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promethazine (rectal)

Pronunciation

Generic Name: promethazine (rectal) (pro METH a zeen)
Brand Name: Phenadoz, Promethegan

What is rectal promethazine?

Promethazine is in a group of drugs called phenothiazines (FEEN-oh-THYE-a-zeens). It works by changing the actions of chemicals in your brain. Promethazine also acts as an antihistamine. It blocks the effects of the naturally occurring chemical histamine in your body.

Promethazine is used to treat allergy symptoms such as itching, runny nose, sneezing, itchy or watery eyes, hives, and itchy skin rashes.

Promethazine also prevents motion sickness, and treats nausea and vomiting or pain after surgery. It is also used as a sedative or sleep aid.

Promethazine is not for use in treating symptoms of asthma, pneumonia, or other lower respiratory tract infections.

Promethazine may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about rectal promethazine?

Promethazine should not be used in a child younger than 2 years old. Promethazine can cause severe breathing problems or death in a child younger than 2.

What should I discuss with my health care provider before using rectal promethazine?

Promethazine should not be used in a child younger than 2 years old. Promethazine can cause severe breathing problems or death in a child younger than 2. Carefully follow your doctor's instructions when giving this medicine to a child of any age.

You should not use this medicine if you are allergic to promethazine or to similar medicines such as chlorpromazine, fluphenazine, mesoridazine, perphenazine, prochlorperazine, thioridazine, or trifluperazine.

To make sure rectal promethazine is safe for you, tell your doctor if you have:

  • asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;

  • a sulfite allergy;

  • a history of seizures;

  • a weak immune system (bone marrow depression);

  • glaucoma;

  • enlarged prostate or problems with urination;

  • stomach ulcer or obstruction;

  • heart disease or high blood pressure;

  • liver disease;

  • adrenal gland tumor (pheochromocytoma);

  • low levels of calcium in your blood (hypocalcemia); or

  • if you have ever had a serious side effect while using promethazine or any other phenothiazine.

FDA pregnancy category C. It is not known whether promethazine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

It is not known whether promethazine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How should I use rectal promethazine?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

This medicine comes with patient instructions for using the rectal suppository. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Do not take promethazine by mouth. It is for use only in your rectum.

Try to empty your bowel and bladder just before using the promethazine suppository.

Remove the outer wrapper from the suppository before inserting it. Avoid handling the suppository too long or it will melt in your hands.

For best results from the suppository, lie down after inserting it and hold in the suppository for a few minutes. The suppository will melt quickly once inserted and you should feel little or no discomfort while holding it in. Avoid using the bathroom just after you have inserted the suppository.

Call your doctor if your symptoms do not improve, or if they get worse while using promethazine.

This medicine can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using rectal promethazine.

Store the rectal suppositories in the refrigerator but do not allow them to freeze.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include overactive reflexes, loss of coordination, severe drowsiness or weakness, fainting, dilated pupils, weak or shallow breathing, or seizure (convulsions).

What should I avoid while using rectal promethazine?

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Drinking alcohol can increase certain side effects of promethazine.

Avoid exposure to sunlight or tanning beds. Promethazine can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Rectal promethazine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using promethazine and call your doctor at once if you have:

  • severe drowsiness, weak or shallow breathing;

  • a light-headed feeling, like you might pass out;

  • confusion, agitation, hallucinations, nightmares;

  • seizure (convulsions);

  • fast or slow heartbeats;

  • jaundice (yellowing of the skin or eyes);

  • uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement);

  • easy bruising or bleeding (nosebleeds, bleeding gums);

  • sudden weakness or ill feeling, fever, chills, sore throat, mouth sores, red or swollen gums, trouble swallowing; or

  • severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Side effects such as confusion and severe drowsiness may be more likely in older adults.

Common side effects may include:

  • drowsiness, dizziness;

  • ringing in your ears;

  • double vision;

  • feeling nervous;

  • dry mouth; or

  • tired feeling, sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Promethazine dosing information

Usual Adult Dose for Allergic Reaction:

Oral or Rectal: 6.25 to 12.5 mg orally or rectally before meals and at bedtime, if necessary, OR 25 mg orally or rectally once a day at bedtime

Parenteral: 25 mg IM or IV once, and may be repeated within 2 hours if necessary

Comments:
-Once treatment begins, the dose should be reduced to the smallest effective amount needed to control symptoms.
-Minor transfusion and/or amelioration of allergic reactions may be controlled with 25 mg doses.

Uses:
-Allergic conjunctivitis due to inhalant allergens and foods
-Amelioration of allergic reactions to blood or plasma
-Dermographism
-In anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symptoms have been controlled
-Mild, uncomplicated allergic skin manifestations of urticaria and angioedema
-Other uncomplicated allergic condition of the immediate type when oral therapy is impossible or contraindicated
-Perennial and seasonal allergic rhinitis
-Vasomotor rhinitis

Usual Adult Dose for Allergic Rhinitis:

Oral or Rectal: 6.25 to 12.5 mg orally or rectally before meals and at bedtime, if necessary, OR 25 mg orally or rectally once a day at bedtime

Parenteral: 25 mg IM or IV once, and may be repeated within 2 hours if necessary

Comments:
-Once treatment begins, the dose should be reduced to the smallest effective amount needed to control symptoms.
-Minor transfusion and/or amelioration of allergic reactions may be controlled with 25 mg doses.

Uses:
-Allergic conjunctivitis due to inhalant allergens and foods
-Amelioration of allergic reactions to blood or plasma
-Dermographism
-In anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symptoms have been controlled
-Mild, uncomplicated allergic skin manifestations of urticaria and angioedema
-Other uncomplicated allergic condition of the immediate type when oral therapy is impossible or contraindicated
-Perennial and seasonal allergic rhinitis
-Vasomotor rhinitis

Usual Adult Dose for Anaphylaxis:

Oral or Rectal: 6.25 to 12.5 mg orally or rectally before meals and at bedtime, if necessary, OR 25 mg orally or rectally once a day at bedtime

Parenteral: 25 mg IM or IV once, and may be repeated within 2 hours if necessary

Comments:
-Once treatment begins, the dose should be reduced to the smallest effective amount needed to control symptoms.
-Minor transfusion and/or amelioration of allergic reactions may be controlled with 25 mg doses.

Uses:
-Allergic conjunctivitis due to inhalant allergens and foods
-Amelioration of allergic reactions to blood or plasma
-Dermographism
-In anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symptoms have been controlled
-Mild, uncomplicated allergic skin manifestations of urticaria and angioedema
-Other uncomplicated allergic condition of the immediate type when oral therapy is impossible or contraindicated
-Perennial and seasonal allergic rhinitis
-Vasomotor rhinitis

Usual Adult Dose for Urticaria:

Oral or Rectal: 6.25 to 12.5 mg orally or rectally before meals and at bedtime, if necessary, OR 25 mg orally or rectally once a day at bedtime

Parenteral: 25 mg IM or IV once, and may be repeated within 2 hours if necessary

Comments:
-Once treatment begins, the dose should be reduced to the smallest effective amount needed to control symptoms.
-Minor transfusion and/or amelioration of allergic reactions may be controlled with 25 mg doses.

Uses:
-Allergic conjunctivitis due to inhalant allergens and foods
-Amelioration of allergic reactions to blood or plasma
-Dermographism
-In anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symptoms have been controlled
-Mild, uncomplicated allergic skin manifestations of urticaria and angioedema
-Other uncomplicated allergic condition of the immediate type when oral therapy is impossible or contraindicated
-Perennial and seasonal allergic rhinitis
-Vasomotor rhinitis

Usual Adult Dose for Light Sedation:

Oral or Rectal: 25 to 50 mg orally or rectally once

Parenteral:
-Early stages of labor: 50 mg IM or IV once
-Nighttime sedation: 25 to 50 mg IM or IV once

Comments:
-Oral and rectal formulations may be used for nighttime, presurgical, or obstetrical sedation.
-Sedative doses may be given the night before surgery.
-Preoperative doses should be given with appropriate doses of an analgesic/hypnotic and an atropine-like agent.

Uses:
-For sedation and relief of apprehension and to produce light sleep from which the patient can be easily aroused
-Preoperative, postoperative, and obstetric (during labor) sedation

Usual Adult Dose for Sedation:

Oral or Rectal: 25 to 50 mg orally or rectally once

Parenteral:
-Early stages of labor: 50 mg IM or IV once
-Nighttime sedation: 25 to 50 mg IM or IV once

Comments:
-Oral and rectal formulations may be used for nighttime, presurgical, or obstetrical sedation.
-Sedative doses may be given the night before surgery.
-Preoperative doses should be given with appropriate doses of an analgesic/hypnotic and an atropine-like agent.

Uses:
-For sedation and relief of apprehension and to produce light sleep from which the patient can be easily aroused
-Preoperative, postoperative, and obstetric (during labor) sedation

Usual Adult Dose for Motion Sickness:

Treatment:
-Oral and Rectal: 25 mg orally, or rectally once, then 12.5 to 25 mg every 4 to 6 hours as needed
-Parenteral: 12.5 to 25 mg IM or IV every 4 hours as needed

Prophylaxis:
-Initial day: 25 mg orally or rectally 30 to 60 minutes before traveling, then 8 to 12 hours as needed
-Succeeding days of travel: 25 mg orally or rectally upon rising, with the dose repeated before the evening meal

Comment:
-Oral formulations are preferred; however, rectal or parenteral formulations may be given if oral formulations are not tolerated.

Use:
-Active and prophylactic treatment of motion sickness

Usual Adult Dose for Nausea/Vomiting:

Treatment: 12.5 to 25 mg IM, IV, orally, or rectally every 4 hours as needed

Prophylaxis:
-Oral and Rectal: 25 mg orally every 4 to 6 hours as needed

Comments:
-Parenteral or rectal formulations may be used when patients cannot tolerate oral formulations.
-Prophylactic doses may be used to prevent nausea and vomiting during surgery and the postoperative period.

Uses:
-Prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery
-Antiemetic therapy in postoperative patients

Usual Adult Dose for Opiate Adjunct:

Parenteral:
Pre- or postoperative use: 25 to 50 mg IM or IV once
Established labor: 25 to 75 mg IM or IV, repeated up to 2 times in 4-hour intervals
-Maximum dose: 100 mg every 24 hours

Comments:
-The average parenteral dose given during established labor is 50 mg.
-Preoperative doses should be given with appropriate doses of an analgesic/hypnotic and an atropine-like agent.

Uses:
-Administered IV as an adjunct to anesthesia or analgesia with reduced amounts of meperidine of other narcotic analgesics in special surgical situations (e.g., repeated bronchoscopy, ophthalmic surgery, poor-risk patients)
-Therapy adjunctive to meperidine or other analgesics for control of postoperative pain

Usual Pediatric Dose for Allergic Reaction:

2 years and older:
Oral or Rectal: 6.25 to 12.5 mg orally or rectally before meals and at bedtime, as necessary OR 25 mg orally or rectally once a day at bedtime

Parenteral: 12.5 mg IM or IV once, and may be repeated within 2 hours if necessary

Comments:
-Once treatment begins, the dose should be reduced to the smallest effective amount needed to control symptoms.
-Minor transfusion and/or amelioration of allergic reactions may be controlled with 12.5 mg doses.

Uses:
-Perennial and seasonal allergic rhinitis
-Vasomotor rhinitis
-Allergic conjunctivitis due to inhalant allergens and foods
-Mild, uncomplicated allergic skin manifestations of urticaria and angioedema
-Amelioration of allergic reactions to blood or plasma
-Dermographism
-Adjunctive therapy to epinephrine and other standard measures for anaphylactic reactions, after acute manifestations have been controlled

Usual Pediatric Dose for Motion Sickness:

2 years and older:
Treatment:
-Parenteral: 6.25 to 12.5 mg IM or IV every 4 hours a day

Treatment and prevention:
-Oral and Rectal: 12.5 to 25 mg orally or rectally 2 times a day

Comments:
-The initial dose should be given 30 to 60 minutes before anticipated travel, and may be repeated in 8 to 12 hours as needed.
-Subsequent doses on succeeding days of travel should be given on rising and again before the evening meal.

Use:
-Active and prophylactic treatment of motion sickness

Usual Pediatric Dose for Nausea/Vomiting:

2 years and older:
Treatment:
Oral or Rectal: 1.1 mg/kg orally or rectally every 4 to 6 hours as needed
-Maximum dose: 25 mg

Parenteral: 6.25 to 12.5 mg IM or IV every 4 hours as needed

Prophylaxis: Up to 25 mg orally or rectally every 4 to 6 hours as needed

Comments:
-This drug should not be used to treat nausea and vomiting of unknown etiology.
-Doses should be adjusted to the age and severity of the patient.

Uses:
-Prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery
-Antiemetic therapy in postoperative patients

Usual Pediatric Dose for Light Sedation:

2 years and older:
Preoperative medication: 1.1 mg/kg IM, IV, orally, or rectally once
-Maximum dose: Up 25 mg

Sedation and/or adjunctive use with analgesics: 12.5 to 25 mg IM, IV, orally, or rectally once

Comments:
-Sedative doses may be given the night before surgery.
-Preoperative doses should be given with appropriate doses of an analgesic/hypnotic and an atropine-like agent.

Uses:
-Preoperative, postoperative, or obstetric sedation
-Relief of apprehension and production of light sleep from which the patient can be easily aroused

Usual Pediatric Dose for Sedation:

2 years and older:
Preoperative medication: 1.1 mg/kg IM, IV, orally, or rectally once
-Maximum dose: Up 25 mg

Sedation and/or adjunctive use with analgesics: 12.5 to 25 mg IM, IV, orally, or rectally once

Comments:
-Sedative doses may be given the night before surgery.
-Preoperative doses should be given with appropriate doses of an analgesic/hypnotic and an atropine-like agent.

Uses:
-Preoperative, postoperative, or obstetric sedation
-Relief of apprehension and production of light sleep from which the patient can be easily aroused

What other drugs will affect rectal promethazine?

Using this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before using promethazine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with promethazine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

See also: Side effects (in more detail)

Where can I get more information?

  • Your pharmacist can provide more information about rectal promethazine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 4.01.

Date modified: October 13, 2017
Last reviewed: June 26, 2014

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