Recommended Topic Related To:

Promethazine HCl and Dextromethorphan Hydrobromide Syrup

"Dec. 3, 2012 -- The U.S. flu season is here -- the earliest start since the "moderately severe" season of 2003.

Just as in 2003, the nasty H3N2 flu bug is causing most cases so far.

"This could be a bad flu year," warned CDC"...

Promethazine HCl and Dextromethorphan Hydrobromide Syrup

Warnings
Precautions

WARNINGS

Promethazine HCl and Dextromethorphan Hydrobromide Syrup should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. Postmarketing cases of respiratory depression, including fatalities, have been reported with use of promethazine in pediatric patients less than 2 years of age. A wide range of weight-based doses of promethazine have resulted in respiratory depression in these patients.

Caution should be exercised when administering promethazine to pediatric patients 2 years of age and older. It is recommended that the lowest effective dose of promethazine be used in pediatric patients 2 years of age and older and concomitant administration of other drugs with respiratory depressant effects be avoided.

CNS Depression

Promethazine HCl may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks, such as driving a vehicle or operating machinery. The impairment may be amplified by concomitant use of other central-nervous-system depressants such as alcohol, sedatives/ hypnotics (including barbiturates), narcotics, narcotic analgesics, general anesthetics, tricyclic antidepressants, and tranquilizers; therefore such agents should either be eliminated or given in reduced dosage in the presence of promethazine HCl (see PRECAUTIONS - Information for Patients and DRUG INTERACTIONS).

Respiratory Depression

Promethazine HCl may lead to potentially fatal respiratory depression.

Use of Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup in patients with compromised respiratory function (e.g. COPD, sleep apnea syndrome) should be avoided.

Lower Seizure Threshold

Promethazine HCl may lower seizure threshold. It should be used with caution in persons with seizure disorders or in persons who are using concomitant medications, such as narcotics or local anesthetics, which may also affect seizure threshold.

Bone-Marrow Depression

Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup should be used with caution in patients with bone-marrow depression. Leukopenia and agranulocytosis have been reported, usually when promethazine HCl has been used in association with other known marrow-toxic agents.

Neuroleptic Malignant Syndrome

A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with promethazine HCl alone or in combination with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmias).

The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to identify cases where the clinical presentation includes both serious medical illness (e.g. pneumonia, systemic infection, etc.) and untreated or inadequately treated extrapyramidal signs and symptoms (EPS). Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology.

The management of NMS should include 1) immediate discontinuation of promethazine HCl, antipsychotic drugs, if any, and other drugs not essential to concurrent therapy, 2) intensive symptomatic treatment and medical monitoring, and 3) treatment of any concomitant serious medical problems for which specific treatments are available. 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 HCl should be carefully considered.

Use in Pediatric Patients

Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup is contraindicated for use in pediatric patients less than two years of age.

Caution should be exercised when administering Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup to pediatric patients 2 years of age and older because of the potential for fatal respiratory depression. Respiratory depression and apnea, sometimes associated with death, are strongly associated with promethazine products and are not directly related to individualized weight-based dosing, which might otherwise permit safe administration. Concomitant administration of promethazine products with other respiratory depressants has an association with respiratory depression, and sometimes death, in pediatric patients.

Antiemetics are not recommended for treatment of uncomplicated vomiting in pediatric patients, and their use should be limited to prolonged vomiting of known etiology. The extrapyramidal symptoms which can occur secondary to Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup administration may be confused with the CNS signs of undiagnosed primary disease, e.g., encephalopathy or Reye's syndrome. The use of Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup should be avoided in pediatric patients whose signs and symptoms may suggest Reye's syndrome or other hepatic diseases.

Excessively large dosages of antihistamines, including promethazine HCl, in pediatric patients may cause sudden death (see OVERDOSAGE). Hallucinations and convulsions have occurred with therapeutic doses and overdoses of Promethazine HCl in pediatric patients.

In pediatric patients who are acutely ill associated with dehydration, there is an increased susceptibility to dystonias with the use of promethazine HCl.

Other Considerations

Administration of promethazine HCl has been associated with reported cholestatic jaundice.

DEXTROMETHORPHAN

Administration of dextromethorphan may be accompanied by histamine release and should be used with caution in atopic children.

PRECAUTIONS

General

Drugs having anticholinergic properties should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal obstruction and bladder-neck obstruction. Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup should be used cautiously in persons with cardiovascular disease or with impairment of liver function.

Dextromethorphan should be used with caution in sedated patients, in the debilitated, and in patients confined to the supine position.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long-term animal studies have not been performed to assess the carcinogenic potential of promethazine or of dextromethorphan. There are no animal or human data concerning carginogenicity, mutagenicity, or impairment of fertility with these drugs. Promethazine was nonmutagenic in the Salmonella test system of Ames.

Pregnancy

Teratogenic Effects-Pregnancy Category C

Teratogenic effects have not been demonstrated in rat-feeding studies at doses of 6.25 and 12.5 mg/kg of promethazine HCl. These doses are 8.3 and 16.7 times the maximum recommended total daily dose for a 50-kg subject. Daily doses of 25 mg/kg intraperitoneally have been found to produce fetal mortality in rats.

Specific studies to test the action of the drug on parturition, lactation, and development of the animal neonate were not done, but a general preliminary study in rats indicated no effect on these parameters. Although antihistamines have been found to produce fetal mortality in rodents, the pharmacological effects of histamine in the rodent do not parallel those in man. There are no adequate and well-controlled studies of Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup in pregnant women.

Animal reproduction studies have not been conducted with the drug combination - promethazine HCl and dextromethorphan. It is not known whether this drug combination can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup should be given to a pregnant woman only if clearly needed. Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nonteratogenic Effects

Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup administered to a pregnant woman within two weeks of delivery may inhibit platelet aggregation in the newborn.

Labor and Delivery

Limited data suggest that use of promethazine HCl during labor and delivery does not have an appreciable effect on the duration of labor or delivery and does not increase the risk of need for intervention in the newborn. The effect on later growth and development of the newborn is unknown. See also Nonteratogenic Effects.

Nursing Mothers

It is not known whether promethazine HCl or dextromethorphan is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup is contraindicated for use in pediatric patients less than two years of age (see WARNINGS - Boxed Warning and Use in Pediatric Patients).

Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup should be used with caution in pediatric patients 2 years of age and older (see WARNINGS-Use in Pediatric Patients).

Geriatric Use

Clinical studies of promethazine HCl formulations did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.

Sedating drugs may cause confusion and over-sedation in the elderly; elderly patients generally should be started on low doses of Promethazine HCl and Dextromethorphan Hydrobromide (promethazine and dextromethorphan) Syrup and observed closely.

Last reviewed on RxList: 5/15/2008
This monograph has been modified to include the generic and brand name in many instances.

Warnings
Precautions
A A A

Promethazine HCl and Dextromethorphan Hydrobromide Syrup - User Reviews

Promethazine HCl and Dextromethorphan Hydrobromide Syrup User Reviews

Now you can gain knowledge and insight about a drug treatment with Patient Discussions.

Here is a collection of user reviews for the medication Promethazine HCl and Dextromethorphan Hydrobromide Syrup sorted by most helpful. Patient Discussions FAQs

Report Problems to the Food and Drug Administration

 

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.


Living Better

Find the secrets to longer life.

Health Resources
Use Pill Finder Find it Now See Interactions

Pill Identifier on RxList

  • quick, easy,
    pill identification

Find a Local Pharmacy

  • including 24 hour, pharmacies

Interaction Checker

  • Check potential drug interactions
Search the Medical Dictionary for Health Definitions & Medical Abbreviations