Phenergan

Phenergan is a prescription medication used to treat acute allergic reactions and symptoms of seasonal allergies, to provide sedation, to prevent and treat nausea and motion sickness, and can also be added to existing pain medication regimens for pain relief in certain situations.

Phenergan belongs to a group of drugs called antihistamines. These drugs work to treat and prevent various symptoms by blocking the effects of histamine, a chemical in the body that is responsible for symptoms of allergies and motion sickness and also plays a role in pain perception and wakefulness.

This medication comes in tablet, rectal suppository, syrup, and injectable form. Your Phenergan dose and dose frequency will be determined by your physician based on the condition being treated.

Common side effects of Phenergan include dry mouth, sensitivity to light, and difficulty urinating.

Phenergan can also cause blurred vision, dizziness, drowsiness, and/or disorientation. Do not drive or operate heavy machinery until you know how Phenergan affects you.

Phenergan is a prescription medication used to treat or prevent:

• acute anaphylactic and uncomplicated allergic reactions
• symptoms of seasonal allergies
• nausea and motion sickness 

Phenergan may also be used to provide sedation or post-operative pain relief.

• Baxter Healthcare Corporation

• Compumed Pharmaceuticals, Inc.

• West-Ward Pharmaceutical Corp.

• Wyeth Pharmaceuticals, Inc.

Serious side effects have been reported with Phenergan. See the "Phenergan Precautions" section.

• dizzness
• drowsiness
• blurred vision
• disorientation
• sensitivity to light
• difficulty urination
• confusion
• dry mouth

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.  Especially tell your doctor if you take:

• Certain drugs used to treat Alzheimer's disease and/or Parkinson's disease such as:
• Donepezil (Aricept)
• Galantamine (Razadyne)
• Rivastigmine (Exelon)
• Tacrine (Cognex)

• Anticholinergic drugs, such as:
  • Atropine
  • Belladonna (Donnatal, B&O Supprettes, Bellamine S)
  • Benztropine (Cogentin)
  • Clidinium (Librax)
  • Clozapine (Clozaril)
  • Darifenacin (Enablex)
  • Diphenhydramine (Benadryl)
  • Dicyclomine (Bentyl)
  • Glycopyrrolate (Robinul)
  • Haloperidol (Haldol)
  • Homatropine (Hycodan)
  • Hyoscyamine (Levsin)
  • Ipratropium (Atrovent)
  • Oxybutynin (Ditropan, Ditropan XL, Oxytrol)
  • Solifenacin (Vesicare)
  • Scopolamine (Transderm Scop)
  • Tiotropium (Spiriva)
  • Tolterodine (Detrol, Detrol LA)

• CYP 2B6 inhibitor medications, such as:
  • Desipramine (Norpramin)
  • Doxorubicin (Adriamycin, Doxil)
  • Miconazole
  • Paroxetine (Paxil, Paxil CR, Pexeva, Brisdelle)
  • Sertraline (Zoloft)
  • Sorafenib (Nexavar)
  • Thiotepa

• CYP 2D6 inhibitor medications, such as:
  • Chlorpromazine
  • Cinacalcet (Sensipar)
  • Delavirdine (Rrescriptor)
  • Fluoxetine (Prozac, Sarafem, Selfemra)
  • Lopinavir/Ritonavir (Kaletra)
  • Miconazole
  • Paroxetine (Paxil, Paxil CR, Pexeva, Brisdelle)
  • Quinidine
  • Quinine
  • Ritonavir (Norvir)
  • Terbinafine (Lamisil)

• Epinephrine
• Monoamine oxidase inhibitors (MAOIs), such as:
  • Isocarboxazid (Marplan)
  • Phenelzine (Nardil)
  • Rasagiline (Azilect)
  • Selegiline (Eldepryl, Emsam, Zelapar)
  • Tranylcypromine (Parnate)

• Other medications that cause drowsiness, such as:
  • Antipsychotic medications
  • Antianxiety medications
  • Antidepressants
  • Muscle relaxants
  • Narcotic pain relievers
  • Sleep medications
  • Some antihistamines

• Pramlintide (Symlin)

This is not a complete list of Phenergan interactions.  Ask your doctor or pharmacist for more information.

Serious side effects have been reported with Phenergan including the following: 

Respiratory depression. Phenergan should not be used in children under two years of age as it can cause breathing difficulties which can lead to death. Caution should also be used when giving Phenergan to children 2 years of age and older.

Severe tissue injury. Severe tissue damage can occur with Phenergan use, especially when Phenergan is injected directly into a vein (IV). Tell your healthcare provider right away if you have any of the following symptoms:

• burning or pain at or around the injection site
• redness at or around the injection site
• swelling at or around the injection site
• loss of sensation at or around the injection site
• paralysis
• blackened/dead tissue at or around the injection site

Seizures. Use of Phenergan can have the effect of lowering the threshold for seizures, and should be used with caution in people with seizure disorders. Consult with your physician about your individual level of risk for developing seizures while using Phenergan.

Bone marrow depression. Phenergan should be used with caution in people with bone marrow depression. Leukopenia and agranulocytosis have been reported when Phenergan has been used in combination with other medications that are toxic to bone marrow.

Neuroleptic malignant syndrome. Neuroleptic malignant syndrome (NMS) has been reported with Phenergan use. Symptoms of NMS include severe fever, muscle rigidity, altered mental status, irregular pulse, quickened heart beat, and/or excessive sweating. If you notice any of these symptoms, discontinue use immediately and get medical attention.

Do not take Phenergan if:

• you are allergic to Phenergan or to any of its ingredients 
• the person to be receiving Phenergan is under 2 years old or comatose
• symptoms are related to the lower respiratory tract

Phenergan can also cause blurred vision, dizziness, drowsiness, and/or disorientation. Do not drive or operate heavy machinery until you know how Phenergan affects you.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Phenergan, there are no specific foods that you must exclude from your diet when receiving Phenergan.

Before taking Phenergan, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to Phenergan or to any of its ingredients
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed
• have a seizure disorder
• have bone marrow depression
• have liver disease
• have glaucoma
• currently use other sedative medications
• drink alcohol
• currently take antipsyhotic medications
• have difficulty urinating
• have Reye's syndrome
• have sleep apnea

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Phenergan falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if Phenergan crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using Phenergan.

Take Phenergan exactly as prescribed.

• This medication comes in tablet, rectal suppository, syrup, and injectable form. It is usually taken one to three times daily. 
• Phenergan tablets and syrup can be taken with or without food.
• Your Phenergan dose and dose frequency will be determined by your physician based on the condition being treated.
• Phenergan can cause unusual results with certain medical tests. Tell any doctor who treats you that you have recently received Phenergan.
• Try to empty your bowel and bladder just before using Phenergan suppositories. Remove the outer wrapper from the Phenergan suppository before inserting it. Avoid handling the suppository too long or it will melt in your hands. For best results from the Phenergan suppository, lie down after inserting it and hold in the suppository for a few minutes. The suppository will melt quickly once inserted. Avoid using the bathroom just after you have inserted the suppository.
• If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of Phenergan at the same time.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your weight
• your age

The recommended dose range of Phenergan for the treatment of various medical conditions is as follows:

Allergic conditions

Phenergan injection: 25 mg injected into directly into a muscle or vein and repeated within two hours, if necessary.

Phenergan suppositories: 25 mg inserted rectally before bed. Alternatively, 6.25 mg - 12.5 mg may be inserted rectally two to three times per day.

Sedation

Phenergan injection: 25 mg - 50 mg injected directly into a muscle or vein once per day at bedtime.

Phenergan suppositories: 12.5 mg - 50 mg inserted rectally before bed or before a procedure.

Nausea and vomiting

Phenergan injection: 12.5 mg - 25 mg injected directly into a muscle or vein up to every four hours.

Phenergan suppositories: 12.5 mg - 25 mg inserted rectally up to every four hours.

Pre or post-operative pain

Phenergan injection: 25 mg - 50 mg injected directly into a muscle or vein on an as needed basis in combination with other pain medications.

If you take too much Phenergan, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If Phenergan is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store Phenergan rectal suppositories in a refrigerator between 36 - 46°F
• Keep this and all medicines out of the reach of children

Respiratory Depression Risk

Phenergan should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. Cases of respiratory depression, including fatalities, have been reported with use of Phenergan in pediatric patients less than 2 years of age. Caution should be exercised when administering Phenergan to pediatric patients 2 years of age and older.

Severe Tissue Injury Risk

Phenergan injection can cause severe irritation and damage to tissues regardless of the route of administration. Irritation and damage can result from perivascular extravasation, unintentional intra-arterial injection, and intraneuronal or perineuronal infiltration. Adverse reactions include burning, pain, thrombophlebitis, tissue necrosis, and gangrene. In some cases, surgical intervention, including fasciotomy, skin graft, and/or amputation have been required.

Due to the risks of intravenous injection, the preferred route of administration of Phenergan Injection is deep intramuscular injection. Subcutaneous injection is contraindicated.