When used for control of postoperative nausea and vomiting, the dosage of analgesics and barbiturates should be reduced accordingly (see Antiemetics should not be used in vomiting of unknown etiology in children and adolescents (see As an adjunct to preoperative or postoperative medication, 25 to 50 mg of promethazine hydrochloride injection in adults may be combined with appropriately reduced doses of analgesics and atropine-like drugs as desired. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. It should be inspected before use and discarded if either color or particulate is observed.Promethazine hydrochloride is a phenothiazine derivative which possesses antihistaminic, sedative, antimotion-sickness, antiemetic, and anticholinergic effects. See DOSAGE AND ADMINISTRATION for important notes on administration.WARNINGS - Severe Tissue Injury, Including GangrenePromethazine hydrochloride injection should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. Due to the close proximity of arteries and veins in the areas most commonly used for intravenous injection, extreme care should be exercised to avoid perivascular extravasation or unintentional intra-arterial injection as pain, severe chemical irritation, severe spasm of distal vessels, and resultant gangrene requiring amputation are likely under such circumstances. Available for Android and iOS devices. encephalopathy or Reye's syndrome. A paradoxical reaction has been reported in pediatric patients receiving single doses of 75 mg to 125 mg orally, characterized by hyperexcitability and nightmares.Atropine-like and symptoms—dry mouth, fixed, dilated pupils, flushing, etc., as well as Avoid analeptics, which may cause convulsions. for the performance of potentially hazardous tasks, such as driving a vehicle (See Angioneurotic edema.

A wide range of weight-based doses of promethazine hydrochloride injection have resulted in respiratory depression in these patients.Caution should be exercised when administering promethazine hydrochloride injection to pediatric patients 2 years of age and older.

When labor is definitely established, 25 to 75 mg (average dose, 50 mg) promethazine hydrochloride injection may be given with an appropriately reduced dose of any desired narcotic (see In pediatric patients 2 years of age and older, the dosage should not exceed half that of the suggested adult dose. Excessive amounts of promethazine hydrochloride injection relative to a narcotic may lead to restlessness and motor hyperactivity in the patient with pain; these symptoms usually disappear with adequate control of the pain.Because of the potential for promethazine hydrochloride to reverse epinephrine’s vasopressor effect, epinephrine should NOT be used to treat hypotension associated with promethazine hydrochloride injection overdose.Concomitant use of other agents with anticholinergic properties should be undertaken with caution.Drug interactions, including an increased incidence of extrapyramidal effects, have been reported when some MAO Inhibitors and phenothiazines are used concomitantly.
PO/PR: 25 mg at bedtime or 12.5 mg before meals and at bedtime (dosage range, 6.25-12.5 mg q8hr) IV/IM: 25 mg; may be repeated in 2 hours when necessary; switch to PO as soon as possible. In the event that a patient complains of pain during intravenous injection of promethazine hydrochloride injection, the injection should be stopped immediately to evaluate for possible arterial injection or perivascular extravasation. Promethazine hydrochloride is metabolized in the liver, with the sulfoxides of promethazine and N-desmethylpromethazine being the predominant metabolites appearing in the urine. There is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS.Since recurrences of NMS have been reported with phenothiazines, the reintroduction of promethazine hydrochloride should be carefully considered.Promethazine hydrochloride injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthma episodes, in certain susceptible people. When given concomitantly with promethazine hydrochloride injection, the dose of barbiturates should be reduced by at least one-half, and the dose of narcotics should be reduced by one-quarter to one-half.

EPINEPHRINE SHOULD NOT BE USED, since its use in a patient with partial adrenergic blockade may further lower the blood pressure.

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