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Analgesics during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Meperidine provides effective pain relief for two to four hours in most patients who need systemic labor analgesics. It is important to keep in mind that fetal clearance of meperidine may be slow because of the immature hepatic enzyme complement. The usual dose is 25–50 mg IV or 50–75 mg IM. Promethazine, in a dose of 25 mg, is also given as an adjunct to prevent nausea (Table 8.3).
Nausea/Vomiting of Pregnancy and Hyperemesis Gravidarum
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Phenothiazines (prochlorperazine [Compazine], promethazine [Phenergan]) appear to be safe in pregnancy. A case-control study of promethazine showed no evidence of increase risk/rate of congenital anomalies in humans [95, 101]. Phenothiazines are often used in addition to or instead of antihistamines. The level 1 evidence for effectiveness is limited. As stated earlier, metoclopramide (with one IM shot of 50 mg of pyridoxine) is superior in decreasing vomiting and subjective improvement compared to monotherapy with either prochlorperazine or promethazine in NVP [86], it had similar efficacy with reduced side effects in HG [90]. Compared to ondansetron, there was no difference in severity of nausea in the setting of HG [100]. Two studies compared promethazine and corticosteroids in patients with HG. One study [102] found a decreased rate of hospital readmission with corticosteroids, the other study [103] found an increase in n/v at 48 hours but not after 17 days with prednisolone [2].
Promethazine
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Promethazine is a phenothiazine derivative with antihistaminic, sedative and antiemetic properties. It selectively blocks peripheral H1 receptors, thereby diminishing the effects of histamine on effector cells. Promethazine also blocks the central histaminergic receptors, thereby depressing the reticular system causing sedative and hypnotic effects. In addition, this agent has centrally acting anticholinergic properties and probably mediates nausea and vomiting by acting on the medullary chemoreceptive trigger zone. Promethazine is used as an antiallergic, in the treatment of pruritus, for sedation and to prevent and treat nausea and vomiting, e.g. from motion sickness. In pharmaceutical products, promethazine is employed as promethazine hydrochloride (CAS number 58-33-3, EC number 200-375-2, molecular formula C17H21CIN2S). It is available as tablets, syrup, injection fluid, suppository and in some countries as cream for the treatment of itch and insect bites (1).
Effect of promethazine on biofilms of gram-positive cocci associated with infectious endocarditis
Published in Biofouling, 2023
Gláucia Morgana de Melo Guedes, Carliane Melo Alves Melgarejo, Alyne Soares Freitas, Bruno Rocha Amando, Cecília Leite Costa, Crister José Ocadaque, Francisco Ivanilsom Firmiano Gomes, Silviane Praciano Bandeira, Rossana de Aguiar Cordeiro, Marcos Fábio Gadelha Rocha, José Júlio Costa Sidrim, Débora de Souza Collares Maia Castelo-Branco
The susceptibility assays of the 11 isolates were performed to determine the minimum inhibitory concentrations (MICs) for the efflux pump inhibitor promethazine- Pamergan®(PMZ, Cristália, Brazil), and the antimicrobials vancomycin (VAN, Sigma-Aldrich, Brazil), oxacillin (OXA, Sigma-Aldrich, Brazil) and ceftriaxone (CRO, Sigma-Aldrich, Brazil), by microdilution method using Müller Hinton broth (Difco, USA), according to the document M100-S28 of the Clinical Laboratory Standards Institute (CLSI 2018). VAN and OXA were evaluated against S. aureus and S. epidermidis and VAN and CRO against S. mutans. S. aureus strain ATCC 29213 and the classic antibacterial drug VAN (CLSI 2018) were used to validate the experiment. The drugs were tested at the following concentration ranges: 12.20–6,250 µg/ml for promethazine, 0.03–16 µg/ml for VAN and OXA, and 0.06 - 32 µg/ml for CRO. The final inoculum concentration was 5 × 105 cfu/ml, as recommended by CLSI. Drug-free wells containing only bacterial inoculum and culture medium were included as growth control and bacterium-free wells containing only culture medium and drug were included as sterility control. For all compounds, MIC was defined as the lowest concentration able of inhibiting 100% of microbial growth (Sidrim et al. 2017).
The pharmacological management of vertigo in Meniere disease
Published in Expert Opinion on Pharmacotherapy, 2020
Juan Manuel Espinosa-Sanchez, José A. Lopez-Escamez
Vestibular suppressants and antiemetic agents are the preferred drugs for the treatment of the acute phase in patients with MD [19]. Most medications share antivertiginous and antiemetic effects to a greater or lesser degree. Diphenhydramine and its derivative dimenhydrinate, meclizine, and cyclizine are H1-receptor antagonists that are useful for treating milder attacks orally. The association cinnarizine plus dimenhydrinate may be also beneficial [20]. Antidopaminergic drugs including metoclopramide, sulpiride, promethazine, and prochlorperazine are commonly used for severe nausea and vomiting. Setrons are serotonin 5-HT3 antagonists, they are mainly used when severe vomiting is a prominent symptom. A short course of steroids, commonly oral dexamethasone or methylprednisolone, is used to reduce vomiting and vestibular symptoms, especially when hearing loss is prominent [21]. Finally, benzodiazepines can be also used for acute crisis of MD because they act as vestibular suppressants enhancing the inhibitory action of GABA in the vestibular nuclei; nevertheless, long-term administration should be avoided, since they induce tolerance and drug addiction. They are also effective as antiemetics and to reduce the anxiety often associated with the episode of vertigo. The use of diuretics (mannitol, glycerol, acetazolamide, hydrochlorothiazide) in acute phase is a common practice in some countries [22].
A pharmacological profile of intravenous amisulpride for the treatment of postoperative nausea and vomiting
Published in Expert Review of Clinical Pharmacology, 2020
The situation is even more challenging in patients who, despite prophylaxis, are experiencing active PONV, usually in the post-anesthesia care unit (PACU) or surgical ward. Nowadays most surgical patients, especially in the US, receive a 5-HT3-antagonist for PONV prophylaxis. Clinical studies have repeatedly shown that redosing with a 5-HT3-antagonist to treat PONV is ineffective [62–64] and, indeed, the prescribing information for the most commonly used agent, ondansetron, advises against the practice, as do consensus guidelines [53]. Many patients will also have received dexamethasone, but, even if they have not, that is a poor treatment option as it takes around 2 h to start working [72]. A retrospective analysis suggested treatment efficacy for the antihistamine promethazine [73]. However, the potential toxicity of intravenous promethazine is alarming, especially the risk of severe tissue damage, including gangrene, associated with extravasation, for which a boxed warning appears in the prescribing information. It also has a range of other undesirable effects, not least sedation, which is unpleasant for a recovering patient and unhelpful for a busy surgical unit. An analysis in one center found the adverse event rate of promethazine to be greater than the combined rate for all other antiemetics used in that center [74].