Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
There may be an increase in the risk of certain neurologic reactions that
affect movement of muscles (EPS, see below) when promethazine is combined with
medicines that also cause EPS. Such drugs include antipsychotics, metoclopramide
(Reglan), and amoxapine (Asendin).
Promethazine should not be used with propylthiouracil (PTU) due to the
increased risk of low white blood cell counts and increased risk of infections.
The reason for this interaction is not known.
Concurrent use of promethazine with the dye used for myelography (x-rays of
the spinal cord) can lower the threshold for
seizures and thus increase the risk
of seizures. Promethazine should be stopped at least 48 hours before myelography
and not restarted until at least 24 hours after myelography.
PREGNANCY: There are no adequate studies of promethazine in
pregnant
women. Administration of promethazine within 2 weeks of delivery may affect
platelet function in the newborn.
NURSING MOTHERS: It is not known whether promethazine is excreted in
breast-milk.
SIDE EFFECTS: Promethazine often causes sedation. In children less
than two it can depress respiration and lead to death. Therefore, it should not
be used in children less than two years old. Dizziness may also occur.
Ironically, promethazine sometimes stimulates patients, particularly children.
Such stimulation may be manifest by restlessness, inability to sleep, heart
palpitations or even seizures. Promethazine also causes anticholinergic side
effects such as blurred vision, dry mouth, dilated pupils, nausea, urinary
retention (inability to urinate), impotence, and constipation.
EPS may occur. EPS are categorized as
dystonic reactions (alterations in
muscle tone), sharp, involuntary muscle movements (often limited to one muscle
or muscle group), akathisia (subjective restlessness), and
Parkinsonism.
Parkinsonian symptoms are more common in older persons whereas children more
often develop involuntary muscle movement reactions. Dystonic reactions are most
commonly seen during the first week of treatment. Restlessness and Parkinsonian
symptoms usually develop days to weeks after starting therapy.
A complex called neuroleptic malignant syndrome (NMS) can occur in patients
receiving phenothiazines. NMS consists of high body temperature, severe EPS,
changes in consciousness and mental status, and increased heart rate with low or
high blood pressure. NMS occurs more frequently in young men and in persons who
are dehydrated.
Rarely, blood cell disorders can occur; low white cell counts can lead to
severe infections.
Phenothiazines such as promethazine can cause skin hyperpigmentation
(darkening) but usually only after prolonged use. The effect usually is
restricted to areas of the body exposed to sunlight. Thus, people who need
long-term treatment with promethazine should either keep out of the sun or use
effective sunscreens.
Phenothiazines can cause blurred vision, difficulty with nighttime vision, or
changes in color vision.
Liver damage has been reported rarely with phenothiazines. Jaundice is
possible. Jaundice also may occur in newborns of mothers who receive
phenothiazines during pregnancy.
Phenothiazines such as promethazine block dopamine receptors. This effect can
lead to increases in blood levels of prolactin, a hormone involved in lactation
(formation of breast milk). As a result, phenothiazines can cause the breast to
produce fluid ("milk") even when a woman is not pregnant. Additionally,
phenothiazines can cause missed menstrual periods, breast enlargement or
tenderness, loss of sexual drive, impotence,
inability to ejaculate, and
priapism. Weight gain also may occur.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Vertigo is a feeling of spinning movement, and at times accompanied by nausea and vomiting occur. Vertigo is most often associated with an inner ear problem. The treatment for vertigo can be lifestyle changes and medication if necessary.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Motion sickness, often referred to as car sickness, sea sickness, or air sickness, is a very common disturbance of the inner ear that is caused by repeated motion. The cause of motion sickness is complex. Symptoms of motion sickness include vomiting, nausea, dizziness, vertigo, sweating, and a feeling of malaise. Treatment of motion sickness include antihistamine medications such as meclizine (Bonine, Antivert, Dramamine), and scopolamine (Transderm Scop) a skin patch.
Nausea and vomiting are symptoms that may be caused by many conditions. Antiemetics are drugs that treat nausea and vomiting. Though some antiemetics for motion sickness and mild nausea are available over the counter (OTC), most require a medical evaluation and prescription.
Meniere disease (idiopathic endolymphatic hydrops) is an inner ear disorder with symptoms that include vertigo, tinnitus, hearing loss, and the sensation of ear fullness. Diuretics, anti-vertigo, anti-nausea and low salt diets are the primary treatment for Meniere disease. Surgery may be recommended if the vertigo cannot be controlled with medication.
Hay fever (allergic rhinitis) is an irritation of the nose caused by pollen and is associated with the following allergic symptoms: nasal congestion, runny nose, sneezing, eye and nose itching, and tearing eyes. Avoidance of known allergens is the recommended treatment, but if this is not possible, antihistamines, decongestants, and nasal sprays may help alleviate symptoms.
Balance is a state of body equilibrium or stability. We often take for granted how dependent we are on a healthy balance system. When the system breaks down, however, patients will describe symptoms such as dizziness, vertigo, lightheadedness, or motion sickness.
Sun sensitivity (photosensitivity) is an inflammation of the skin induced by the combination of medications or substances and sunlight. The affect on the skin is redness, which looks similar to a sunburn. Generally, these reactions are either phototoxic or photoallergic. Phototoxic drugs are more common than photoallergic drugs. Symptoms of phototoxic reactions are a burning and stinging sensation and then redness. Symptoms of photoallergic reactions are itching, redness, swelling, blisters of the affected area. Treatment generally is discontinuation of the medication and topical application of creams.
The majority of stinging insects in the United States are from Bees, Yellow Jackets, Hornets, Wasps and Fire Ants. Severity of reactions to stings varies greatly. Avoidance and prompt treatment are essential. In selected cases, allergy injection therapy is highly effective.
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