Promethazine

When ATH:
R06AD02

Characteristic.

Phenothiazines. Crystalline powder white or pale yellow in color, without smell. It is slowly oxidized in air, acquiring blue. Very easy soluble in water, readily soluble in alcohol.

Pharmacological action.
Antihistamine, antiallergic, sedation, snotvornoe, antiemetic, mestnoanesteziruyuschee, protivozudnoe.

Application.

Allergodermatozı, prurigo, eczema, ekssudativnyi diatyez, hives, rash and other skin allergic reactions to drugs and chemicals, itch, allergic conjunctivitis, nasal allergy, pollen disease, stings of wasps, Bees, The Scorpion, Bumblebees, serum sickness, angioedema, false croup, asthmatic bronchitis, atopic asthma, anaphylactic and anaphylactoid reactions (in the complex therapy), rheumatic fever with severe allergic component; Meniere's syndrome, dizziness, nausea and vomiting, motion sickness syndrome; anxiety, neuroses and neurosis-like states, psychoses, insomnia, extrapyramidal disorder (in patients receiving antipsychotics), neuralgia nerve troynichnogo, migraine, xoreja, hyperthermia; premedication and postoperative period (as a sedative, for artificial hibernation, potentiation of anesthesia and local anesthesia), a study of gastric secretion (when used as a stimulator of secretion of histamine).

Contraindications.

Hypersensitivity (incl. other phenothiazines), coma, Simultaneous use of MAO inhibitors and the period during 14 days after their reception, Alcoholic intoxication, liver and / or kidney failure, pregnancy, lactation, episodic vomiting in children of unspecified origin, early childhood up 2 Months (for parenteral administration), Children up to age 6 years (orally).

Restrictions apply.

Jaundice, prostatauxe, susceptibility to urinary retention, stenosis of the bladder neck, otkrыtougolynaya or zakrыtougolynaya glaucoma, peptic ulcer with pyloroduodenal obstruction, diseases of the lower respiratory tract, suppression of bone marrow function, diseases of the cardiovascular system (severe angina, arterial hypertension, decompensated chronic heart failure, atrial tachyarrhythmia), epilepsy, sleep apnea syndrome, Reye's syndrome, pregnancy, lactation, advanced age.

Pregnancy and breast-feeding.

Contraindicated in pregnancy.

Category actions result in FDA - C. (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

At the time of treatment should stop breastfeeding.

Side effects.

From the nervous system and sensory organs: sedation, dizziness, drowsiness, anxiety, excitation, nightmares, increased frequency of sleep apnea; REER - disorientation, confusion, extrapyramidal disorder, increase in seizure activity (children); ccomodation and vision, noise or ringing in the ears.

Cardio-vascular system and blood (hematopoiesis, hemostasis): orthostatic hypotension (at / in the introduction), hypertension, tachycardia or bradycardia; rarely - leukopenia, thrombocytopenia, agranulocytosis.

From the digestive tract: anesthesia and dry mouth, nausea, vomiting, cholestasis, constipation.

From the respiratory system: dry nose, glotke.

With the genitourinary system: rarely - difficulty or painful urination.

Allergic reactions: hives, dermatitis, asthma.

Other: increased perspiration, photosensitivity, soreness (when i / m administration).

Cooperation.

Do effects of analgesics, hypnotics, trankvilizatorov, neytroleptikov, anesthetic agents, local anesthetics, Mr. holinoblokatorov, antihypertensives (dose adjustments). Reduces the effect of amphetamine derivatives, Mr. holinomimetikov, anticholinesterase drugs, ephedrine, guanethidine, levodopa, dopamine. Barbiturates accelerate elimination and reduce the activity. Beta-blockers increase (mutually) plasma concentration (to extreme hypotension, Arrhythmia, neobratimaya retinopathy, pozdnyaya dyskinesia). It reduces the effect of bromocriptine and increases the concentration of prolactin in the blood serum. Tricyclic antidepressants and anticholinergics potentiate m-anticholinergic activity, ethanol, clonidine, antiepileptics - CNS depression. MAO inhibitors (co-administration is not recommended) phenothiazines, and increase the risk of hypotension and extrapyramidal disorders. Quinidine increases the likelihood cardiodepressive action.

Overdose.

Symptoms: facial flushing, breathlessness, dryness of mucous membranes, midriaz, anxiety, motor hyperactivity, excitation, delirium (children), extrapyramidal disorder, tremor, epileptiform seizures (rarely), gipotenziya, respiratory depression, loss of consciousness.

Treatment: induction of vomiting, gastric lavage, appointment of activated carbon, laxatives (ingestion), in / in a liquid; monitoring and maintenance of vital functions; simptomaticheskaya therapy: vasoconstrictors (with hypotension), oxygen (to maintain adequate oxygenation).

We do not recommend the use of analeptics (can cause seizures) and epinephrine (may increase the hypotensive). With the development of extrapyramidal reactions using anticholinergics, used to treat Parkinson's disease, diphenhydramine or barbiturates. Dialysis nyeeffyektivyen.

Dosing and Administration.

Inside (after meal), / m, I /. Adults: of 12.5-25 mg 3-4 times in the daytime and 25-50 mg at night (the maximum dose: single - 75 mg, daily - 500 mg). When kinetosis - 12.5-25 mg 3-4 times a day inside. Nausea and vomiting - early 25 mg, then - 12.5-25 mg every 4-6 hours. Babies: aged 2-6 years - 12,5 mg, 6-14 years - 25 mg 3-4 times a day. Parenteral (emergencies, anesthesia practice): / m (deep in the muscle) at a dose of 0.5-1 mg / kg 3-5 times per day (in severe cases, the initial dose of 1-2 mg / kg), The maximum daily dose - 250 mg; I / (for hibernation) 0,150.3 mg / kg (maximum permissible concentration) - 25 mg / ml, insertion rate - 25 mg / min). To prepare for the operation - the previous evening 25-50 mg orally together with other drugs; to-day operations of the 2,5 h before it - 50 mg / m (in combination with an analgesic and holinolitikom), possible re-introduction of 1 no; children in a dose - 1,1 mg / kg. To prevent motion sickness syndrome once per 1 hours before the trip for adults - 25-50 mg, Children - 10-20 mg. For adjunctive therapy of anaphylactic shock - 10-20 mg / slow (after injection of epinephrine) and then for a further 24-48 hours to prevent relapse.

Precautions.

It can suppress the cough reflex, therefore caution is necessary in patients (especially children) with exacerbation of chronic respiratory disease. Caution should be used in people with impaired liver function, diseases of the cardiovascular system and the suppression of bone marrow hematopoiesis. In old age, caution is required when parenteral administration of high doses, tk. possible extrapyramidal disorders and acute urinary retention. Prolonged use should be periodically monitored cellular composition of peripheral blood. As an antiemetic should be used only when prolonged vomiting of known etiology. In order to prevent the oppression of the CNS recommended the appointment of caffeine. Prolonged use increases the risk of dental diseases (caries, periodontitis, candidiasis) due to a decrease salivation. May mask ototoxic effects (tinnitus and dizziness) used drugs together. Raises requirement for riboflavin. Should not be used during the drivers of vehicles and people, skills relate to the high concentration of attention (especially at the beginning of the course). It is necessary to eliminate the use of alcohol at the time of treatment.

Cautions.

The solution is not intended for a / a and s / c administration. Some formulations contain sodium metabisulfite promethazine, which may cause allergic reactions, including anaphylactic and asthmatic. To prevent distortion of the results of skin prick tests for allergens, necessary to cancel 72 h to prick test. During treatment, possible false-positive test results for pregnancy.

Cooperation

Active substance	Description of interaction
Azelastin	FMR: synergism. Strengthens (mutually) deprimatsiyu and reduces the speed of psychomotor reactions; Avoid simultaneous use.
Akarʙoza	FMR: antagonizm. Against the background of weakening the effect of promethazine; with a joint appointment is necessary to monitor the concentration of glucose in the blood.
Alprazolam	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment is necessary to reduce the dose.
Amitriptyline	FMR: synergism. Can amplify and prolong (mutually) sedation; joint application requires a reduction in dosage.
Atropyn	FMR: synergism. Strengthens (mutually) Mr. holinoliticheskie effects; the combined appointment of caution.
Biperiden	FMR: synergism. Against the backdrop of intensified promethazine central and peripheral effects; joint application requires caution.
Bromocriptine	FMR: antagonizm. Against the background of promethazine attenuated ability to inhibit the secretion of prolactin (may develop hyperprolactinemia).
Buprenorphine	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment requires monitoring of clinical status with a view to the timely correction of dosing regimen.
Haloperidol	FMR: synergism. Strengthens (mutually) CNS depression.
Gidroksizin	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment should reduce the dose.
Glipizide	FMR: antagonizm. Against the background of weakening the effect of promethazine; with a joint appointment is necessary to monitor the concentration of glucose in the blood.
Guanfaцin	FMR: synergism. Strengthens (mutually) sedation.
Diazepam	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment is necessary to reduce the dose.
Difengidramin	FMR: synergism. Strengthens (mutually) effects, incl. hypnotic.
Dopamine	FMR: antagonizm. Against the background of the effect of promethazine attenuated.
Zolpidem	FMR: synergism. Boosts and prolongs (mutually) CNS depression; joint application requires dose reduction.
Izofluran	FMR: synergism. Boosts and prolongs (mutually) sedation. Against the background of promethazine used a smaller dose.
Imipramine	FMR: synergism. Can amplify and prolong (mutually) sedation; joint application requires dose reduction.
Ipratropiya bromide	FMR: synergism. Strengthens (mutually) anticholinergic effects; the combined appointment of caution.
Carbamazepine	FMR. Enhances CNS depression, It increases the risk of neuroleptic malignant syndrome.
Ketamine	FMR: synergism. Boosts and prolongs (mutually) sedation. Against the background of promethazine used a smaller dose.
Klozapyn	FMR: synergism. Boosts and prolongs (mutually) sedation; joint application requires a dose reduction.
Clomipramine	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment should be reduced dose.
Clonazepam	FMR: synergism. Strengthens (mutually) CNS depression; joint application requires a change in dose.
Klonidin	FMR: synergism. Strengthens (mutually) CNS depression.
Codeine	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment requires monitoring of clinical status with a view to the timely correction of dosing regimen.
Lorazepam	FMR: synergism. Strengthens (mutually) CNS depression; joint application requires a change in dose.
Maprotilin	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment needed dose reduction.
Methoxsalen	FMR: synergism. Against the background of promethazine may increase the effect.
Midazolam	FMR: synergism. Boosts and prolongs (mutually) CNS depression; with a joint appointment should reduce the dose.
Moclobemide	FMR: synergism. It increases the risk of extrapyramidal disorders (inhibits MAO).
Morphine sulfate	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment requires monitoring of clinical status for the purpose of timely correction dosages.
Oxazepam	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment is necessary to reduce the dose.
Oxybutynin	FMR: synergism. Strengthens (mutually) anticholinergic effects; joint application requires caution.
Olanzapine	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment is necessary to reduce the dose.
Perfenazyn	FMR: synergism. Boosts and prolongs (mutually) sedation; joint application requires to reduce the dose.
Pramipexole	FMR: antagonizm. Against the background of the effect of promethazine attenuated.
Procarbazine	FMR: synergism. It may increase the likelihood of extrapyramidal disorders (inhibits MAO).
Propofol	FMR: synergism. Boosts and prolongs (mutually) sedation. Against the background of promethazine used a smaller dose.
Selegiline	FMR: synergism. Increases (as well as other inhibitors of MAO) the likelihood of extrapyramidal disorders.
Tioridazin	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment should reduce the dose.
Tolterodine	FMR: synergism. Strengthens (mutually) anticholinergic effects; joint application requires caution.
Topiramate	FMR: synergism. Strengthens (mutually) negative effect on the CNS.
Tramadol	FMR. Strengthens (mutually) sedation. Against the background of promethazine increases the risk of seizures. Joint application requires caution.
Trigeksifenidil	FMR: synergism. Against the backdrop of intensified promethazine central and peripheral effects; joint application requires caution.
Trifluoperazine	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment should reduce the dose.
Phenobarbital	FMR: synergism. Boosts and prolongs (mutually) CNS depression; with a joint appointment needed dose reduction.
Fentanyl	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment requires monitoring of clinical status for the purpose of timely correction dosages.
Flufenazin	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment should reduce the dose.
Quinidine	FMR. Against the background of promethazine more likely kardiodepressii.
Xlordiazepoksid	FMR: synergism. Boosts and prolongs (mutually) sedation; joint application requires dose reduction.
Chlorpromazine	FMR: synergism. Boosts and prolongs (mutually) sedation; In a joint application should be to reduce the dose.
Chlorprothixene	FMR: synergism. Boosts and prolongs (mutually) sedation; with a joint appointment should reduce the dose.
Epinephrine	FMR: antagonizm. Against the background of possible distortion of promethazine vasoconstrictor effect.
Ethanol	FMR: synergism. Strengthens (mutually) CNS depression. Against the background of promethazine reduced tolerance.
Ephedrine	FMR: antagonizm. Against the background of promethazine attenuated pressor effect.