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Author: Admin | 2025-04-28
Inadvertently administered intra-arterially or if extravasation were to occur, some medication safety experts (e.g., the Institute for Safe Medication Practices [ISMP]) recommend that parenteral administration of the drug be avoided and replaced by safer alternative therapies.FDA states that subcutaneous or intra-arterial administration of promethazine hydrochloride is contraindicated. Promethazine hydrochloride should not be administered intra-arterially, because chemical irritation may be severe and cause severe arteriospasm, possibly resulting in impairment of circulation and gangrene requiring amputation. Since promethazine discolors blood on contact, aspiration of dark blood at the site of injection does not rule out the possibility of intra-arterial placement of the needle.Promethazine is contraindicated in patients who have exhibited hypersensitivity or idiosyncrasy to promethazine or other phenothiazines. Promethazine also is contraindicated in pediatric patients younger than 2 years of age, because of the risk of developing potentially fatal respiratory depression. (See Cautions: Pediatric Precautions.) In addition, the drug is contraindicated in patients who have received large doses of other CNS depressants and/or who are comatose. The manufacturers state that the drug is contraindicated for use in the treatment of lower respiratory tract symptoms (e.g., asthma). There is some evidence that epileptic patients may experience increased severity of seizures if treated with promethazine, and the drug may be contraindicated in these patients. Since increases in blood pressure may occur, promethazine should be administered with extreme caution, if at all, to patients in hypertensive crisis. Some manufacturers state that promethazine also is contraindicated in patients with bone marrow depression, angle-closure glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal obstruction, or bladder neck obstruction, while others state that the drug may be used with caution in such patients. Some experts do not recommend administering promethazine to pediatric patients who are vomiting, unless the vomiting is prolonged and there is a known cause.Pediatric PrecautionsPromethazine (like other antihistamines) should not be used in premature or full-term neonates.Because respiratory depression (sometimes fatal) has been reported in pediatric patients younger than 2 years of age receiving a wide range of weight-adjusted doses of promethazine hydrochloride during postmarketing surveillance, the drug is contraindicated in this pediatric age group. Promethazine should
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