The need-to-know information for Promethazine
PromethazinePearls and Fun Nuggets
1. Promethazine was made in the 1940’s 📰 It was first synthesized by a group at Rhone-Poulenc (which later became part of Sanofi) led by Paul Charpentier[23] The team was seeking to improve on diphenhydramine; the same line on medical chemistry led to the creation of chlorpromazine.[24]
2. It can cause horrific injury if extravasated 😳 In 2009, the US 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.
3. It’s often used illicitly 🍹 The recreational drug Purple drank often contains a combination of promethazine with codeine containing cold medication.[25]
4. Promethazine has a variety of medical uses 📜 Including:
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- As a sedative[10]
- As antiallergic medication to combat hay fever (allergic rhinitis), etc., or to treat allergic reactions, alone or in combination with oral decongestants such as pseudoephedrine[10]
- As an adjunct treatment for anaphylactoid conditions (IM/IV route preferred)[10]
- As a motion sickness or seasickness remedy when used with ephedrine or pseudoephedrine[10]
- 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 in line being metoclopramide or prochlorperazine).[11]
- Previously, it was used as an antipsychotic,[12] although it is generally not administered for this purpose now; promethazine has only approximately 1/10 of the antipsychotic strength of chlorpromazine.
- Treatment for migraines; however, other similar medications, like Compazine, have been shown to have a more favorable treatment profile,[13] and are used almost exclusively over promethazine.
Patient Perspectives
“This is a very potent drug. I’ll say that. Highly effective for nausea and works very quickly, and that was what I was taking it for, so I’m giving it a 9. The one point deduction is for the weird side effects. Definitely makes you super drowsy, and I also experienced mood swings, crying jags, and what almost felt like hot flashes. But they’re preferable to the extreme nausea, so… weigh your options.”
“Works GREAT getting rid of the nausea I have from taking Fentanyl and Oxicodone.”
“I’ve been struggling with chronic nausea for a year now as well as an extreme fear of vomiting and anxiety nausea which I was happily surprised to see a lot of other people who took this medicine said it was a lifesaver for that. I had such high hopes for this medicine but unfortunately almost ended in a trip to the ER. Within three hours of taking it I felt extremely drunk, hollow, tingly, like my arms weren’t attached to my body, heart palpitations, which of course only triggered a panic attack and made it worse. Oh, and it literally didn’t even touch my nausea 🙁 Needless to say that was my first and last dose!”
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