Promethazine (Promethazine Hydrochloride)
Also sold as: Phenergan, Prome, Promethaz
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet 10mg, 25mg +3
Indications
- Allergic reactions / urticaria
- Nausea and vomiting (antiemetic)
- Motion sickness prophylaxis
- Preoperative sedation
- Insomnia (sedative)
- Pruritus
Adult Dosing
Allergic reaction / urticaria
10-25 mg PO at bedtime
As needed
Nausea / vomiting
12.5-25 mg PO/IM/IV Q4-6H
As needed
Motion sickness prophylaxis
25 mg PO 30-60 min before travel
Single dose pre-travel
Preoperative sedation
25-50 mg IM 30-60 min before surgery
Single pre-operative dose
Insomnia
25-50 mg PO at bedtime
As needed
Pediatric Dosing
Use with extreme caution in young children (respiratory suppression black box warning)
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 30 mL/min | No adjustment |
| CrCl < 30 mL/min | Use with caution; may need dose reduction |
Hepatic Adjustment
Severe: use with caution or avoid.
Pregnancy & Lactation
Pregnancy: Category C
Safe in pregnancy for nausea; commonly used for morning sickness.
Lactation: Caution
Excreted in breast milk; monitor infant.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Alcohol / CNS depressants (opioids, benzodiazepines) | Significant CNS depression and respiratory suppression risk | Major |
| MAOIs | Enhanced anticholinergic effects; risk of hypertensive crisis | Major |
| Anticholinergics | Additive anticholinergic effects (dry mouth, urinary retention) | Moderate |
| Lithium | Reduced lithium levels | Moderate |
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Side Effects
Common
- Drowsiness / sedation
- Dry mouth
- Blurred vision
- Dizziness
- Urinary retention
- Constipation
Serious / Discontinue If
- Respiratory depression (BLACK BOX <2 years)
- Neuroleptic malignant syndrome (rare)
- Extrapyramidal symptoms
- Photosensitivity
- Seizures
Contraindications
- Age <2 years (BLACK BOX warning)
- Respiratory disease (asthma, COPD)
- Sleep apnea
- Bone marrow suppression
- Hypersensitivity to promethazine or phenothiazines
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Phenergan 25 mg | Wyeth | 10 tab ₹90-120 |
| Prome 25 mg | Cipla | 10 tab ₹70 |
| Promethaz 25 mg | Various | 10 tab ₹60-80 |
Monitoring Required
- Drowsiness / sedation level
- Respiratory rate (especially in young children)
- Allergic reaction resolution
- Blood pressure if high-dose
Patient Counseling Points
- AVOID in children <2 years due to respiratory depression risk
- Significant sedation; do NOT drive or operate machinery
- Avoid alcohol entirely (severe CNS depression)
- Dry mouth common; sip water frequently
- Photosensitivity: use sunscreen if going out
- Report difficulty urinating or severe constipation
- For motion sickness: take 30-60 min before travel
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Clinically reviewed by: Dr. Nitya Sharma, MD (Anesthesiology), Pediatric Sedation Fellowship
Last reviewed: 2026-04-12
References
- BNF — Promethazine
- FDA BLACK BOX Warning <2 years
- Anesthesia Premedication Guidelines