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Phenylephrine / promethazine Disease Interactions

There are 22 disease interactions with phenylephrine / promethazine:

Major

Phenothiazines (applies to phenylephrine/promethazine) acute alcohol intoxication

Major Potential Hazard, High plausibility. Applicable conditions: Alcoholism

The use of phenothiazines is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of phenothiazines may be additive with those of alcohol. Severe respiratory depression and respiratory arrest may occur. Therapy with phenothiazines should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  4. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  5. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  6. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  8. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  9. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  10. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  13. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
View all 13 references
Major

Phenothiazines (applies to phenylephrine/promethazine) cardiovascular disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Dehydration, Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Pheochromocytoma, Arrhythmias

Phenothiazines may cause hypotension (including orthostatic hypotension), reflex tachycardia, increased pulse rate, syncope, and dizziness, particularly after the first parenteral dose but rarely after the first oral dose. Low-potency agents such as chlorpromazine and thioridazine are more likely to induce these effects, which usually subside within the first couple of hours following administration. Tolerance to the hypotensive effects often develops after a few doses. Rarely, fatal cardiac arrest has occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include edema, thrombosis, and ECG abnormalities such as PR and QT interval prolongation, diffuse T-wave flattening, and ST segment depression. Therapy with phenothiazines should be avoided or otherwise administered cautiously in patients with severe cardiovascular disease, pheochromocytoma, a predisposition to hypotension, or conditions that could be exacerbated by hypotension such as a history of myocardial infarction, angina, or ischemic stroke. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. If parenteral therapy is given, patients should be in a supine position during administration and for at least 30 to 60 minutes afterwards. Patients who experience orthostatic hypotension should be cautioned not to rise too abruptly. Occasionally, when severe, hypotension may require treatment with vasoconstrictive agents such as norepinephrine or phenylephrine. Epinephrine should not be used, however, since phenothiazines can reverse its vasopressor effects and cause a further lowering of blood pressure.

References

  1. Jones J, Sklar D, Dougherty J, White W "Randomized double-blind trial of intravenous prochlorperazine for the treatment of acute headache." JAMA 261 (1989): 1174-6
  2. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  4. Kumar BB "Letter: Acute hypotension from thioridazine." JAMA 234 (1975): 1321
  5. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  6. Witz L, Shapiro M, Shenkman L "Chlorpromazine induced fluid retention masquerading as idiopathic oedema." Br Med J 294 (1987): 807-8
  7. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  8. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  9. Dorson P, Crismon M "Chlorpromazine accumulation and sudden death in a patient with renal insufficiency." Drug Intell Clin Pharm 22 (1988): 776-8
  10. Varia I, Krishnan R, Davidson J "Deep-vein thrombosis with antipsychotic drugs." Psychosomatics 24 (1983): 1097-8
  11. Fletcher GF, Kazamias TM "Cardiotoxic effects of Mellaril: conduction disturbances and supraventricular arrhythmias." Am Heart J 78 (1969): 135-8
  12. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  14. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  15. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  16. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  17. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  18. Stevenson R, Blanshard C, Patterson D "Ventricular fibrillation due to lithium withdrawal: an interaction with chlorpromazine?" Postgrad Med J 65 (1989): 936-8
  19. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  20. Margolis J "Massive edema induced by thioridazine (Mellaril): an unusual complication." J Am Geriatr Soc 20 (1972): 593-4
  21. Schreiber G, Belmaker R "In vivo differentiation of cardiac vagal blocking effects of chlorpromazine and haloperidol." Biol Psychiatry 22 (1987): 1417-21
  22. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  23. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  24. Fruncillo R, Gibbons W, Vlasses P, Ferguson R "Severe hypotension associated with concurrent clonidine and antipsychotic medication." Am J Psychiatry 142 (1985): 274
View all 24 references
Major

Phenothiazines (applies to phenylephrine/promethazine) CNS depression

Major Potential Hazard, High plausibility. Applicable conditions: Altered Consciousness, Respiratory Arrest

The use of phenothiazines is contraindicated in comatose patients and patients with severe central nervous system depression. Phenothiazines may potentiate the CNS and respiratory depression in these patients.

References

  1. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  5. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  7. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  9. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  11. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  12. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  13. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
View all 13 references
Major

Phenothiazines (applies to phenylephrine/promethazine) head injury

Major Potential Hazard, High plausibility.

The use of phenothiazines is contraindicated in patients with suspected or established subcortical brain damage, with or without hypothalamic involvement. Phenothiazines can interfere with thermoregulatory mechanisms, and a hyperthermic reaction with temperatures in excess of 104 F may occur in such patients, sometimes not until 14 to 16 hours after drug administration.

References

  1. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  2. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  4. Keshavan MS, Kambhampati RK "Prolonged fever without extrapyramidal symptoms during neuroleptic treatment" J Clin Psychopharmacol 9 (1989): 230-1
  5. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  6. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  8. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  9. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. Caroff S, Rosenberg H, Gerber JC "Neuroleptic malignant syndrome and malignant hyperthermia" Lancet 1 (1983): 244
  11. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  12. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  13. Dilsaver SC "Effects of neuroleptics on body temperature" J Clin Psychiatry 49 (1988): 78-9
View all 13 references
Major

Promethazine (applies to phenylephrine/promethazine) antidopaminergic effects 1

Major Potential Hazard, Moderate plausibility. Applicable conditions: Dehydration, Hypocalcemia, Tardive Dyskinesia, Neuroleptic Malignant Syndrome

Promethazine has weak central antidopaminergic activity. While its use is rarely associated with adverse effects secondary to dopaminergic blockade, large doses have produced extrapyramidal reactions. During chronic administration and/or high-dose therapy, the usual contraindications, warnings and precautions applicable to phenothiazines should be observed with promethazine.

References

  1. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  3. Nicholson AN "Central effects of H1 and H2 antihistamines." Aviat Space Environ Med 56 (1985): 293-8
Major

Promethazine (applies to phenylephrine/promethazine) asthma

Major Potential Hazard, High plausibility. Applicable conditions: Pulmonary Impairment

Promethazine is contraindicated for use in the treatment of lower respiratory tract symptoms including asthma. Furthermore, promethazine tablets may lead to potentially fatal respiratory depression, and its use should be avoided in patients with compromised respiratory function such as patients with COPD, and sleep apnea.

Major

Sympathomimetics (applies to phenylephrine/promethazine) cardiovascular disease

Major Potential Hazard, High plausibility. Applicable conditions: Cerebrovascular Insufficiency, Hyperthyroidism, Pheochromocytoma

Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

References

  1. Covington TR, Lawson LC, Young LL, eds. "Handbook of Nonprescription Drugs. 10th ed." Washington, DC: American Pharmaceutical Association (1993):
  2. Frewin DB "Phenylpropanolamine. How safe is it?" Med J Aust 2 (1983): 54-5
  3. Gordon RD, Ballantine DM, Bachmann AW "Effects of repeated doses of pseudoephedrine on blood pressure and plasma catecholamines in normal subjects and in patients with phaeochromocytoma." Clin Exp Pharmacol Physiol 19 (1992): 287-90
  4. Shapiro SR "Hypertension due to anorectic agent." N Engl J Med 280 (1969): 1363
  5. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  6. Frewin DB, Leonello PP, Frewin ME "Hypertension after ingestion of Trimolets." Med J Aust 2 (1978): 497-8
  7. Loizou LA, Hamilton JG, Tsementzis SA "Intracranial haemorrhage in association with pseudoephedrine overdose." J Neurol Neurosurg Psychiatry 45 (1982): 471-2
  8. Kroenke K, Omori DM, Simmons JO, Wood DR, Meier NJ "The safety of phenylpropanolamine in patients with stable hypertension." Ann Intern Med 111 (1989): 1043-4
  9. Kase CS, Foster TE, Reed JE, Spatz EL, Girgis GN "Intracerebral hemorrhage and phenylpropanolamine use." Neurology 37 (1987): 399-404
  10. Edwards M, Russo L, Harwood-Nuss A "Cerebral infarction with a single oral dose of phenylpropanolamine." Am J Emerg Med 5 (1987): 163-4
  11. Fallis RJ, Fisher M "Cerebral vasculitis and hemorrhage associated with phenylpropanolamine." Neurology 35 (1985): 405-7
  12. Noble R "A controlled clinical trial of the cardiovascular and psychological effects of phenylpropanolamine and caffeine." Drug Intell Clin Pharm 22 (1988): 296-9
  13. Kikta DG, Devereaux MW, Chandar K "Intracranial hemorrhages due to phenylpropanolamine." Stroke 16 (1985): 510-2
  14. Lake CR, Zaloga G, Clymer R, Quirk RM, Chernow B "A double dose of phenylpropanolamine causes transient hypertension." Am J Med 85 (1988): 339-43
  15. Dickerson J, Perrier D, Mayersohn M, Bressler R "Dose tolerance and pharmacokinetic studies of L (+) pseudoephedrine capsules in man." Eur J Clin Pharmacol 14 (1978): 253-9
  16. Johnson DA, Etter HS, Reeves DM "Stroke and phenylpropanolamine use" Lancet 2 (1983): 970
  17. O'Connell MB, Gross CR "The effect of multiple doses of phenylpropanolamine on the blood pressure of patients whose hypertension was controlled with beta blockers." Pharmacotherapy 11 (1991): 376-81
  18. Gill ND, Shield A, Blazevich AJ, Zhou S, Weatherby RP "Muscular and cardiorespiratory effects of pseudoephedrine in human athletes." Br J Clin Pharmacol 50 (2000): 205-13
  19. Pentel PR, Aaron C, Paya C "Therapeutic doses of phenylpropanolamine increase supine systolic blood pressure." Int J Obes 9 (1985): 115-9
  20. Samenuk D, Link MS, Homoud MK, et al. "Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine." Mayo Clin Proc 77 (2002): 12-6
  21. Rosen RA "Angina associated with pseudoephedrine ." Ann Emerg Med 10 (1981): 230-1
  22. Lake CR, Gallant S, Masson E, Miller P "Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports." Am J Med 89 (1990): 195-208
  23. Humberstone PM "Hypertension from cold remedies." Br Med J 1 (1969): 846
  24. Maher LM, Peterson PL, Dela-Cruz C "Postpartum intracranial hemorrhage and phenylpropanolamine use" Neurology 37 (1987): 1686
  25. Dowse R, Scherzinger SS, Kanfer I "Serum concentrations of phenylpropanolamine and associated effects on blood pressure in normotensive subjects: a pilot-study." Int J Clin Pharmacol Ther Toxicol 28 (1990): 205-10
  26. Haller CA, Benowitz NL "Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids." N Engl J Med 343 (2000): 1833-8
  27. McDowell JR, LeBlanc HJ "Phenylpropanolamine and cerebral hemorrhage." West J Med 142 (1985): 688-91
  28. Howrie DL, Wolfson JH "Phenylpropanolamine-induced hypertensive seizures." J Pediatr 102 (1983): 143-5
  29. Gibson GJ, Warrell DA "Hypertensive crises and phenylpropanolamine." Lancet 2 (1972): 492-3
  30. Horowitz JD, Lang WJ, Howes LG, Fennessy MR, Christophidis N, Rand MJ, Louis WJ "Hypertensive responses induced by phenylpropanolamine in anorectic and decongestant preparations." Lancet 1 (1980): 60-1
  31. Horowitz JD, McNeil JJ, Sweet B, Mendelsohn FA, Louis WJ "Hypertension and postural hypotension induced by phenylpropanolamine (Trimolets)." Med J Aust 1 (1979): 175-6
  32. Bruno A, Nolte KB, Chapin J "Stroke associated with ephedrine use." Neurology 43 (1993): 1313-6
  33. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
  34. Finton CK, Barton M, Chernow B "Possible adverse effects of phenylpropanolamine (diet pills) on sympathetic nervous system function--caveat emptor!" Mil Med 147 (1982): 1072
  35. Clark JE, Simon WA "Cardiac arrhythmias after phenylpropanolamine ingestion." Drug Intell Clin Pharm 17 (1983): 737-8
  36. Maher LM, Peterson PL, Dela-Cruz C "Postpartum intracranial hemorrhage and phenylpropanolamine use." Neurology 37 (1987): 1886,1890
  37. Caperton E "Raynaud's phenomenon. Role of diet pills and cold remedies." Postgrad Med 73 (1983): 291-2
  38. McEwen J "Phenylpropanolamine-associated hypertension after the use of "over- the-counter" appetite-suppressant products." Med J Aust 2 (1983): 71-3
  39. To LB, Sangster JF, Rampling D, Cammens I "Ephedrine-induced cardiomyopathy." Med J Aust 2 (1980): 35-6
  40. Wiener I, Tilkian AG, Palazzolo M "Coronary artery spasm and myocardial infarction in a patient with normal coronary arteries: temporal relationship to pseudoephedrine ingestion." Cathet Cardiovasc Diagn 20 (1990): 51-3
  41. O'Connell MB, Gross CR "The effect of single-dose phenylpropanolamine on blood pressure in patients with hypertension controlled by beta blockers." Pharmacotherapy 10 (1990): 85-91
  42. Mariani PJ "Pseudoephedrine-induced hypertensive emergency: treatment with labetalol." Am J Emerg Med 4 (1986): 141-2
  43. Pentel PR, Mikell FL, Zavoral JH "Myocardial injury after phenylpropanolamine ingestion." Br Heart J 47 (1982): 51-4
  44. Stoessl AJ, Young GB, Feasby TE "Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics." Stroke 16 (1985): 734-6
  45. Leo PJ, Hollander JE, Shih RD, Marcus SM "Phenylpropanolamine and associated myocardial injury." Ann Emerg Med 28 (1996): 359-62
  46. Mansoor GA "Herbs and alternative therapies in the hypertension clinic." Am J Hypertens 14(9 Pt 1) (2001): 971-5
  47. Elliott CF, Whyte JC "Phenylpropanolamine and hypertension." Med J Aust 1 (1981): 715
  48. Lee KY, Beilin LJ, Vandongen R "Severe hypertension after ingestion of an appetite suppressant (phenylpropanolamine) with indomethacin." Lancet 1 (1979): 1110-1
  49. Bernstein E, Diskant BM "Phenylpropanolamine: a potentially hazardous drug." Ann Emerg Med 11 (1982): 311-5
  50. Lee KY, Beilin LJ, Vandongen R "Severe hypertension after administration of phenylpropanolamine" Med J Aust 1 (1979): 525-6
  51. Teh AY "Phenylpropanolamine and hypertension" Med J Aust 2 (1979): 425-6
  52. Lake CR, Zaloga G, Bray J, Rosenberg D, Chernow B "Transient hypertension after two phenylpropanolamine diet aids and the effects of caffeine: a placebo-controlled follow-up study." Am J Med 86 (1989): 427-32
  53. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
  54. Wooten MR, Khangure MS, Murphy MJ "Intracerebral hemorrhage and vasculitis related to ephedrine abuse." Ann Neurol 13 (1983): 337-40
  55. Kizer KW "Intracranial hemorrhage associated with overdose of decongestant containing phenylpropanolamine" Am J Emerg Med 2 (1984): 180-1
  56. Chin C, Choy M "Cardiomyopathy induced by phenylpropanolamine." J Pediatr 123 (1993): 825-7
View all 56 references
Moderate

Antihistamines (applies to phenylephrine/promethazine) anticholinergic effects

Moderate Potential Hazard, High plausibility. Applicable conditions: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary Retention

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.

References

  1. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  3. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  5. "Product Information. Drixoral (dextromethorphan)." Schering-Plough, Liberty Corner, NJ.
  6. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  7. "Product Information. Zyrtec (cetirizine)." Pfizer US Pharmaceuticals, New York, NY.
  8. "Product Information. Dramamine (dimenhydrinate)" Pharmacia and Upjohn, Kalamazoo, MI.
  9. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  10. "Product Information. Vistaril (hydroxyzine)." Pfizer US Pharmaceuticals, New York, NY.
  11. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  12. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC, Chadds Ford, PA.
  13. Watemberg NM, Roth KS, Alehan FK, Epstein CE "Central anticholinergic syndrome on therapeutic doses of cyproheptadine." Pediatrics 103 (1999): 158-60
  14. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  16. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  17. "Product Information. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
  18. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  19. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  20. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
View all 20 references
Moderate

Antihistamines (applies to phenylephrine/promethazine) asthma/COPD

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Chronic Obstructive Pulmonary Disease

It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.

References

  1. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  2. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Drixoral (dextromethorphan)." Schering-Plough, Liberty Corner, NJ.
  5. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  6. "Product Information. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
  7. "Product Information. Dramamine (dimenhydrinate)" Pharmacia and Upjohn, Kalamazoo, MI.
  8. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  9. "Product Information. Vistaril (hydroxyzine)." Pfizer US Pharmaceuticals, New York, NY.
  10. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  12. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  13. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  14. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  15. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  16. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC, Chadds Ford, PA.
  17. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
View all 17 references
Moderate

Phenothiazines (applies to phenylephrine/promethazine) breast cancer

Moderate Potential Hazard, Moderate plausibility.

The chronic use of phenothiazines is associated with persistent elevations in prolactin levels. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Therapy with phenothiazines should be administered cautiously in patients with existing or suspected malignancy of the breast.

References

  1. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  2. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  5. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  6. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  8. Ristic PI, Ory SJ, Lurain JR "Endometrial adenocarcinoma associated with drug-induced hyperprolactinemia." Obstet Gynecol 67 (1986): s86-8
  9. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  10. Ash PR, Bouma D "Exaggerated hyperprolactinemia in response to thiothixene ." Arch Neurol 38 (1981): 534-5
  11. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  12. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  13. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  14. Kane JM "Antipsychotic drug side effects: their relationship to dose." J Clin Psychiatry 46 (1985): 16-21
  15. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  16. Gift T, Plum K, Price M "Depot fluphenazine and plasma prolactin." Prog Neuropsychopharmacol Biol Psychiatry 9 (1985): 407-12
View all 16 references
Moderate

Phenothiazines (applies to phenylephrine/promethazine) dystonic reactions

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Dehydration, Hypocalcemia

Phenothiazines may cause acute, dose-related dystonic reactions secondary to central dopaminergic blockade. These reactions are characterized by spastic contraction of discrete muscle groups and may include torticollis, opisthotonos, carpopedal spasm, trismus, difficulty swallowing, perioral spasms with protrusion of the tongue, and oculogyric crisis. Onset is usually within 24 to 96 hours following initiation of therapy or an increase in dosage. Risk factors include young age, male gender, use of high-potency agents (e.g., fluphenazine, perphenazine, trifluoperazine), high dosages, and IM administration. Therapy with phenothiazines should be administered cautiously in patients, particularly children, with hypocalcemia or severe dehydration, since these patients may be more susceptible to dystonic reactions. Most symptoms subside within a few hours and are almost always reversible within 24 to 48 hours following withdrawal of therapy. However, severe reactions such as laryngospasm may be life-threatening and require appropriate supportive therapy. Parenteral administration of an anticholinergic antiparkinsonian agent (e.g., benztropine, trihexyphenidyl) or diphenhydramine usually produces a prompt response and may be given orally for short-term maintenance to prevent recurrence of symptoms if phenothiazine therapy must be continued.

References

  1. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  2. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  3. Wood G, Waters A "Prolonged dystonic reaction to chlorpromazine in myxoedema coma." Postgrad Med J 56 (1980): 192-3
  4. Singh H, Levinson DF, Simpson GM, Lo ES, Friedman E "Acute dystonia during fixed-dose neuroleptic treatment." J Clin Psychopharmacol 10 (1990): 389-96
  5. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  6. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  8. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  9. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  10. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  11. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  12. Harries JR "Oculogyric crises due to phenothiazines." Br Med J 3 (1967): 241
  13. Lamont S "Acute reactions to phenothiazine derivatives." Br J Anaesth 44 (1972): 539-40
  14. Nahata MC, Clotz MA, Krogg EA "Adverse effects of meperidine, promethazine, and chlorpromazine for sedation in pediatric patients." Clin Pediatr (Phila) 24 (1985): 558-60
  15. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  16. Idzorek S "Antiparkinsonian agents and fluphenazine decanoate." Am J Psychiatry 133 (1976): 80-2
  17. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  18. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  19. Bailie GR, Nelson MV, Krenzelok EP, Lesar T "Unusual treatment response of a severe dystonia to diphenhydramine." Ann Emerg Med 16 (1987): 705-8
  20. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  21. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  22. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  23. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  24. West D "Dangers of fluphenazine." Br J Psychiatry 117 (1970): 718-9
  25. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  26. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  27. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  28. Reecer MV, Clinchot DM, Tipton DB "Drug-induced dystonia in a patient with C4 quadriplegia. Case report." Am J Phys Med Rehabil 72 (1993): 97-8
  29. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  30. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  31. Schumock GT, Martinez E "Acute oculogyric crisis after administration of prochlorperazine." South Med J 84 (1991): 407-8
View all 31 references
Moderate

Phenothiazines (applies to phenylephrine/promethazine) hematologic toxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts

Phenothiazines may infrequently cause hematologic toxicity, including agranulocytosis, thrombocytopenia, eosinophilia, aplastic anemia, purpura, granulocytopenia, and hemolytic anemia. Mild leukopenia may occur frequently with large doses over prolonged periods but is generally reversible despite continued treatment. Therapy with phenothiazines should be administered cautiously, if at all, in patients with preexisting blood dyscrasias or bone marrow suppression. Complete blood counts should be obtained regularly, and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, bleeding, pallor, dizziness, or jaundice. Most cases of agranulocytosis have occurred between the fourth and tenth weeks of therapy.

References

  1. Yassa R "Agranulocytosis in the course of phenothiazine therapy." J Clin Psychiatry 46 (1985): 341-3
  2. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  3. Holt RJ "Fluphenazine decanoate-induced cholestatic jaundice and thrombocytopenia." Pharmacotherapy 4 (1984): 227-9
  4. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  5. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  7. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  9. Aram H "Henoch-Schonlein purpura induced by chlorpromazine." J Am Acad Dermatol 17 (1987): 139-40
  10. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  11. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  13. Ben-Yehuda A, Bloom A, Lijhovetzky G, et al "Chlorpromazine-induced liver and bone marrow granulomas associated with agranulocytosis." Isr J Med Sci 26 (1990): 449-51
  14. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  15. Young A, Kehoe R "Two cases of agranulocytosis on addition of a butyrophenone to a long-standing course of phenothiazine treatment." Br J Psychiatry 154 (1989): 710-12
  16. Holt R "Neuroleptic drug-induced changes in platelet levels." J Clin Psychopharmacol 4 (1984): 130-2
  17. Rosenthal DS, Stein GF, Santos JC "Thioridazine agranulocytosis." JAMA 200 (1967): 81-2
  18. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  19. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  20. Stein P, Inwood M "Hemolytic anemia associated with chlorpromazine therapy." Can J Psychiatry 25 (1980): 659-61
  21. Zengotita H, Holt R "Neuroleptic drug-induced coagulopathy: mechanism of reaction and duration of effect." J Clin Psychiatry 47 (1986): 35-7
View all 21 references
Moderate

Phenothiazines (applies to phenylephrine/promethazine) liver disease

Moderate Potential Hazard, Moderate plausibility.

Phenothiazines are extensively metabolized by the liver and may accumulate in patients with hepatic impairment. In addition, the use of some phenothiazines has been associated with adverse hepatic effects including cholestatic jaundice and elevated liver enzymes, generally within the first few months of therapy. Cholestatic jaundice usually occurs between the second and fourth weeks of therapy in approximately 0.1% to 4% of all patients. Therapy with phenothiazines should be administered cautiously in patients with preexisting liver disease, liver enzyme abnormalities, or hepatitis. Liver function and urine bilirubin tests should be performed periodically during prolonged therapy, and patients should be instructed to immediately report any signs or symptoms suggestive of cholestatic jaundice such as upper abdominal pain, nausea, yellow skin, influenza-like symptoms, rash, and fever. Phenothiazine therapy should be discontinued, preferably permanently, if jaundice occurs and is attributable to the drug. Clinical recovery is usually observed within a few weeks following withdrawal of therapy, although histopathologic changes may persist for longer periods.

References

  1. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  2. Snyder S "Fluphenazine jaundice. Report of a case." Am J Gastroenterol 73 (1980): 336-40
  3. Barancik M, Brandborg LL, Albion MJ "Thioridazine-induced cholestasis." JAMA 200 (1967): 69-70
  4. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. Maxwell JD, Carrella M, Parkes JD, et al "Plasma disappearance and cerebral effects of chlorpromazine in cirrhosis." Clin Sci 43 (1972): 143-51
  6. Simpson GM, Yadalam KG, Levinson DF, et al "Single-dose pharmacokinetics of fluphenazine after fluphenazine decanoate administration." J Clin psychopharmacol 10 (1990): 417-21
  7. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  8. Dossing M, Andreasen B "Drug-induced liver disease in Denmark." Scand J Gastroenterol 17 (1982): 205-11
  9. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  10. Derby LE, Gutthann SP, Jick H, Dean AD "Liver disorders in patients receiving chlorpromazine or isoniazid." Pharmacotherapy 13 (1993): 353-8
  11. Lok AS, Ng IO "Prochlorperazine-induced chronic cholestasis." J Hepatol 6 (1988): 369-73
  12. Hu OY, Tang H-S, Sheeng T-Y, et al "Pharmacokinetics of promazine I: disposition in patients with acute viral hepatitis B." Biopharm Drug Dispos 11 (1990): 557-68
  13. Taylor G, Houston JB, Shaffer J, Mawer G "Pharmacokinetics of promethazine and its sulphoxide metabolite after intravenous and oral administration to man." Br J Clin Pharmacol 15 (1983): 287-93
  14. Bach N, Thung S, Schaffner F, Tobias H "Exaggerated cholestasis and hepatic fibrosis following simultaneous administration of chlorpromazine and sodium valproate." Dig Dis Sci 34 (1989): 1303-7
  15. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  16. Moradpour D, Altorfer J, Flury R, Greminger P, Meyenberger C, Jost R, Schmid M "Chlorpromazine-induced vanishing bile duct syndrome leading to biliary cirrhosis." Hepatology 20 (1994): 1437-41
  17. Holt RJ "Fluphenazine decanoate-induced cholestatic jaundice and thrombocytopenia." Pharmacotherapy 4 (1984): 227-9
  18. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  19. Whitfield LR, Kaul PN, Clark ML "Chlorpromazine metabolism IX: pharmacokinetics of chlorpromazine following oral administration in man." J Pharmacokinet Biopharm 6 (1978): 187-96
  20. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  21. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  22. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  23. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  24. Chetty M, Moodley SV, Miller R "Important metabolites to measure in pharmacodynamic studies of chlorpromazine." Ther Drug Monit 16 (1994): 30-6
  25. Reinhart MJ, Benson RM, Kwass SK, Storey WF "Suggestive evidence of hepatotoxicity concomitant with thioridazine hydrochloride use." JAMA 197 (1966): 767-9
  26. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  27. Seeff L "Drug-induced chronic liver disease, with emphasis on chronic active hepatitis." Semin Liver Dis 1 (1981): 104-15
  28. Podevin P, Biour M "Drug-induced ''allergic hepatitis''." Clin Rev Allergy Immunol 13 (1995): 223-44
  29. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
View all 29 references
Moderate

Phenothiazines (applies to phenylephrine/promethazine) NMS

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Neuroleptic Malignant Syndrome

The central dopaminergic blocking effects of phenothiazines may precipitate or aggravate a potentially fatal symptom complex known as Neuroleptic Malignant Syndrome (NMS). NMS is observed most frequently when high-potency neuroleptic agents like haloperidol or fluphenazine are administered intramuscularly but may occur with any agent possessing neuroleptic activity given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Phenothiazine therapy should not be initiated in patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of phenothiazines should be carefully considered, since NMS may recur.

References

  1. Rampertaap MP "Neuroleptic malignant syndrome." South Med J 79 (1986): 331-6
  2. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  3. Zubenko G, Pope HG, Jr "Management of a case of neuroleptic malignant syndrome with bromocriptine." Am J Psychiatry 140 (1983): 1619-20
  4. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  5. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  7. Caroff SN "The neuroleptic malignant syndrome." J Clin Psychiatry 41 (1980): 79-83
  8. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  9. Dhib-Jalbut S, Hesselbrock R, Brott T, Silbergeld D "Treatment of the neuroleptic malignant syndrome with bromocriptine" JAMA 250 (1983): 484-5
  10. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  11. Morris H, McCormick W, Reinarz J "Neuroleptic malignant syndrome." Arch Neurol 37 (1980): 462-3
  12. Tenenbein M "The neuroleptic malignant syndrome: occurrence in a 15-year-old boy and recovery with bromocriptine therapy." Pediatr Neurosci 12 (1985): 161-4
  13. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  14. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  15. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  16. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  17. Manser TJ, Warner JF "Neuroleptic malignant syndrome associated with prochlorperazine." South Med J 83 (1990): 73-4
  18. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  19. Granato JE, Stern BJ, Ringel A, Karim AH, Krumholz A, Coyle J, Adler S "Neuroleptic malignant syndrome: successful treatment with dantrolene and bromocriptine." Ann Neurol 14 (1983): 89-90
  20. Caroff S, Rosenberg H, Gerber JC "Neuroleptic malignant syndrome and malignant hyperthermia" Lancet 1 (1983): 244
  21. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  22. Grunhaus L, Sancovici S, Rimon R "Neuroleptic malignant syndrome due to depot fluphenazine." J Clin Psychiatry 40 (1979): 99-100
  23. Price W, Giannini A "A paradoxical response to chlorpromazine: a possible variant of the neuroleptic malignant syndrome." J Clin Pharmacol 23 (1983): 567-9
  24. West D "Dangers of fluphenazine." Br J Psychiatry 117 (1970): 718-9
View all 24 references
Moderate

Phenothiazines (applies to phenylephrine/promethazine) parkinsonism

Moderate Potential Hazard, Moderate plausibility.

The use of phenothiazines is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Propylamino derivatives such as chlorpromazine, promazine, and triflupromazine may be more likely to induce these effects. Therapy with phenothiazines should be administered cautiously in patients with Parkinson's disease or parkinsonian symptoms.

References

  1. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  2. Edelstein H, Knight RT "Severe parkinsonism in two AIDS patients taking prochlorperazine." Lancet 2 (1987): 341-2
  3. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  4. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  5. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  8. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  9. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  10. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  11. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  12. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  13. Mariani P "Adverse reactions to chlorpromazine in the treatment of migraine." Ann Emerg Med 17 (1988): 380-1
  14. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  15. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  16. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  17. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  18. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  19. Lamb P, Mindham RH, Ezzat MA "Letter: Parkinsonism induced by fluphenazine decanoate." Lancet 1 (1976): 484
  20. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  21. Rajput A, Rozdilsky B, Hornykiewicz O, et al "Reversible drug-induced parkinsonism." Arch Neurol 39 (1982): 6446
  22. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  23. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  24. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
View all 24 references
Moderate

Phenothiazines (applies to phenylephrine/promethazine) renal dysfunction

Moderate Potential Hazard, Moderate plausibility.

Phenothiazines and their metabolites are excreted by the kidney. There are very limited data concerning the use of phenothiazines in patients with renal disease. Therapy with phenothiazines should be administered cautiously in patients with significantly impaired renal function. The manufacturers recommend periodic renal function tests for all patients during prolonged therapy.

References

  1. McAllister CJ, Scowden EB, Stone WJ "Toxic psychosis induced by phenothiazine administration in patients with chronic renal failure." Clin Nephrol 10 (1978): 191-5
  2. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  4. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  5. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  7. Dorson P, Crismon M "Chlorpromazine accumulation and sudden death in a patient with renal insufficiency." Drug Intell Clin Pharm 22 (1988): 776-8
  8. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  9. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  11. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  12. Fabre J, Freudenreich J, de Duckert A, Pitton JS, Rudhardt M, Virieux C "Influence of renal insufficiency on the excretion of chloroquine, phenobarbital, phenothiazines and methacycline." Helv Med Acta 33 (1967): 307-16
  13. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  14. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  15. Taylor G, Houston JB, Shaffer J, Mawer G "Pharmacokinetics of promethazine and its sulphoxide metabolite after intravenous and oral administration to man." Br J Clin Pharmacol 15 (1983): 287-93
  16. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
View all 16 references
Moderate

Phenothiazines (applies to phenylephrine/promethazine) seizure disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: CNS Disorder

Phenothiazines can lower the seizure threshold and induce seizures, particularly when dosages are high or increased rapidly and during the initiation of therapy. Of the phenothiazines used in the treatment of psychosis, chlorpromazine appears to have the greatest epileptogenic potential, while fluphenazine and thioridazine have the least. Therapy with phenothiazines should be administered cautiously in patients with a history of seizures or other factors predisposing to seizures such as abnormal EEG, preexisting CNS pathology, or head trauma. Adequate anticonvulsant therapy should be maintained during administration of phenothiazines.

References

  1. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  2. Markowitz J, Brown R "Seizures with neuroleptics and antidepressants." Gen Hosp Psychiatry 9 (1987): 135-41
  3. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  4. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  5. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  6. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  8. Waterhouse RG "Epileptiform convulsions in children following premedication with Pamergan SP100." Br J Anaesth 39 (1967): 268-70
  9. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  10. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  13. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  14. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  15. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  16. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  17. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  18. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 18 references
Moderate

Phenothiazines (applies to phenylephrine/promethazine) tardive dyskinesia

Moderate Potential Hazard, Moderate plausibility.

Phenothiazines may commonly precipitate symptoms of tardive dyskinesia (TD), a syndrome consisting of rhythmic involuntary movements variously involving the tongue, face, mouth, lips, jaw, and/or trunk and extremities, following chronic use of at least several months but often years. Elderly patients, particularly women, are most susceptible. Also, propylpiperazine derivatives like fluphenazine, perphenazine, prochlorperazine, and trifluoperazine may be more likely to induce this syndrome. Both the risk of developing TD and the likelihood that it will become irreversible increase with the duration and total cumulative dose of phenothiazine therapy administered. However, patients may infrequently develop symptoms after relatively brief treatment periods at low dosages. If TD occurs during phenothiazine therapy, prompt withdrawal of the offending agent or at least a lowering of the dosage should be considered. TD symptoms usually become more severe after drug discontinuation or a dosage reduction, but may gradually improve over months to years. In patients with preexisting drug-induced TD, initiating or increasing the dosage of phenothiazine therapy may temporarily mask the symptoms of TD but may eventually worsen the condition. The newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine) tend to be associated with a substantially reduced risk of inducing TD and are considered the drugs of choice in patients being treated for psychosis.

References

  1. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  2. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  3. Mukherjee S, Rosen AM, Cardenas C, Varia V, Olarte S "Tardive dyskinesia in psychiatric outpatients: a study of prevalence and association with demographic, clinical, and drug history variables." Arch Gen Psychiatry 39 (1982): 466-9
  4. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  5. Yesavage JA, Tanke ED, Sheikh JI "Tardive dyskinesia and steady-state serum levels of thiothixene." Arch Gen Psychiatry 44 (1987): 913-5
  6. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  7. Csernansky JG, Grabowski K, Cervantes J, Kaplan J, Yesavage JA "Fluphenazine decanoate and tardive dyskinesia: a possible association." Am J Psychiatry 138 (1981): 1362-5
  8. Yassa R, Iskandar H, Ally J "The prevalence of tardive dyskinesia in fluphenazine-treated patients." J Clin Psychopharmacol 8 (1988): 17S-20S
  9. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  10. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  11. Mariani P "Adverse reactions to chlorpromazine in the treatment of migraine." Ann Emerg Med 17 (1988): 380-1
  12. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  13. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  14. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  15. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  16. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  17. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  18. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  19. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  20. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  21. Kolakowska T, Williams AO, Ardern M "Tardive dyskinesia and current dose of neuroleptic drugs" Arch Gen Psychiatry 42 (1985): 925
  22. Yassa R, Dimitry R "Single phenothiazines and tardive dyskinesia." J Clin Psychiatry 44 (1983): 233-4
  23. Perenyi A, Arato M "Fluphenazine and tardive dyskinesia" Arch Gen Psychiatry 41 (1984): 727
  24. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  25. Glazer WM, Moore DC "The diagnosis of rapid abnormal involuntary movements associated with fluphenazine decanoate." J Nerv Ment Dis 168 (1980): 439-41
  26. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  27. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  28. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  29. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  30. McClelland HA, Metcalfe AV, Kerr TA, Dutta D, Watson P "Facial dyskinesia: a 16-year follow-up study" Br J Psychiatry 158 (1991): 691-6
View all 30 references
Moderate

Promethazine (applies to phenylephrine/promethazine) antidopaminergic effects 2

Moderate Potential Hazard, Low plausibility. Applicable conditions: Parkinsonism

Promethazine has weak central antidopaminergic activity. While its use is rarely associated with adverse effects secondary to dopaminergic blockade, large doses have produced extrapyramidal reactions. During chronic administration and/or high-dose therapy, the usual contraindications, warnings and precautions applicable to phenothiazines should be observed with promethazine.

References

  1. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  2. Nicholson AN "Central effects of H1 and H2 antihistamines." Aviat Space Environ Med 56 (1985): 293-8
  3. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
Moderate

Sympathomimetics (applies to phenylephrine/promethazine) BPH

Moderate Potential Hazard, High plausibility. Applicable conditions: Benign Prostatic Hyperplasia, Prostate Tumor

Sympathomimetic agents may cause or worsen urinary difficulty in patients with prostate enlargement due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate.

References

  1. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Covington TR, Lawson LC, Young LL, eds. "Handbook of Nonprescription Drugs. 10th ed." Washington, DC: American Pharmaceutical Association (1993):
  3. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
Moderate

Sympathomimetics (applies to phenylephrine/promethazine) diabetes

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.

References

  1. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Covington TR, Lawson LC, Young LL, eds. "Handbook of Nonprescription Drugs. 10th ed." Washington, DC: American Pharmaceutical Association (1993):
  3. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  4. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
View all 4 references
Moderate

Sympathomimetics (applies to phenylephrine/promethazine) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension

Sympathomimetic agents can induce transient mydriasis via stimulation of alpha-1 adrenergic receptors. In patients with anatomically narrow angles or narrow-angle glaucoma, pupillary dilation can provoke an acute attack. In patients with other forms of glaucoma, mydriasis may occasionally increase intraocular pressure. Therapy with sympathomimetic agents should be administered cautiously in patients with or predisposed to glaucoma, particularly narrow-angle glaucoma.

References

  1. Covington TR, Lawson LC, Young LL, eds. "Handbook of Nonprescription Drugs. 10th ed." Washington, DC: American Pharmaceutical Association (1993):
  2. Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects 5th" Boston, MA: Butterworth-Heinemann (2001):
  3. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.

Phenylephrine / promethazine drug interactions

There are 691 drug interactions with phenylephrine / promethazine

Phenylephrine / promethazine alcohol/food interactions

There is 1 alcohol/food interaction with phenylephrine / promethazine

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.