promethazine hydrochloride

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promethazine hydrochloride

Avomine (UK), Histantil (CA), Phenergan (CA), PMS-Promethazine, Promethegan, Sominex (UK), Ziz (UK)

Pharmacologic class: Phenothiazine (nonselective)

Therapeutic class: Antihistamine, antiemetic, sedative-hypnotic

Pregnancy risk category C

FDA Box Warning

• Don't use promethazine in patients younger than age 2 due to potential for fatal respiratory depression. (Postmarketing cases of respiratory depression have been reported in these patients.)

• Use caution when administering to pediatric patients age 2 years and older. Preferably, use lowest effective dosage in these patients and avoid concurrent use of other drugs with respiratory depressant effects.

• Promethazine injection can cause severe chemical irritation and damage to tissue regardless of administration route. Irritation and damage can result from perivascular extravasation, unintentional intra-arterial injection, and intraneuronal or perineuronal infiltration.

• Adverse reactions to I.V. injection include burning, pain, thrombophlebitis, tissue necrosis, and gangrene. In some cases, surgical intervention, including fasciotomy, skin graft, or amputation, has been required.

• Because of risks of I.V. injection, preferred parenteral administration route is deep I.M. injection. Subcutaneous injection is contraindicated.

Action

Blocks effects but not release of histamine and exerts strong alphaadrenergic effect. Also inhibits chemoreceptor trigger zone in medulla and alters dopamine effects by indirectly reducing reticular stimulation in CNS.

Availability

Injection: 25 mg/ml and 50 mg/ml in 1-ml ampules and 1- and 10-ml vials

Suppositories: 12.5 mg, 25 mg, 50 mg

Syrup: 6.25 mg/5 ml

Tablets: 12.5 mg, 25 mg, 50 mg

Indications and dosages

Type 1 hypersensitivity reaction

Adults: 25 mg P.O. or P.R. at bedtime or 12.5 mg P.O. before meals and at bedtime. Or 25 mg I.M. or I.V.; may repeat in 2 hours.

Children older than age 2: 25 mg P.O. or P.R. at bedtime or 6.25 to 12.5 mg P.O. t.i.d.

Motion sickness

Adults: Initially, 25 mg P.O. or P.R. 30 to 60 minutes before traveling; may repeat 8 to 12 hours later if needed. On successive travel days, 25 mg P.O. or P.R. b.i.d. (on arising and before evening meal).

Children older than age 2: 12.5 to 25 mg P.O. or P.R. b.i.d.

Sedation

Adults: 25 to 50 mg P.O., I.M., I.V., or P.R. at bedtime

Children older than age 2: 12.5 to 25 mg P.O. or P.R. at bedtime

Adjunct to preoperative or postoperative analgesia

Adults: 25 to 50 mg P.O., P.R., I.M., or I.V. given with appropriately reduced dosage of narcotic or barbiturate and required dosage of belladonna alkaloid

Children older than age 2: 0.5 mg/lb P.O., P.R., I.M., or I.V., given with appropriately reduced dosage of narcotic or barbiturate and required dosage of belladonna alkaloid

Nausea

Adults: 25 mg P.O. or P.R.; may repeat doses of 12.5 to 25 mg P.O. or P.R. q 4 to 6 hours p.r.n. Or 12.5 to 25 mg I.M. or I.V.; may repeat q 4 hours p.r.n.

Children older than age 2: 25 mg or 0.5 mg/lb P.O. or P.R.; may repeat doses of 12.5 to 25 mg P.O. or P.R. q 4 to 6 hours p.r.n. May give I.M. or I.V. as no more than half of adult dosage. Know that drug should not be given if cause of vomiting is unknown.

Contraindications

• Hypersensitivity to drug

• Previous idiosyncratic reaction to phenothiazines

• Coma

• Intra-arterial and subcutaneous injection

• Children younger than age 2

Precautions

Use cautiously in:

• cardiovascular or hepatic disease, seizures, bone marrow depression, narrow-angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal or bladder neck obstruction

• CNS depression caused by narcotics, barbiturates, general anesthesia, tranquilizers, or alcohol

• pregnant or breastfeeding patients.

Administration

• Don't give I.V. at concentrations greater than 25 mg/ml or faster than 25 mg/minute.

• Use light-resistant covering for I.V. drug.

Inject I.M. deep into large muscle. Don't give by subcutaneous route.

Adverse reactions

CNS: confusion, disorientation, fatigue, marked drowsiness, sedation, dizziness, extrapyramidal reactions, insomnia, nervousness, neuroleptic malignant syndrome

CV: hypertension, hypotension, bradycardia, tachycardia

EENT: blurred vision, diplopia, tinnitus

GI: constipation, dry mouth

Hematologic: blood dyscrasias

Hepatic: cholestatic jaundice

Respiratory: respiratory depression

Skin: photosensitivity, rash

Other: hypersensitivity reaction

Interactions

Drug-drug. Anticholinergics: additive anticholinergic effects

CNS depressants: additive CNS depression

Epinephrine: reversal of epinephrine's vasopressor effects

MAO inhibitors: increased extrapyramidal effects

Drug-diagnostic tests. Glucose: increased level

Granulocytes, platelets, white blood cells: decreased counts

Pregnancy test: false-positive or false-negative result

Skin tests using allergen extracts: false-negative results

Drug-herbs. Betel nut: increased risk of extrapyramidal reactions

Evening primrose oil: increased risk of seizures

Kava: increased risk of adverse drug effects

Drug-behaviors. Alcohol use: additive CNS depression

Sun exposure: increased risk of photosensitivity

Patient monitoring

Monitor neurologic status. Stay alert for signs and symptoms of neuroleptic malignant syndrome (high fever, sweating, unstable blood pressure, stupor, muscle rigidity, and autonomic dysfunction).

• In long-term therapy, assess for other adverse CNS effects, including extrapyramidal reactions.

• Monitor CBC and liver function tests.

Patient teaching

Teach patient to recognize and immediately report signs and symptoms of hypersensitivity reaction or neuroleptic malignant syndrome.

• Tell patient about drug's other significant neurologic effects. Instruct him to contact prescriber if these occur.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, alertness, and motor skills.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

promethazine hydrochloride

(prō-mĕth′ə-zēn′, -zĭn)
n.
An antihistamine with sedative properties, used to treat allergic rhinitis and other allergic reactions, to prevent and treat motion sickness, and as a sedative and antiemetic.
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References in periodicals archive ?
Chen, "Identification of immunoglobulin E (IgE)-binding epitopes and recombinant IgE reactivities of a latex cross-reacting Indian jujube Ziz m 1 allergen," Clinical and Experimental Immunology, vol.
gentili of the town Ziz valley Sc452 H.gentili Oued Ziz valley, on road N13, 3 km SE Ziz valley Sc804 H.
Ziz 2005 'Tangkal longsor, selamatan', Jawa Pos, 3 February.
"The Ziz and the Hanukkah Miracle" is a very good book for children ages 4-8.
But see MISHNEH LEMELEKH, HILKHOT ISHUT 16:4; TUREI ZAHAV, EVEN HAEZER 1:18; RESPONSA ZIZ ELIEZER 3 no.
Radio Anguilla, ABS in Antigua, ZBVI in the British Virgin Islands, DBS in Dominica, GBN in Grenada, ZJB in Montserrat, ZIZ in St.
"The Island of Ziz," satirizing the cutting-edge concept of "antishitification" -- whose symbolic connotation does not require any comment -- and its approbation on a deserted island serving as an experimental site for the enthusiastic Ukrainian researcher, is perceived as an absurd story, and yet it is deeply rooted in the Soviet or post-Soviet social and cultural context.
Regina PETRIS (que en 1927 tenia 60 anos) arribo al pais en 1906, era esposa de Francisco Orlich Ziz (nacido en Austria, croata, agricultor y dueno de fincas).
"Toward a Notion of Critical Self-Creation: Slavoj Ziz ek and the 'Vortex of Madness'." New Literary History 29.1 (1998): 153-68.
El anciano, Bartolo Ziz, le confeso que "lo habia aprendido por tradicion, por orden de su padre, quien a la vez lo habia aprendido del suyo en su oportunidad" (Diaz Vasconcelos 1942:112).
Some desert river systems are permanent in their headstreams but intermittent in their lower courses, among them the Oued Draa, Oued Rheris, Oued Ziz, Oued Guir, Oued Zousfana, and Oued Saoura in the Saharan regions of the Maghreb.