical conditions
Source: http://mims.com.ph/

Contraindications
Concentrations - Hypersensitivity to antihistamines or phenothiazines - Comatose patients - Severe CNS depression - Bone marrow depression - Vomiting of unknown cause - Concomitant therapy with MAOIs - Lactation Precaution - Lower respiratory tract disorders - Glaucoma - Prosthatic hypertrophy - CV disease, hypertension - Breast cancer - Thyrotoxicosis - Children - Child with history of sleep apnea - A family history of SIDS - Reyes syndrome - Elderly - Pregnancy Drug interaction Drug to drug - Additive anticholinergic effects with anticholinergic drugs - Increased frequency and severity of neuromuscular excitation and hypotension with methohexital, thiamylal, Phenobarbital anesthetic, thiopental - Enhanced CNS depression with alcohol Drug to food - none reported
Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 999-1000

Adverse Reaction CNS: Dizziness, drowsiness, poor coordination, confusion, restlessness, excitation, seizures, tremors, headache, blurred vision, diplopia, vertigo, tinnitus CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles Dermatologic: Urticaria, rash, photosensitivity, chills GI: Epigastric distress, nausea, vomiting, diarrhea, constipation GU: Urinary frequency, dysuria, urinary retention, decreased libido, impotence Hematologic: Hemolytic anemia, hypoplastic anemia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia Local: Thickening of bronchial secretions, chest tightness, dry mouth, nose and throat; respiratory depression, suppression of cough reflex, potential of aspiration Other: Tingling, heaviness and wetness of hands
Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 1000

Nursing Responsibilities
Before - Observe 15 rights in drug administration. - Assess for hypersensitivity and other contraindications. - Reduce dosage for patients with hepatic impairment. - Reduce dosage of barbiturates given concurrently with promethazine by at least a half. - Arrange for dosage reduction of opioid analgesics given concomitantly by onefourth to one-half. During - Do not give tablets or rectal suppositories to children younger than 2 yr. - Give IM injections deep into muscle. - Do not administer subcutaneously, tissue necrosis may occur. - Do not administer intrarterially; arteriospasm and gangrene of the limb may result. - Instruct to take drug exactly as prescribed. After - Instruct to avoid alcohol. - Instruct to avoid driving or engaging in other dangerous activities of dizziness, drowsiness or vision changes occur. - Educate about avoiding prolonged exposure to the sun, or using of sunscreen or covering garments. - Maintain fluid intake, use precautions against heatstroke in hot weather. - Report sore throat, fever, unusual bleeding or bruising, rash, fever, weakness, tremors, impaired vision, dark urine, pale stools, yellowing of the skin or eyes.

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 999

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 999

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 999-1000

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 1000-1001