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20-September-2008 09:55:58 - Promethazine Promethazine Systematic IUPAC name N,N-dimethyl- 1-10H-phenothiazin-10-yl propan-2-amine Identifiers CAS number 60-87-7 ATC code D04AA10 R06AD02, R06AD05 PubChem 4927 DrugBank APRD00601 Chemical data Formula C17H20N2S Mol. mass 284.425 g/mol Pharmacokinetic data Bioavailability 88% absorbed but after first-pass metabolism reduced to 25% absolute bioavailability Protein binding 93% Metabolism Hepatic glucuronidation and sulfoxidation Half life 16-19 hours Excretion Renal and biliary Therapeutic considerations Pregnancy cat. CAU CUS Legal status PUK â„ž-onlyUS injection POMUK Routes Oral, rectal, IV, IM Promethazine is a first-generation H1 receptor antagonist antihistamine and antiemetic medication. It is a prescription drug in the United States, but is available over the counter in the United Kingdom, Switzerland, and many other countries brand names Phenergan, Promethegan, Romergan, Fargan, Farganesse, Prothiazine, Avomine, Atosil.1 Promethazine also has strong anticholinergic and sedative effects. Previously it was used as an antipsychotic, although it is generally not administered for this purpose now; promethazine has only approximately 1/10 of the antipsychotic strength of chlorpromazine. Chemically, promethazine hydrochloride HCl appears as a white to faint yellow crystaline powder which is practically odorless. Slow oxidation may occur upon prolonged exposure to air causing blue discoloration. Promethazine as the hydrochloric salt is freely soluble in water and somewhat soluble in alcohol.2 Contents 1 Indications 2 Contraindications 3 Mechanism of action 4 Side effects 5 Laboratory examinations 6 Recreational use 7 References 8 External links Indications As a sedative.3 For preoperative sedation and to counteract postnarcotic nausea.3 As antiallergic medication to combat hay fever, allergic rhinitis, etc. To treat allergic reactions it can be given alone or in combination with oral decongestants like pseudo-ephedrine.3 As an adjunct treatment for anaphylactoid conditions IM/IV route preferred.3 Together with codeine or dextromethorphan against cough. As a motion sickness or seasickness remedy when used with Ephedrine or Pseudoephedrine.3 As an antipruritic pruritus vulvae.3 To combat moderate to severe morning sickness and hyperemesis gravidarum. In the UK promethazine is drug of first choice, being preferred as an older drug with which there is a greater experience of use in pregnancy second line being metoclopramide or prochlorperazine.4 Whilst in the US, Zofran ondansetron is the usual drug of choice, Contraindications Promethazine should not be given to children under two years of age; there is potential for fatal respiratory depression in this age group.5 Hypersensitivity to phenothiazines6 Closed angle glaucoma6 Intoxication with alcohol or other central depressants6 Severe hypotension or shock6 Coma due to any reason6 Severely impaired liver function6 Urine hesitancy due to enlargement of the prostate gland6 Mechanism of action Promethazine is a phenothiazine derivative that competitively blocks histamine H1 receptors without blocking the secretion of histamine.7 It has sedative, anti-motion-sickness, anti-emetic, and anti-cholinergic effects However, unlike other phenothiazines, it has no dopaminergic action due to a structural difference with other phenothiazines.8 Side effects Some common side effects include: Blurred vision Confusion in the elderly Drowsiness, dizziness, fatigue, more rarely vertigo Dry mouth Seizures extremely rare Neuroleptic malignant syndrome extremely rare Respiratory depression in patients under age of 2 and in those with severely compromised pulmonal function Constipation Euphoria very rare with high IV doses and/or coadministration with opioids/CNS depressants Restless legs 9 When incorrectly administered parenterally, severe reactions requiring immediate medical attention include: Phlebitis inflammation of a vein, potentially severe when administered intravenously10 Severe tissue necrosis due to arterial or inadvertent perivascular extravasation10 Gangrene10 Arterial spasm / Distal vessel spasm10 Thrombophlebitis10 Vascular Insufficiency10 Deep Vein Thrombosis10 Paralysis Parathesia It is recommended that Promethazine only be given through an existing intravenous set in a large vein, and diluted to concentration no greater than 25mg per ml, not to exceed a rate of administration of 25mg a min. Serious complications including those listed above have resulted from improper parenteral administration, including those requiring surgical intervention and amputation.10 Laboratory examinations All patients should have their blood pressure measured frequently. During long-term therapy, blood cell counts, liver function studies, EKG, and EEG are recommended. The intervals should be determined according to the risk profile of the patient. In high doses Promethazine can create auditory and visual hallucinations causing panic and intense fear. If mixed with alcohol less needs to be taken to get these effects therefore can really take someone by surprise.citation needed Recreational use Promethazine is sometimes used as a recreational drug in conjunction with codeine in prescription cough syrup. The syrup by itself contains 7% alcohol. The traditional mixture of Sprite and cough syrup with codeine, which is known as purple drank or Sizzurp, is popularized in the rap world, especially in the Houston area.11 It is also sometimes used to counteract nausea caused by illicit opioid use. References ^ RxList: Promethazine ^ http://www.rxlist.com/cgi/generic/phenergan.htm RxList: Promethazine Description ^ a b c d e f RxList Indications for Promethazine ^ British National Formulary March 2003. 4.6 Drugs used in nausea and vertigo - Vomiting of pregnancy, BNF, 45. ^ Letter from Wyeth Pharmaceuticals to practitioners regarding use of Phenergan in under twos PDF. FDA. ^ a b c d e f g RxList Contraindications ^ David J McCann and Brett Roth, Toxicity, Antihistamine, eMedicine Toxicology, updated June 21, 2007 ^ Pharmacology of Promethazine ^ Cordingley Neurology ^ a b c d e f g h Baxter: Promethazine HCl Injection, USP Information ^ Peters RJ, Kelder SH, Markham CM, Yacoubian GS, Peters LA, Ellis A 2003. Beliefs and social norms about codeine and promethazine hydrochloride cough syrup CPHCS onset and perceived addiction among urban Houstonian adolescents: an addiction trend in the city of lean. J Drug Educ 33 4: 415-25. doi:10.2190/NXJ6-U60J-XTY0-09MP. PMID 15237866. External links Promethazine. U.S. National Library of Medicine and National Institutes of Health. v d e Antipruritics D04 Antihistamines for topical use Thonzylamine - Mepyramine - Thenalidine - Tripelennamine - Chloropyramine - Promethazine - Tolpropamine - Dimetindene - Clemastine - Bamipine - Isothipendyl - Diphenhydramine - Chlorphenoxamine Anesthetics for topical use Lidocaine - Cinchocaine - Oxybuprocaine - Benzocaine - Quinisocaine - Tetracaine - Pramocaine v d e Histamine antagonists H1 or non-selective Alkylamines Bepotastine Bamipine Brompheniramine Chlorpheniramine Dexbrompheniramine Dexchlorpheniramine Dimethindene Metron S Pheniramine Pyrrobutamine Talastine Thenaldine Tolpropamine Triprolidine Ethanolamines Aminoalkyl ethers Bietanautine Bromazine/Bromodiphenhydramine Carbinoxamine Chlorphenoxamine Clemastine Diphenylpyraline Diphenhydramine Doxylamine Embramine p-Methyldiphenhydramine Moxastine Orphenadrine Phenyltoloxamine Setastine Ethylenediamines Chloropyramine Chlorothen Histapyrrodine Methafurylene Mepyramine Methapyrilene Pyrilamine Talastine Thenyldiamine Thonzylamine Tripelennamine Pyribenzamine Phenothiazine Tricyclics Ahistan Etymemazine Hydroxyethylpromethazine Isopromethazine Isothipendyl Mequitazine Methdilazine Oxomemazine Promethazine Thiazinamium Other Tricyclics Azatadine Clobenzepam Cyproheptadine Deptropine Isothipendyl Loratidine Piperazine Buclizine Chlorcyclizine Cinnarizine Clocinizine Hydroxyzine Niaprazine Oxatomide Benzhydryl compounds Cyclizine, Meclizine Others including selective, 2nd gen, 3rd gen Antazoline Astemizole Azatadine Azelastine Bepottastine Bamipine Cetoxine Clemizole Clobenztropine Deptropine Desloratadine Dimebon Ebastine Emedastine Epinastine Ketotifen Levocabastine Loratadine Mebhydrolin Mizolastine Phenindamine Pimethixene Pyrrobutamine Rupatadine Thenalidine Tritoqualine Alkylamine Acrivastine Tricyclic Olopatadine Piperazine Levocetirizine, Cetirizine Benzhydryl compounds Fexofenadine, Terfenadine H2 Cimetidine Famotidine Ranitidine Roxatidine Lafutidine Niperotidine Nizatidine H3 A-349,821 ABT-239 Burimamide Ciproxifan Clobenpropit Conessine Impentamine Iodophenpropit Thioperamide VUF-5681 H4 JNJ 7777120 Thioperamide VUF-6002 Retrieved from http://en..org/wiki/Promethazine Categories: Antiemetics | H1 receptor antagonists | Hypnotics | PhenothiazinesHidden categories: All articles with statements | Articles with statements since February 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Français Magyar Nederlands 日本語 ‪Norsk nynorsk‬ Polski Português РуÑ?Ñ?кий Svenska ไทย ä¸æ–‡ This page was last modified on 14 August 2008, at 00:1
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