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promethazine

promethazine
Brand names: Phenergan
Form Strength
SOLUTION, INJECTABLE 25 mg/mL
SUPPOSITORY, RECTAL 12.5 mg; 25 mg; 50 mg
SYRUP, ORAL 6.25 mg/5 mL
TABLET, ORAL 25 mg
Display First Generation Antihistamines, Phenothiazines, Anxiolytics, Sedatives, and Hypnotics, Miscellaneous Class: 040400, 28160824, 282492
High Alert Drug : Policy
Medication comments:

Refrigerator item (suppository) 

High Alert Drug: IV promethazine
 • Dosing/administration guidelines.
 • Not to be given by IV push.
 • To be infused over at least 10 minutes. Maximum dose of 12.5mg.
 • No infusion in hand or wrist veins.
 • Autosubstitution to prochlorperazine unless ordered as “do not substitute.”
 • Pregnant patients will not be automatically substituted to prochlorperazine.
 • Stored in dispensing cabinet with warning alert “not for IV push” and reference to policy.
Per policy, use of these medications is restricted as noted below:  
generic (Brand) Restrictions
promethazine IV (Phenergan) Intravenous promethazine is restricted to Obstetric patients with hyperemesis ONLY, where other treatments have failed.
Per policy, orders for these non-formulary agents will be changed to formulary equivalents.
Non-Formulary Agent Formulary Equivalent
promethazine (Phenergan) 12.5 mg IV push prochlorperazine (Compazine) 5 mg IV push Intravenous Promethazine is restricted to Obstetric patients with hyperemesis ONLY, where other treatments have failed.
promethazine (Phenergan) 25 mg IV push prochlorperazine (Compazine) 10 mg IV push Intravenous Promethazine is restricted to Obstetric patients with hyperemesis ONLY, where other treatments have failed.
 Available ED To-Go medications. 
Description (Qty)
promethazine (Phenergan) 25 mg tablets (#4)
Adult Extravasation Management
promethazine (Phenergan)
Agent type: Non-Chemotherapeutic
Vesicant/Irritant: Vesicant
Local Care: Warm or cold compress
Antidote: None
Comments: • Refractory cases: Consider Nitroglycerin 2% topical or hyaluronidase (200 units/ml)
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: promethazine (Phenadoz, Phenergan)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Drug(s) first-generation antihistamines
Rationale Highly anticholinergic; clearance reduced with advanced age, and tolerance develops when used as hypnotic; risk of confusion, dry mouth, constipation, and other anticholinergic effects or toxicity. Cumulative exposure to anticholinergic drugs is associated with an increased risk of falls, delirium, and dementia, even in younger adults. Consider total anticholinergic burden during regular medication reviews and be cautious in "young-old" as well as "old-old" adults.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome anticholinergics ⇄ Delirium
Rationale Avoid in older adults with or at high risk of delirium because of the potential of inducing or worsening delirium.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome anticholinergics ⇄ Dementia or cognitive impairment
Rationale Avoid because of adverse CNS effects. If used, periodic deprescribing attempts should be considered to assess ongoing need and/or the lowest effective dose.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome anticholinergics ⇄ History of falls or fractures
Rationale May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation Avoid unless safer alternatives are not available.
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome strongly anticholinergic drugs, except antimuscarinics for urinary incontinence ⇄ Lower urinary tract symptoms, benign prostatic hyperplasia
Rationale May decrease urinary flow and cause urinary retention
Recommendation Avoid in men
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome antiemetics ⇄ Parkinson disease
Rationale DOPamine-receptor antagonists with the potential to worsen Parkinsonian symptoms.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es) anticholinergics ⇄ anticholinergics
Risk Rationale Use of more than one medication with anticholinergic properties increases the risk of cognitive decline, delirium, and falls or fractures.
Recommendation Avoid; minimize the number of anticholinergic drugs Click for list.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
Pediatric Pharmacy Association 2025 KIDs List of Key Potentially Inappropriate Drugs in Pediatrics 
Medication: promethazine (Phenadoz, Phenergan)
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug dopamine antagonists
Risk/Rationale Respiratory failure, death
Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in younger than 2 yr
Caution in 2-18 yr of age
 Quality of evidence: Moderate, Strength of Recommendation: Strong
Last updated: Sep. 25, 2025
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Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556



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