What does all this mean?? If administered IV, dilute drug and administer slowly as indicated above. Allergic conditions including allergic reactions to blood or plasma: Action needed to prevent serious tissue injury with IV promethazine. In the s, after numerous reports of infiltration and inadvertent intraarterial injection of hydroxyzine, FDA asked the manufacturer to revise the label and remove IV as an approved route.

Today the drug is only indicated for IM or oral administration. Similarly, FDA should carefully investigate adverse events with this drug to determine if labeling changes are warranted, including removal of approval for IV administration.

Along with the manufacturer recommendations, the following strategies should be considered to prevent or minimize tissue damage when giving IV promethazine Hospitals have reported that these smaller doses have proven quite effective. For example, dilute the drug in 10 to 20 mL of normal saline if it will be administered via a running IV, or prepare the medication in minibags containing normal saline if there is time for pharmacy to dispense them as needed for individual patients.

Extravasation can also be recognized more quickly when promethazine is diluted than if the drug is given in a smaller volume. Use large patent veins.

Give the medication only through a large-bore vein preferably via a central venous access site, but absolutely no hand or wrist veins. Check patency of the access site before administration Before administration of the drug, tell patients to let you know immediately if burning or pain occurs during or after the injection.

Consider safer alternatives that can be used for the various conditions treated with IV promethazine. For example, 5-hydroxytryptamine type 3 5-HT3 receptor antagonists may be used for both prophylaxis and as a rescue antiemetic. In anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symptoms have been controlled.

For other uncomplicated allergic conditions of the immediate type when oral therapy is impossible or contraindicated. For sedation and relief of apprehension and to produce light sleep from which the patient can be easily aroused.

Active treatment of motion sickness. Prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery. As an adjunct to analgesics for the control of postoperative pain. Preoperative, postoperative, and obstetric during labor sedation. 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.

Comatose State Phenergan Injection is contraindicated in comatose states. Subcutaneous Injection Phenergan Injection should not be given by the subcutaneous route because evidence of chemical irritation has been noted, and necrotic lesions have resulted following subcutaneous injection.

The preferred parenteral route of administration is by deep intramuscular injection. Idiosyncratic Reaction or Hypersensitivity Phenergan Injection is contraindicated in patients who have demonstrated an idiosyncratic reaction or hypersensitivity to promethazine or other phenothiazines.

Warnings Respiratory Depression Pediatrics Phenergan Injection should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. A wide range of weight-based doses of Phenergan Injection have resulted in respiratory depression in these patients. Caution should be exercised when administering Phenergan Injection to 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 Phenergan Injection in patients with compromised respiratory function or patients at risk for respiratory failure e.

COPD, sleep apnea should be avoided. Adverse event reports include burning, pain, erythema, swelling, sensory loss, palsies, paralysis, severe spasm of distal vessels, thrombophlebitis, venous thrombosis, phlebitis, abscesses, tissue necrosis, and gangrene. Due to the close proximity of arteries and veins in the areas most commonly used for intravenous injection, extreme care should be exercised to avoid perivascular extravasation or unintentional intra-arterial injection as pain, severe chemical irritation, severe spasm of distal vessels, and resultant gangrene requiring amputation are likely under such circumstances.

Aspiration of dark blood does not preclude intra-arterial needle placement because blood is discolored upon contact with Phenergan Injection. Use of syringes with rigid plungers or of small-bore needles might obscure typical arterial backflow if this is relied upon alone. In the event that a patient complains of pain during intravenous injection of Phenergan Injection, the injection should be stopped immediately to evaluate for possible arterial injection or perivascular extravasation.

There is no proven successful management of unintentional intra-arterial injection or perivascular extravasation after it occurs.

Sympathetic block and heparinization have been employed during the acute management of unintentional intra-arterial injection, because of the results of animal experiments with other known arteriolar irritants. Lower Seizure Threshold Phenergan Injection may lower seizure threshold and 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 Phenergan Injection should be used with caution in patients with bone-marrow depression. Leukopenia and agranulocytosis have been reported, usually when promethazine hydrochloride 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 hydrochloride 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. 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 hydrochloride, 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 hydrochloride should be carefully considered. Sulfite Sensitivity Phenergan Injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthma episodes, in certain susceptible people.

The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people.

Visual Inspection This product is light sensitive and should be inspected before use and discarded if either color or particulate is observed.

Cholestatic Jaundice Administration of promethazine has been associated with reported cholestatic jaundice. 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.

Phenergan Injection should be used cautiously in persons with cardiovascular disease or impairment of liver function. Patients should be advised to immediately report persistent or worsening pain or burning at the injection site. Phenergan Injection may cause marked drowsiness or impair the mental or physical abilities required for the performance of potentially hazardous tasks, such as driving a vehicle or operating machinery.

Pediatric patients should be supervised to avoid potential harm in bike riding or in other hazardous activities. When given concomitantly with Phenergan Injection, the dose of barbiturates should be reduced by at least one-half, and the dose of narcotics should be reduced by one-quarter to one-half.

Comatose State Phenergan Injection is contraindicated in buy states, buy iv phenergan. Because animal reproduction studies buy not always predictive of human response, Phenergan Injection should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Arkine trihexyphenidyl hcl 2mg intravenous administration in healthy volunteers, the plasma half-life for promethazine has been reported to range from 9 to 16 hours. As an adjunct to analgesics for the control of postoperative pain. For example, 5-hydroxytryptamine type 3 5-HT3 receptor antagonists may be used for both prophylaxis and as a rescue antiemetic. Buy hydrochloride is metabolized in the liver, buy iv phenergan, with the sulfoxides of promethazine and N-desmethylpromethazine being the predominant metabolites appearing in the urine. I dilute it in 10cc NS and if fluids are running Phenergan hang it as a secondary over minutes depending on the pt's vein status, buy iv phenergan. Phenergan degree of dissociation is proportional to its Ka dissociation constant. Phenergan Increased or decreased blood pressure, tachycardia, bradycardia, faintness. The product is light sensitive. Antiemetics are not recommended for treatment of uncomplicated vomiting in pediatric patients, and their use should be limited to prolonged vomiting of known etiology. I don't give Phenergan anymore without diluting it in 50 cc's of NS.

This possibility should be considered with Phenergan Injection. Due to the close proximity of arteries and veins in the areas most commonly used for intravenous injection, extreme care should be exercised to avoid perivascular extravasation or phenergan intra-arterial injection as pain, severe chemical irritation, severe spasm of distal vessels, and resultant gangrene requiring amputation are likely under such circumstances. Phenergan animal reproduction studies are not always predictive of human response, Phenergan Injection should be used during pregnancy buy if the potential benefit justifies the potential risk to the fetus. Adverse reactions include burning, buy iv phenergan, pain, buy, tissue necrosis, and gangrene, buy iv phenergan. Due to the risks of intravenous injection, the preferred route of administration of Phenergan Injection is deep intramuscular injection. Subcutaneous injection is contraindicated, buy iv phenergan. Nursing Phenergan It is not known whether Phenergan Injection is excreted in human milk. Precautions General Drugs buy anticholinergic properties should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal obstruction, and buy obstruction. Before administration of the phenergan, tell patients to let you know immediately if burning or pain occurs during or after the injection. NaCl is the salt of a strong acid and strong base and has a neutral pH. Antiemetics are not recommended for treatment of uncomplicated vomiting in pediatric lexapro sleep disorder, and their use should be limited to prolonged vomiting of known etiology. Clinical effects are generally apparent within 5 minutes of an intravenous injection and within 20 minutes of an intramuscular injection. Postmarketing cases of respiratory depression, including fatalities, buy been reported with use of promethazine in pediatric patients less than 2 years of age. Avoid concomitant administration of other drugs with respiratory depressant effects because of an association with respiratory depression, and sometimes death, buy iv phenergan, in phenergan patients. If administered IV, dilute drug and administer slowly as indicated above. Adequate studies to determine the action of the drug on parturition, buy iv phenergan, lactation and development of the animal neonate have not been conducted.

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