Bedside Snapshot
- Use It For
- Nausea and vomiting when first-line agents fail or are unsuitable; allergic and transfusion reactions; anaphylaxis adjunct after epinephrine; motion sickness; sedation
- Adult Dose
- Nausea: 12.5–25 mg PO/PR every 4–6 hr, or deep IM every 4 hr (prefer ondansetron)
- Allergic reaction: 25 mg deep IM; may repeat within 2 hr, then PO
- IV: avoid; only if IM is impossible, ≤1 mg/mL in NS over 20–40 min
- Pediatric Dose
- Contraindicated under 2 yr. Age ≥2 yr: nausea 1.1 mg/kg (0.5 mg/lb) PO (max 25 mg); injection no more than half the adult dose; lowest effective dose
- Onset / Duration
- IV: within 5 min / 4–6 hr; IM: within 20 min / 4–6 hr; PO: within 20 min / 4–6 hr; effects can last up to 12 hr
- Do Not Give / Hold If
- Age <2 yr; coma; phenothiazine allergy; subcut or intra-arterial injection; IV >1 mg/mL or via a hand or wrist vein; PO/PR for asthma or lower respiratory symptoms; pain at the site: stop
- Watch For
- Tissue injury: site pain, burning, blanching
- Respiratory depression: falling SpO₂, rising EtCO₂
- Hypotension, dystonia, paradoxical agitation
- Reversal / Rescue
- No antidote; naloxone does not reverse it. Support ventilation; hypotension: fluids, then norepinephrine or phenylephrine, never epinephrine; dystonia: diphenhydramine
- Must Remember
- Prefer ondansetron. If injectable promethazine is used, give deep IM only; never subcut, intra-arterial or undiluted IV push. ISMP and ASHP advise removing the injection from hospital formularies
Indications
Emergency & Prehospital
- Nausea and vomiting: prefer ondansetron. Reach for promethazine when first-line antiemetics are unavailable, ineffective or unsuitable. If an injection is needed, use deep IM only (see Dosing & Administration)
- Allergic reactions: for uncomplicated immediate-type reactions when oral therapy is impossible. In anaphylaxis, it is an adjunct only, given after epinephrine has controlled the acute symptoms
- Motion sickness: prevention and active treatment
ED / ICU / Transport
- Allergic reactions to blood or plasma: mild allergic transfusion reactions
- Postoperative nausea and vomiting: prevention and control
- Sedation and opioid adjunct: light sleep from which the patient is easily roused; adjunct to reduced-dose analgesics for postoperative pain
- Vertigo and vestibular nausea: H1 and muscarinic blockade in the vestibular pathway (off-label)
- Migraine and headache in the ED (off-label, second-line; adjunct antiemetic): in an RCT, promethazine 25 mg IV and prochlorperazine 10 mg IV both relieved headache. Prochlorperazine worked faster and caused less drowsiness. Prefer chlorpromazine, metoclopramide or prochlorperazine. Those three carry Level B evidence (AHS/AAN guidance, as summarized in the 2026 practice advisory). That RCT used the IV route. Injectable promethazine also carries a tissue-injury warning and ISMP/ASHP remove-from-formulary cautions (see Dosing & Administration)
Other Uses
- Sedation in labor: alone or with a reduced opioid dose
- Nausea and vomiting of pregnancy: oral or rectal option (off-label)
- Nighttime and preoperative sedation: hospitalized adults
- Allergic rhinitis, allergic conjunctivitis, mild urticaria or angioedema, dermographism: oral or rectal therapy
Dosing & Administration
These doses come from the label. Where a dose departs from the label, the row says so or cites its source.
Available Forms
- Injection 25 mg/mL: 1 mL (25 mg) ampule or vial; for deep IM or diluted IV infusion
- Injection 50 mg/mL: 1 mL (50 mg) ampule. A 25 mg dose is 0.5 mL of this strength. Prefer the 25 mg/mL strength for IV dilution and for doses of 25 mg or less. A partial draw from 50 mg/mL invites a double-dose error
- Tablets: 12.5 mg, 25 mg, 50 mg
- Rectal suppositories: 12.5 mg, 25 mg
- Oral solution: 6.25 mg/5 mL
- EMS / transport: agency-specific. Follow the formulary, because many systems no longer stock the injection
High-Alert Medication: Since 2007, ISMP has flagged promethazine injection as high-alert. Route and dilution errors cause gangrene and amputation. Independently double-check each of these: the strength (25 vs 50 mg/mL), the route (deep IM only, avoid IV) and, where IV is unavoidable, the dilution (≤1 mg/mL in NS), rate and site (large vein, never hand or wrist).
House Stance on Injectable Use: Prefer another antiemetic, such as ondansetron. Where injectable promethazine is still used, the FDA label prefers deep IM. Skip IV: the boxed warning is about severe tissue injury. ISMP (Targeted Medication Safety Best Practice 13, 2026–2027) and ASHP (2023 policy) say hospitals should pull injectable promethazine from formulary, IM use included. An IM needle can also end up in an artery. Differs from FDA label: the label also permits diluted IV infusion. This page advises against IV.
Adult Dosing
| Indication | Dose & Route | Repeat / Max | Notes |
|---|---|---|---|
| Nausea and vomiting, PO, PR or deep IM (prefer ondansetron) | 12.5–25 mg PO, PR or deep IM | PO or PR every 4–6 hr as needed; IM not more often than every 4 hr; no labeled daily max | High-alert for the injection: never subcut. Use PR when oral intake is not tolerated. Reduce co-administered opioid and barbiturate doses |
| Nausea and vomiting, IV (not recommended) | Only if IM is impossible: 12.5–25 mg diluted in 50 mL NS, IV infusion over 20–40 min | Not more often than every 4 hr; max concentration 1 mg/mL; max rate 2.5 mL/min | High-alert Avoid. Where still used per label: large vein, preferably central; never hand or wrist |
| Allergic reaction, including mild transfusion reaction | 25 mg deep IM | May repeat within 2 hr if needed; then switch to PO as soon as possible | High-alert Adjust to the smallest dose that controls symptoms |
| Allergic conditions, PO or PR (rhinitis, conjunctivitis, urticaria, dermographism) | 25 mg PO or PR at bedtime, or 12.5 mg before meals and at bedtime | 6.25–12.5 mg three times daily often suffices; no labeled daily max | Adjust to the smallest dose that controls symptoms |
| Anaphylaxis, adjunct only | 25 mg deep IM | Only after epinephrine and once acute symptoms are controlled; repeat as for allergic reaction | High-alert Never a substitute for IM epinephrine |
| Motion sickness | 25 mg PO 30–60 min before travel | Repeat 8–12 hr later if needed; then 25 mg on rising and before the evening meal | — |
| Sedation or opioid adjunct | 25–50 mg deep IM or PO | Single dose; reduce opioids by one-quarter to one-half and barbiturates by at least one-half | High-alert (injection). Nighttime, preoperative or postoperative use |
| Sedation in labor | 50 mg deep IM in early labor; 25–75 mg (average 50 mg) once labor is established | May repeat once or twice at 4-hr intervals; max 100 mg in 24 hr | High-alert Give with a reduced opioid dose |
Pediatric Dosing
| Indication | Dose (per kg) & Route | Max Single / Max Total | Notes |
|---|---|---|---|
| Children under 2 yr | Contraindicated in children under 2 years | Do not give by any route | Fatal respiratory depression (boxed warning). Use another antiemetic, such as ondansetron |
| Nausea and vomiting, age ≥2 yr, PO | 1.1 mg/kg (0.5 mg/lb) PO | Max 25 mg/dose = usual adult dose (NASEMSO Universal Care Guideline p. 13); every 4–6 hr as needed | Only for prolonged vomiting of known cause; no other respiratory depressants. PR: same 1.1 mg/kg (0.5 mg/lb) dose, max 25 mg; suppositories come only as 12.5 and 25 mg, so use the strength at or below the calculated dose. If the calculated dose is below 12.5 mg (under about 11 kg), do not use a suppository; use the oral solution (6.25 mg/5 mL) or another antiemetic, such as ondansetron |
| Any injection indication, age ≥2 yr | No more than half the adult dose, deep IM | No more than half the adult dose (label wording): max 12.5 mg/dose for nausea or allergy; max 25 mg/dose for sedation | High-alert IV not recommended; only if IM is impossible: diluted to ≤1 mg/mL, max 1.25 mL/min, large vein |
| Allergic conditions, age ≥2 yr, PO or PR | 25 mg at bedtime, or 6.25–12.5 mg three times daily | Fixed doses, not weight-based; no labeled daily max | The label gives one allergy regimen and says to adjust it "in children or adults" to the smallest dose that relieves symptoms |
| Motion sickness, age ≥2 yr | 12.5–25 mg PO or PR | Twice daily; max 25 mg/dose | — |
| Sedation or premedication, age ≥2 yr | 12.5–25 mg PO or PR at bedtime; premedication 1.1 mg/kg (0.5 mg/lb) with a reduced opioid dose | Injection label: not more than half the adult dose (≤25 mg) | The label conflicts: 1.1 mg/kg exceeds 25 mg above about 23 kg, and its pediatric IV dilution table covers doses up to 50 mg. Above about 23 kg the premedication is capped at 25 mg, the usual adult dose (NASEMSO Universal Care Guideline p. 13). Hallucinations, seizures and paradoxical excitation occur at therapeutic doses |
Weight-based dosing help: Pediatric Weight-Based Dosing.
Preparation & Administration
- Deep IM: deep into a large muscle, never subcutaneously; ask the patient to report any burning
- IV dilution (label; IV not recommended): 0.9% sodium chloride only. Adults: 12.5 mg, 25 mg or 50 mg in 50 mL; 75 mg in 100 mL. Children: up to 25 mg in 25 mL; 25–50 mg in 50 mL. Final concentration ≤1 mg/mL
- IV rate: infuse over 20–40 min on a pump; max 2.5 mL/min for a 50 mL bag, 5 mL/min for a 100 mL bag, 1.25 mL/min in children
- Line: large vein, preferably central, never hand or wrist; check patency first; stop at any pain
- Ampules: draw up through a filter needle
- Inspect: discard if discolored or particulate, before and after dilution; protect from light
- Diluted solution: use within 4 hr at room temperature or 24 hr refrigerated
Contraindications & Precautions
Contraindications
- Age under 2 years (every form and route)
- Subcutaneous or intra-arterial injection
- IV injection at concentrations above 1 mg/mL, including undiluted IV push
- Comatose state
- Hypersensitivity or idiosyncratic reaction to promethazine or other phenothiazines
- Oral and rectal forms: treatment of lower respiratory tract symptoms, including asthma (antihistamine class contraindication)
Precautions
- Compromised respiratory function: avoid every form (injection, tablets, suppositories) in COPD, sleep apnea or risk of respiratory failure. Respiratory depression can be fatal
- Children 2 years and older: avoid when Reye syndrome or liver disease is possible; not for vomiting of unknown cause
- Seizure disorders: it lowers the seizure threshold. The effect is stronger with opioids or local anesthetics
- Anticholinergic risk: narrow-angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, bladder-neck or pyloroduodenal obstruction
- Bone-marrow depression, cardiovascular or liver disease: use with caution
- Sulfite sensitivity: the injection contains sodium metabisulfite. That can trigger asthma or anaphylactic reactions
- Parkinson disease: dopamine blockade can make symptoms worse
- Driving and hazardous tasks: it impairs driving and operating machinery. Alcohol or other CNS depressants make it worse. Counsel patients released after a dose not to drive. Supervise children during activities such as bike riding
Hold / Reassess If
- Pain, burning, blanching or swelling at the injection or infusion site: stop immediately
- Patient already sedated or hard to rouse, SpO₂ <90% or a rising EtCO₂ trend
- SBP <90 mmHg
- New involuntary movements, restlessness or agitation after a dose
FDA Boxed Warning: Under 2 years, it can kill through respiratory depression. Do not use. Any parenteral route can cause severe tissue injury, including gangrene. Subcutaneous and intra-arterial injection are contraindicated, as is IV injection above 1 mg/mL. Deep IM is the preferred route. This page advises against IV use. If IV is unavoidable, it needs dilution and a large vein.
Adverse Effects & Toxicity
Common
- Drowsiness: the most prominent effect. US labels give no frequencies
- Anticholinergic effects: dry mouth, blurred vision, urinary retention
- Dizziness, confusion, disorientation: especially in older adults
- BP and heart-rate changes in either direction
- Photosensitivity, urticaria, injection-site burning
Serious / Life-Threatening
| Effect | Recognition | Management |
|---|---|---|
| Severe tissue injury, gangrene | Burning or pain during injection, blanching, cyanosis, swelling, sensory loss; arterial injection causes severe arteriospasm | Stop at once; evaluate for arterial injection or extravasation; urgent surgical review |
| Respiratory depression, apnea | Deep sedation, falling SpO₂, rising EtCO₂; highest risk under 2 yr and with opioids or benzodiazepines | Airway, O₂, BVM ventilation; stop other sedatives |
| Hypotension | Falling BP, faintness | Supine, IV fluids; norepinephrine or phenylephrine if refractory; never epinephrine |
| Extrapyramidal reactions | Oculogyric crisis, torticollis, tongue protrusion; more likely in dehydrated children | Diphenhydramine or an anticholinergic antiparkinson agent |
| Paradoxical excitation, seizures | Hyperexcitability, nightmares, hallucinations, delirium; mostly children and older adults | Stop promethazine; diazepam for seizures |
| Angioedema, hypersensitivity (including sulfite reactions to the injection) | Facial, lip or tongue swelling, urticaria, wheeze, hypotension | Stop the drug; treat as an allergic reaction, with IM epinephrine for anaphylaxis |
| Neuroleptic malignant syndrome (rare) | Hyperpyrexia, rigidity, altered mental status, autonomic instability | Stop promethazine and other dopamine blockers; cooling and intensive support |
| Blood dyscrasias, cholestatic jaundice | Leukopenia, agranulocytosis (fever, sore throat), thrombocytopenia; jaundice | Stop the drug; CBC and liver tests |
Overdose & Toxicity Management
- Signs: CNS depression up to coma, profound hypotension, respiratory depression, sudden death; stimulation in children and older adults; atropine-like signs (dry mouth, fixed dilated pupils, flushing)
- Immediate management: airway and assisted ventilation, O₂, cardiac monitoring. Diazepam for seizures. Correct acidosis and electrolytes. Avoid analeptics (respiratory stimulants). They can cause seizures
- Oral ingestion: activated charcoal may be given if the airway is protected; involve poison control
- Antidote: none. Naloxone does not reverse promethazine. It reverses only a co-administered opioid
- Hypotension: IV fluids and repositioning, then norepinephrine or phenylephrine. Epinephrine can lower BP further
- Extracorporeal removal: dialysis is not helpful
Monitoring
| Parameter | When / How Often | Target / Act If |
|---|---|---|
| Clinical: injection or infusion site | During and after every parenteral dose; ask about pain | Pain, burning, blanching or swelling: stop, evaluate for arterial injection or extravasation |
| Clinical: sedation level and respiratory rate | Baseline, then frequently after dosing; closer with opioids or benzodiazepines | Hard to rouse or slowing respirations: no further sedatives, support the airway |
| Clinical: SpO₂ and waveform EtCO₂ | Continuous with co-sedation, in children and in lung disease | SpO₂ <90% or rising EtCO₂: airway support, ventilate |
| Clinical: BP and HR | Baseline and after each IV dose | SBP <90 mmHg: supine, fluids; a vasopressor other than epinephrine |
| Clinical: movement and behavior | Each reassessment | Dystonia: diphenhydramine; restlessness or hallucinations: stop promethazine |
| Laboratory: CBC | Prolonged use or marrow-toxic co-therapy | Leukopenia or agranulocytosis on the CBC: stop the drug |
| Laboratory: test interference | When interpreting results after a dose | Glucose may rise; immunologic urine hCG tests may read falsely positive or negative: confirm by another method |
Interactions & Compatibility
Clinically Significant Interactions
| Drug / Class | Effect | What To Do |
|---|---|---|
| CNS depressants (opioids, benzodiazepines, barbiturates, alcohol, general anesthetics, tricyclic antidepressants) | Additive sedation and respiratory depression | Reduce opioid doses by one-quarter to one-half and barbiturates by at least one-half; monitor EtCO₂ |
| Epinephrine | Promethazine can reverse epinephrine's pressor effect | Do not treat promethazine hypotension with epinephrine; epinephrine stays first-line for anaphylaxis itself |
| Dopamine antagonists (metoclopramide, prochlorperazine, droperidol, haloperidol) | Additive extrapyramidal effects and NMS risk | Avoid stacking dopamine blockers; choose a different class |
| MAO inhibitors | More extrapyramidal effects reported when MAOIs and phenothiazines are combined | Use with caution; watch for dystonia and akathisia |
| Anticholinergics (diphenhydramine, meclizine, scopolamine) | Additive anticholinergic effects: delirium, retention, ileus | Use with caution; watch for delirium, urinary retention and ileus, especially in older adults. Diphenhydramine remains a labeled treatment for promethazine-induced dystonia |
| Haloperidol and other CYP2D6 substrates | Promethazine inhibits CYP2D6; a haloperidol injection label lists it among CYP2D6 inhibitors that raise haloperidol levels | Watch for haloperidol toxicity, including QTc prolongation; lower the haloperidol dose if needed |
IV Compatibility
- Dilute only in 0.9% sodium chloride. Do not mix or dilute it with any other drug or solution (label).
- Known incompatibility: the ketorolac label warns that ketorolac precipitates when mixed with promethazine in a syringe.
- Verify with an institutional compatibility resource.
Special Populations
- Pediatrics: contraindicated under 2 years. From age 2, use the lowest effective dose and no other respiratory depressants. Hallucinations and seizures occur. So does dystonia, especially when the child is dehydrated. Doses: Pediatric Dosing table.
- Neonates: contraindicated. If the mother received promethazine within 2 weeks of delivery, it may inhibit platelet aggregation in the newborn.
- Pregnancy: There are no adequate human studies. Rat studies showed no malformations at 2.1–4.2 times the maximum human dose. The label covers sedation in labor. Data there are limited: no effect on labor length or newborn interventions. Clinicians use it off-label for nausea and vomiting of pregnancy. In an emergency, give it when the benefit justifies the risk.
- Lactation: Occasional short-term use appears to pose little risk to the breastfed infant. With repeated doses, watch the infant for sedation. It can lower prolactin and may hinder the start of lactation. An antiemetic without strong antihistamine action is preferred.
- Older Adults: 2023 AGS Beers Criteria: avoid (strong recommendation). It is highly anticholinergic, and its clearance is reduced. Avoid it in Parkinson disease too. If used, start at the low end of the dosing range (12.5 mg; 6.25 mg is a labeled oral dose) and watch closely for confusion and oversedation.
- Renal Impairment: No specific adjustment is established. Metabolites are excreted in urine.
- Hepatic Impairment: Use with caution. Cholestatic jaundice has been reported. No specific adjustment is established.
- Obesity / Dosing Weight: adult doses are fixed, not weight-based. Pediatric per-kg doses are capped at the adult dose.
Field & Transport Considerations
- Scope: Paramedic, RN and critical-care transport, where the formulary carries it. State scope-of-practice rules apply.
- Storage & Stability: injection at 20–25 °C (68–77 °F), protected from light in its carton; discard if discolored or if a precipitate forms. Suppositories are stored refrigerated at 2–8 °C (36–46 °F).
- Carried Concentration: 25 mg/mL and 50 mg/mL ampules look alike. State the mg and mL aloud before you draw up.
- Route in the Field: Prefer ondansetron or another formulary antiemetic. If you use injectable promethazine, give deep IM. Avoid IV, and never give an undiluted IV push. ISMP and ASHP advise hospitals to remove the injection, including for IM use. Follow the agency formulary.
- Handoff Essentials: time, dose, route and injection site; any site pain; other sedatives or opioids given; sedation level, SpO₂ and EtCO₂ trend. If released after a dose: no driving.
Clinical Pearls
Pain Means Stop: Burning or pain during a promethazine injection can mean the drug is intra-arterial or has leaked outside the vessel. Stop at once and evaluate. Late recognition has ended in fasciotomy or amputation.
IM Is Not Risk-Free: The tissue-injury warning covers every parenteral route, IM included. Go deep into a large muscle. Never subcutaneously. An IM needle can also enter an artery.
Under 2 Means Never: Fatal apnea happened across a wide range of weight-based doses. Careful dosing will not make it safe for infants and toddlers. Choose another antiemetic, such as ondansetron.
Exam Discriminator: Hypotension After Promethazine: Alpha-blockade can reverse epinephrine's pressor effect, so epinephrine may drop BP further. Give fluids, then norepinephrine or phenylephrine.
Naloxone Will Not Wake It: Promethazine sedation is not opioid-mediated. After a promethazine and opioid combination, naloxone reverses only the opioid. Support ventilation for the rest.
Promethazine vs Other Antiemetics:
- Ondansetron: little sedation and no tissue-injury warning. Caution for QT
- Prochlorperazine, metoclopramide: dopamine blockers. Watch for akathisia and dystonia
- Droperidol: potent. It carries a boxed QT warning
- Promethazine: sedating. It suits motion or vestibular nausea, or when sedation is wanted
Pharmacology
Mechanism of Action
- Competitive H1 receptor antagonism. Histamine release is not blocked. The result: antiallergic, sedative and antiemetic effects
- Muscarinic blockade. That gives motion-sickness relief, and it also causes dry mouth, urinary retention and delirium
- Weak dopamine D2 blockade, about one-tenth that of chlorpromazine. It drives the antiemetic effect in the chemoreceptor trigger zone. Extrapyramidal effects and NMS are possible
- Partial alpha-adrenergic blockade. That causes hypotension and reverses the pressor effect of epinephrine
Pharmacokinetics
| Route | Onset | Peak | Duration |
|---|---|---|---|
| IV | Within 5 min | Not stated in US labels | 4–6 hr (up to 12 hr) |
| IM | Within 20 min | Not stated in US labels | 4–6 hr (up to 12 hr) |
| PO | Within 20 min | Not stated in US labels | 4–6 hr (up to 12 hr) |
| PR | Not stated in US labels | Not stated in US labels | Not stated in US labels |
- Half-life: 9–16 hr after IV dosing; mean 9.8 hr after IM dosing (healthy volunteers)
- Metabolism: hepatic; promethazine sulfoxides and N-desmethylpromethazine are the main urinary metabolites; inhibits CYP2D6
- Elimination: mainly in urine, as metabolites. Dialysis does not remove it usefully
Names & Classification
- Generic Name
- Promethazine hydrochloride
- Brand Names
- Phenergan (injection); most US supply is generic; oral combinations with codeine, dextromethorphan or phenylephrine
- Pharmacologic Class
- Phenothiazine derivative; first-generation H1 receptor antagonist
- Therapeutic Class
- Antiemetic; antihistamine; sedative
- Controlled Substance
- Not controlled (promethazine with codeine is a separate C-V product)
- ISMP High-Alert
- Yes: ISMP high-alert medication (promethazine injection, listed since 2007); oral and rectal forms are not listed
- Look-Alike / Sound-Alike
- None on the ISMP list of confused drug names; the main mix-up is the 25 mg/mL vs 50 mg/mL injection strength
References
- Hikma Pharmaceuticals USA. (2025). Phenergan (promethazine hydrochloride injection, USP): Prescribing information (revised December 2023; DailyMed, updated July 2, 2025). U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6f7e47cc-f823-4336-8107-f980e3049617
- Amneal Pharmaceuticals of New York. (2026). Promethazine hydrochloride tablets, USP: Prescribing information (DailyMed, updated February 17, 2026). U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b5734b8-6a52-44ff-ac29-9a91a4335394
- Padagis. (2026). Promethazine HCl suppositories, USP 12.5 mg and 25 mg: Prescribing information (DailyMed, updated October 8, 2026). U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=047b9a7c-586b-4635-a63e-2c7ce9ec34e7
- Le, C. K., Stevens, C. A., Park, J. H., & Clark, R. F. (2025). Promethazine: A review of therapeutic uses and toxicity. Journal of Emergency Medicine, 70, 127–133. https://doi.org/10.1016/j.jemermed.2024.09.013
- 2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. https://doi.org/10.1111/jgs.18372
- Institute for Safe Medication Practices. (2026). ISMP targeted medication safety best practices for hospitals: 2026–2027 (Best Practice 13: eliminate injectable promethazine from the formulary). ISMP/ECRI. https://online.ecri.org/hubfs/ISMP/Resources/ISMP_TargetedMedicationSafetyBestPractices_Hospitals.pdf
- National Institute of Child Health and Human Development. (2026). Promethazine. In Drugs and Lactation Database (LactMed) (updated February 15, 2026). https://www.ncbi.nlm.nih.gov/books/NBK501081/
- Callan, J. E., Kostic, M. A., Bachrach, E. A., & Rieg, T. S. (2008). Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial. Journal of Emergency Medicine, 35, 247–253. https://doi.org/10.1016/j.jemermed.2007.09.047
- Hoydonckx, Y., Feoktistov, A., Amoozegar, F., Anderson, C. C., Barad, M., Burke, E., Chitsantikul, P., Doshi, T. L., Englesakis, M., Goel, A., Gupta, H., Kissoon, N., Kirschner, A., Kohan, L., Lauritsen, C. G., Miller, F., Monsour, D., Nader, A., Ogunlaja, O., Schuster, N., Schwenk, E. S., Silberstein, S. D., Souza, D., Yuan, H., & Narouze, S. (2026). Practice advisory for intravenous management of headache disorders in hospitalized patients: a review of the evidence and consensus recommendations. Regional Anesthesia & Pain Medicine, 51(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC12911631
- Anthea Pharma Private Limited. (2026). Ketorolac tromethamine injection, solution: Prescribing information (DailyMed, revised February 2026). U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7a7c8579-d423-4699-9435-69c4d127c654
- Fresenius Kabi USA. (2026). Haloperidol lactate injection, solution: Prescribing information (DailyMed, revised June 2026). U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b1ad2abd-a9d6-44e3-957b-36a73260f4f5
- National Association of State EMS Officials. (2022). National Model EMS Clinical Guidelines, Version 3.0: Universal Care Guideline (Patient Care Goals, p. 13). NASEMSO. https://hhs.iowa.gov/media/198/download
Medical Disclaimer
- For Educational Purposes Only: This content is intended for educational reference and should not be used for clinical decision-making.
- Not a Substitute for Professional Judgment: Always consult your local protocols, institutional guidelines, and supervising physicians.
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