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Promethazine

 
Drug Info:

Promethazine

Brand names: Anergan™, Antinaus®, Pentazine®, Phenadoz™, Phenergan®, Phenergan® Fortis, Progan™, Prometh®, Promethegan®

Chemical formula:



Promethazine Hydrochloride Rectal suppository

What is this medicine?

PROMETHAZINE (proe METH a zeen) is an antihistamine. It is used to treat allergic reactions and to treat or prevent nausea and vomiting from illness or motion sickness. It is also used to make you sleep before surgery, and to help treat pain or nausea after surgery.
 
This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
•glaucoma
•high blood pressure or heart disease
•kidney disease
•liver disease
•lung or breathing disease, like asthma
•prostate trouble
•pain or difficulty passing urine
•seizures
•an unusual or allergic reaction to promethazine or phenothiazines, other medicines, foods, dyes, or preservatives
•pregnant or trying to get pregnant
•breast-feeding

How should I use this medicine?

This medicine is for rectal use only. Do not take by mouth. Wash your hands before and after use. Take off the foil wrapping. Wet the tip of the suppository with cold tap water to make it easier to use. Lie on your side with your lower leg straightened out and your upper leg bent forward toward your stomach. Lift upper buttock to expose the rectal area. Apply gentle pressure to insert the suppository completely into the rectum, pointed end first. Hold buttocks together for a few seconds. Remain lying down for about 15 minutes to avoid having the suppository come out. Do not use more often than directed.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed. This medicine should not be given to infants and children younger than 2 years old.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

Do not take this medicine with any of the following medications:
•medicines called MAO Inhibitors like Nardil, Parnate, Marplan, Eldepryl
•other phenothiazines like trimethobenzamide

This medicine may also interact with the following medications:
•barbiturates such as phenobarbital
•bromocriptine
•certain antidepressants
•certain antihistamines used in allergy or cold medicines
•epinephrine
•levodopa
•medicines for sleep
•medicines for mental problems and psychotic disturbances
•medicines for movement abnormalities as in Parkinson's disease, or for gastrointestinal problems
•muscle relaxants
•prescription pain medicines

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Tell your doctor or health care professional if your symptoms do not start to get better in 1 to 2 days.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. To reduce the risk of dizzy or fainting spells, do not stand or sit up quickly, especially if you are an older patient. Alcohol may increase dizziness and drowsiness. Avoid alcoholic drinks.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water may help. Contact your doctor if the problem does not go away or is severe.

This medicine may cause dry eyes and blurred vision. If you wear contact lenses you may feel some discomfort. Lubricating drops may help. See your eye doctor if the problem does not go away or is severe.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

If you are diabetic, check your blood-sugar levels regularly.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
•blurred vision
•irregular heartbeat, palpitations or chest pain
•muscle or facial twitches
•pain or difficulty passing urine
•seizures
•skin rash
•slowed or shallow breathing
•unusual bleeding or bruising
•yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
•headache
•nightmares, agitation, nervousness, excitability, not able to sleep (these are more likely in children)
•stuffy nose

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store in a refrigerator between 2 and 8 degrees C (36 and 46 degrees F). Throw away any unused medicine after the expiration date.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

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A phenothiazine derivative used as an antihistaminic, antiemetic and tranquilizer in the form of the hydrochloride salt.

Wikipedia on Answers.com:

Promethazine

Top
Promethazine
Systematic (IUPAC) name
(RS)-N,N-dimethyl-1-(10H-phenothiazin-10-yl)propan-2-amine
Clinical data
AHFS/Drugs.com monograph
MedlinePlus a682284
Pregnancy cat. C(AU) C(US)
Legal status P (UK) -only (US)
(injection POM(UK))
Routes Oral, rectal, IV, IM, topical
Pharmacokinetic data
Bioavailability 88% absorbed but after first-pass metabolism reduced to 25% absolute bioavailability[1]
Protein binding 93%
Metabolism Hepatic glucuronidation and sulfoxidation
Half-life 10-19 hours[1][2]
Excretion Renal and biliary
Identifiers
CAS number 60-87-7 YesY
58-33-3 (hydrochloride)
ATC code D04AA10 R06AD02, R06AD05
PubChem CID 4926
DrugBank APRD00601
ChemSpider 4759 N
UNII FF28EJQ494 YesY
KEGG D00494 YesY
ChEBI CHEBI:8461 YesY
ChEMBL CHEMBL643 YesY
Chemical data
Formula C17H20N2S 
Mol. mass 284.42 g/mol
SMILES eMolecules & PubChem
 N(what is this?)  (verify)

Promethazine is a first-generation antihistamine of the phenothiazine family. The drug has anti-motion sickness, antiemetic, and anticholinergic effects, as well as a strong sedative effect and in some countries is prescribed for insomnia when benzodiazepines are contraindicated. It is available over-the-counter in the United Kingdom, Australia, Switzerland, and many other countries, but by prescription in the United States (brand names Phenergan, Promethegan, Romergan, Fargan, Farganesse, Prothiazine, Avomine, Atosil, Receptozine, Lergigan, and Sominex in the UK).[3]

Contents

Indications

Chemistry

Chemically, promethazine hydrochloride appears as a white to faint yellow crystalline powder that is practically odorless. Slow oxidation may occur upon prolonged exposure to air usually causing blue discoloration. Promethazine as the hydrochloride salt is freely soluble in water and somewhat soluble in alcohol. Promethazine is a chiral compound, occurring as a mixture of enantiomers (pictured).[7]

Promethazine, 10-(2-dimethylaminopropyl)phenothiazine, is synthesized by alkylating phenothiazine with 1-dimethylamino-2-propylchloride:[8][9]

Promethazine synthesis.png

Pharmacology

Promethazine is a phenothiazine derivative that is structurally different from the neuroleptic phenothiazines, with similar but different effects.[1] It acts primarily as a strong antagonist of the H1 receptor (antihistamine) and a moderate mACh receptor antagonist (anticholinergic),[1] and also has weak to moderate affinity for the 5-HT2A,[10] 5-HT2C,[10] D2,[11][12] and α1-adrenergic receptors,[13] where it acts as an antagonist at all sites as well.

Another notable property of promethazine is that it is a local anesthetic, via blockade of sodium channels.[13]

Side effects

Some common side effects include:

  • Tardive dyskinesia
  • Confusion in the elderly
  • Drowsiness, dizziness, fatigue, more rarely vertigo
  • Dry mouth
  • Respiratory depression in patients under age of 2 and in those with severely compromised pulmonal function
  • Constipation
  • Chest Discomfort/Pressure. (typically in cases when patient is already taking medication for high blood pressure)
  • Euphoria (very rare, except with high IV doses and/or coadministration with opioids/CNS depressants)
  • Akathisia [14]
  • Paresthesia
  • Short temper/Irritability

Extremely rare side effects include:

Because of potential for more severe side effects, this drug is on the list to avoid in the elderly. (See NCQA’s HEDIS Measure: Use of High Risk Medications in the Elderly).

Product liability lawsuit

In 2009, the U.S. Supreme Court ruled on a product liability case involving promethazine. Diana Levine, a woman suffering from a migraine, was administered Wyeth's Phenergan via IV push. The drug was injected improperly resulting in gangrene and subsequent amputation of her right forearm below the elbow. A state jury awarded her $6 million in punitive damages.

The case was appealed to the Supreme Court on grounds of federal preemption and substantive due process.[15] The Supreme Court upheld the lower courts' rulings stating that "Wyeth could have unilaterally added a stronger warning about IV-push administration" without acting in opposition to federal law.[16] In effect, this means that drug manufacturers can be held liable for injuries if warnings of potential adverse effects (approved by the U.S. Food and Drug Administration, "FDA") are deemed insufficient by state courts.

On September 9, 2009, the FDA made the decision that a black box warning for injection be put on promethazine stating the contraindication for subcutaneous administration. The preferred administrative route is intramuscular (IM) which reduces risk of surrounding muscle and tissue damage [17]

See also

  • Purple drank (a recreational drug concoction containing promethazine)

References

  1. ^ a b c d Strenkoski-Nix LC, Ermer J, DeCleene S, Cevallos W, Mayer PR (August 2000). "Pharmacokinetics of promethazine hydrochloride after administration of rectal suppositories and oral syrup to healthy subjects". American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists 57 (16): 1499–505. PMID 10965395. http://www.ajhp.org/cgi/pmidlookup?view=long&pmid=10965395. 
  2. ^ Paton DM, Webster DR (1985). "Clinical pharmacokinetics of H1-receptor antagonists (the antihistamines)". Clinical Pharmacokinetics 10 (6): 477–97. PMID 2866055. http://content.wkhealth.com/linkback/openurl?issn=0312-5963&volume=10&issue=6&spage=477. 
  3. ^ RxList: Promethazine
  4. ^ a b c d e RxList Indications for Promethazine.
  5. ^ British National Formulary (March 2001). "4.6 Drugs used in nausea and Vertigo - Vomiting of pregnancy". BNF (45 ed.). .
  6. ^ [1].
  7. ^ http://www.rxlist.com/cgi/generic/phenergan.htm RxList: Promethazine Description
  8. ^ P. Charpentier, U.S. Patent 2,530,451 (1950)
  9. ^ S.B. Sidney, J.A. Nicholson, U.S. Patent 2,607,773 (1952)
  10. ^ a b Fiorella D, Rabin RA, Winter JC (October 1995). "The role of the 5-HT2A and 5-HT2C receptors in the stimulus effects of hallucinogenic drugs. I: Antagonist correlation analysis". Psychopharmacology 121 (3): 347–56. PMID 8584617. 
  11. ^ Seeman P, Watanabe M, Grigoriadis D, et al. (November 1985). "Dopamine D2 receptor binding sites for agonists. A tetrahedral model". Molecular Pharmacology 28 (5): 391–9. PMID 2932631. http://molpharm.aspetjournals.org/cgi/pmidlookup?view=long&pmid=2932631. 
  12. ^ Burt DR, Creese I, Snyder SH (April 1977). "Antischizophrenic drugs: chronic treatment elevates dopamine receptor binding in brain". Science 196 (4287): 326–8. doi:10.1126/science.847477. PMID 847477. http://www.sciencemag.org/cgi/pmidlookup?view=long&pmid=847477. 
  13. ^ a b Jagadish Prasad, P. (2010). Conceptual Pharmacology. Universities Press. pp. 295, 303, 598. ISBN 978-81-7371-679-9. http://books.google.com/books?id=s0e_FlM8LKYC&pg=PA295. Retrieved 27 November 2011. 
  14. ^ Cordingley Neurology
  15. ^ Liptak, Adam (2001-09-18). "Drug Label, Maimed Patient and Crucial Test for Justices". The New York Times. http://www.nytimes.com/2008/09/19/us/19scotus.html?n=Top/Reference/Times%20Topics/Organizations/S/Supreme%20Court&_r=1&adxnnl=1&oref=slogin&adxnnlx=1225505895-T2aivHeTdvJTT7b+uEsK1Q. Retrieved 2008-10-31. 
  16. ^ Stout, David (2009-03-04). "Drug Approval Is Not a Shield From Lawsuits, Justices Rule". The New York Times. http://www.nytimes.com/2009/03/05/washington/05scotus.html. Retrieved 2009-03-04. 
  17. ^ http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm182169.htm

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Drug Info. Gold Standard. Copyright © 2008 by Gold Standard. All rights reserved.  Read more
Saunders Veterinary Dictionary. Saunders Comprehensive Veterinary Dictionary 3rd Edition. Copyright © 2007 by D.C. Blood, V.P. Studdert and C.C. Gay, Elsevier. All rights reserved.  Read more
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