PROMETHAZINE HYDROCHLORIDE

PROMETHAZINE HYDROCHLORIDE- promethazine hydrochloride injection, solution
XGen Pharmaceuticals DJB, Inc.

WARNINGS: RESPIRATORY DEPRESSION IN PEDIATRICS AND SEVERE TISSUE INJURY, INCLUDING GANGRENE

Respiratory Depression — Pediatrics

Promethazine hydrochloride injection should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. Post-marketing cases of respiratory depression, including fatalities, have been reported with use of promethazine in pediatric patients less than 2 years of age. Caution should be exercised when administering promethazine hydrochloride injection to pediatric patients 2 years of age and older (see WARNINGS — Respiratory Depression).

Severe Tissue Injury, Including Gangrene

  • Severe chemical irritation and damage to tissues regardless of the route of parenteral administration has been reported in patients treated with promethazine hydrochloride injection including gangrene, tissue necrosis, and thrombophlebitis; and in some cases, surgical intervention including fasciotomy, skin graft, and/or amputation have been required (see WARNINGS-Severe Tissue Injury, Including Gangrene).
  • The use of promethazine hydrochloride injection by the following routes of administration is CONTRAINDICATED:
    o Intravenous injection at concentrations greater than 1 mg/mL

    o Intra-arterial injection
    o Subcutaneous injection (see
    CONTRAINDICATIONS ).
  • The preferred route of administration is by deep intramuscular administration.
  • Promethazine hydrochloride injection may be administered intravenously after dilution through an intravenous catheter inserted in a large vein. Preferably through a central venous catheter (see DOSAGE AND ADMINISTRATION ).
  • If pain occurs at the injection site during intravenous infusion, immediately discontinue the infusion and evaluate for possible arterial injection or perivascular extravasation, and initiate appropriate medical management.

DESCRIPTION

Promethazine hydrochloride injection, USP is a sterile, pyrogen-free solution for deep intramuscular or intravenous administration. Promethazine hydrochloride (10H-phenothiazine-10-ethanamine, N, N, α-trimethyl-, monohydrochloride, (±)-) is a racemic compound and has the following structural formula:

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Each mL contains promethazine hydrochloride, either 25 mg or 50 mg, edetate disodium 0.1 mg, calcium chloride 0.04 mg, sodium metabisulfite 0.25 mg and phenol 5 mg in Water for Injection, USP. pH 4.0 to 5.5; buffered with acetic acid-sodium acetate. Sealed under nitrogen.

Promethazine hydrochloride injection is a clear, colorless solution. The product is light sensitive. It should be inspected before use and discarded if either color or particulate is observed.

CLINICAL PHARMACOLOGY

Promethazine hydrochloride is a phenothiazine derivative which possesses antihistaminic, sedative, antimotion-sickness, antiemetic, and anticholinergic effects. Promethazine is a competitive H 1 receptor antagonist, but does not block the release of histamine. Structural differences from the neuroleptic phenothiazines result in its relative lack (1/10 that of chlorpromazine) of dopamine antagonist properties. Clinical effects are generally apparent within 5 minutes of an intravenous injection and within 20 minutes of an intramuscular injection. Duration of action is four to six hours, although effects may persist up to 12 hours. Promethazine hydrochloride is metabolized in the liver, with the sulfoxides of promethazine and N-desmethylpromethazine being the predominant metabolites appearing in the urine. Following intravenous administration in healthy volunteers, the plasma half-life for promethazine has been reported to range from 9 to 16 hours. The mean plasma half-life for promethazine after intramuscular administration in healthy volunteers has been reported to be 9.8 ± 3.4 hours.

INDICATIONS AND USAGE

Promethazine hydrochloride injection is indicated for the following conditions:

  1. Amelioration of allergic reactions to blood or plasma.
  2. In anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symptoms have been controlled.
  3. For other uncomplicated allergic conditions of the immediate type when oral therapy is impossible or contraindicated.
  4. For sedation and relief of apprehension and to produce light sleep from which the patient can be easily aroused.
  5. Active treatment of motion sickness.
  6. Prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery.
  7. As an adjunct to analgesics for the control of postoperative pain.
  8. Preoperative, postoperative, and obstetric (during labor) sedation.
  9. Intravenously in special surgical situations, such as repeated bronchoscopy, ophthalmic surgery, and poor-risk patients, with reduced amounts of meperidine or other narcotic analgesic as an adjunct to anesthesia and analgesia.

CONTRAINDICATIONS

The use of promethazine hydrochloride injection is contraindicated:

WARNINGS

Respiratory Depression

Pediatrics

Promethazine hydrochloride injection should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. Post-marketing 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 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. It is recommended that the lowest effective dose of promethazine hydrochloride injection be used in pediatric patients 2 years of age and older. Avoid concomitant administration of other drugs with respiratory depressant effects because of an association with respiratory depression, and sometimes death, in pediatric patients.

Other

Because of the risk of potentially fatal respiratory depression, use of promethazine hydrochloride injection in patients with compromised respiratory function or patients at risk for respiratory failure (e.g. COPD, sleep apnea) should be avoided.

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