# Promethazine for allergic reaction?



## Shishkabob (Oct 12, 2009)

So I was bored and checking through AMR's protocols, looking over the paramedic stuff.  I get down to the drug section and look at Phenergen.  


Now, I already knew it was an antiemetic, but I was surprised to read that it was also an antihistamine, and don't ever remember reading that anywhere.  


So, has anyone used phenergen instead of diphenhydramine for it's antihistamine properties in their protocols?  Or is it like Epi, where it's there, but not enough to even consider using it for that over benadryl, and stick with benadryl for the antihistamine/sedation effects?

Perhaps to those with a sensitivity to benadryl?


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## akflightmedic (Oct 12, 2009)

Actually I have posted on this before, it has been a while and I did not bother to search to find the link for you.

However, if you go to the manufacturer website or read the paper insert in the promethazine box, you will see it was designed for allergic reactions initially.

In fact, many of my Euro and Australian counterparts looked at me like I was absolutely crazy when I suggested it for an anti emetic. They had never heard of it being used as such...LOL.

We both were shocked the other was using it as a primary drug for different reasons, guess it all depends on what part of the world in which you stand.

Cheers Mate!


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## MrBrown (Oct 12, 2009)

Promethazine is a friggin brilliant anti-emetic I love the stuff to bits

Oh wow man does it get you smashed really good too!

We use it a BLS level PO and at Intermediary level IM/IV for allergic reactions but *not* anaphylaxis for that we use adrenaline and hyrdocortisone


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## Melclin (Oct 12, 2009)

I seem to have a mild allergy to something here in this house/neighbourhood. Have trouble getting to sleep for the redness and itchiness.

Take a couple of phenergen, no more iches... and I'm out like a light. 

Its used primarily here as an anti-histamine. I had never heard of its use as an anti-emetic until I came on this board. Good to know though. I chucked a couple back once when I had a crook gut a while back. Worked a treat.


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## wvditchdoc (Oct 13, 2009)

Phenergan is classed strictly as a Antihistamine, it is not classed as an Antiemetic. Just one of those gee whiz nifty things it can be used for. 

*Promethazine (Phenergan)*

*Class:* Antihistamine (h1 antagonist).

*Actions:* Mild anticholinergic activity, antiemetic, potentiates actions of analgesics.

*Indications:* Nausea and vomiting, motion sickness, to potentiate the effects of analgesics, sedation.

*Contraindications:* Comatose states, patients who have received a large amount of depressants (including alcohol).

*Precautions:* Avoid accidental intra-arterial injection.

*Side Effects:* May impair mental and physical ability, drowsiness.

*Dosage:* 12.5 - 25 mg.

*Routes:* IV/IM/PO

*Pediatric Dosage:* 0.5 mg/kg.


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## Aidey (Oct 13, 2009)

It was also used as an anti-psychotic for a while, but it didn't work very well.


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## cm4short (Oct 13, 2009)

I used it in the clinical setting on a patient who was allergic to benadryl.


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## redcrossemt (Oct 13, 2009)

cm4short said:


> I used it in the clinical setting on a patient who was allergic to benadryl.



Is it possible for someone to be "allergic" to diphenhydramine or another anti-histamine?


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## MrBrown (Oct 14, 2009)

redcrossemt said:


> Is it possible for someone to be "allergic" to diphenhydramine or another anti-histamine?



Maybe not the bendaryl itself but they could be allergic to the dye, flavour etc or a compound it is bound to


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## 8jimi8 (Oct 14, 2009)

funny you were noticing this.  I noticed the same thing.  My father in law was asking me the difference between compazine and phenergan last night and when I was looking them up I noticed that a therapeutic use of phenergan was as an anti-histamine.  

I kinda figured it was a mild effect, given that I've never heard of it being used that way.

I'd be interested in knowing how it stands up against diphenhydramine for this effect.


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## Melclin (Oct 14, 2009)

Also has some local anesthetic properties, a fact to which I can testify is quite true. All in all its a pretty great drug.


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## emtbill (Oct 15, 2009)

I always wondered why promethazine is given to potentiate narcotics. Is it because it is a prophylactic for nausea and vomiting, which could be detrimental to the patient, or does it actually promote binding of the narcotic to opiod receptors or something?


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## mycrofft (Oct 15, 2009)

*Prometh "potentiates analgesics"*

Also, can potentiate seizures. We used to give it as a preop med sometimes along with Valium when I was in nursing school at Pteranodon U.

You can have odd reactions to Benadryl, especially parenteral. One of my superiors at a job long ago had a reaction to ampicillin, came to work for tx, got IV Benadryl and started hallucinating and screaming.


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## eveningsky339 (Oct 16, 2009)

mycrofft said:


> Also, can potentiate seizures. We used to give it as a preop med sometimes along with Valium when I was in nursing school at Pteranodon U.
> 
> You can have odd reactions to Benadryl, especially parenteral. One of my superiors at a job long ago had a reaction to ampicillin, came to work for tx, got IV Benadryl and started hallucinating and screaming.



Sounds like a typical Monday to me.


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## chadwick (Dec 11, 2009)

I hate to say it this way but Phenergan makes the analgesic and euphoric effect more potent. You get more bang out of your narcotic effects.


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## Shishkabob (Dec 11, 2009)

chadwick said:


> I hate to say it this way but Phenergan makes the analgesic and euphoric effect more potent. You get more bang out of your narcotic effects.



Already known that it has potentiating effects.  ^_^


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## chadwick (Dec 11, 2009)

Sorry, that was meant as a direct reply to EMTBill.


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## gamma6 (Dec 14, 2009)

redcrossemt said:


> Is it possible for someone to be "allergic" to diphenhydramine or another anti-histamine?



i would have to say yes because some people are allergic to some odd stuff...hell i had this pt tell me she was allergic to epi..i was like wtf...


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## redcrossemt (Dec 14, 2009)

gamma6 said:


> i would have to say yes because some people are allergic to some odd stuff...hell i had this pt tell me she was allergic to epi..i was like wtf...



You can't be allergic to epinephrine... It could cause side effects that the patient doesn't like, but it doesn't mean they are allergic to it. Also, as mentioned previously, they could be allergic to a formulation of it (perhaps a nasal spray or inhaler with other ingredients).


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## Markhk (Dec 15, 2009)

redcrossemt said:


> Also, as mentioned previously, they could be allergic to a formulation of it (perhaps a nasal spray or inhaler with other ingredients).



Yeah, the preservative for epinephrine are sulfites (in particular, sodium metabisulfite). People with sulfite allergies can still use the Epi-pen though; the benefits of epi outweigh that of the sulfite allergy risk. 

Back to Phenergan...remember that IV injection can cause severe tissue damage...most hospitals prefer now to give it deep IM. 

http://www.youtube.com/watch?v=OpYfVkygS1Q


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## MrBrown (Dec 15, 2009)

Markhk said:


> Back to Phenergan...remember that IV injection can cause severe tissue damage...most hospitals prefer now to give it deep IM.
> 
> http://www.youtube.com/watch?v=OpYfVkygS1Q



I can attest to this first hand, promethazine IV burns something bloody terrible even when given slowly.  Didn't get any nasty necrosis (although I did get a rash from the IV tape) but wow did it hurt!

Good stuff tho, got me nicely wasted and seeing funny things on the ceiling which did not exist


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## stonez (Dec 15, 2009)

In South Africa it is ONLY indicated for Anaphylaxis or severe allergy.


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## gamma6 (Dec 15, 2009)

redcrossemt said:


> You can't be allergic to epinephrine... It could cause side effects that the patient doesn't like, but it doesn't mean they are allergic to it. Also, as mentioned previously, they could be allergic to a formulation of it (perhaps a nasal spray or inhaler with other ingredients).



trust me man i know, i kinda said whatever to her.....this lady was a little nutts anyways....i was like " i guess you are screwed when a systemic allergic reaction starts to kick in"....well there is always vasopressin....


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## ExpatMedic (Dec 20, 2009)

Have I used it in place of other medications for allergic reactions? No, our protocols are not written in a way that allows us to.  However, like others have mentioned, it apparently does work.


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## Lifeguards For Life (Dec 20, 2009)

While Promethazine is chiefly classified as an antiemetic, it is a long-acting derivative of phenothyiazine(an example, of a group of tranquilizing drugs with antipsychotic actions thought to act by blocking dopaminergic transmissions) with marked antihistaminic activity, and prominent sedative, amnesic and anti-motion sickness actions.

Unlike other drugs derived from phenothiazine, extra pyramidal effects are rare, though in higher doesages, the potential for toxicity is eual to that of other derivatives. Much like other antihistamines, promethazine exerts antiseritonin, anticholinergic, and local anestheitc properties. Antiemetic MOA, is thought to be depressing CTZ in the medulla.

Regarding being allergic to epi;
"I have an allergic reaction to epinephrine - I get heart palpitations, start shaking and sweating, and get a bad headache. Last time, I felt as though I was going to die!"-the above complaints are all adverse reactions of the drug.

It is impossible to be allergic to epinephrine (epinephrine is the same as adrenaline). Our bodies produce epinephrine all the time. If you were allergic to it, you'd be long dead before reading this.

On an interesting note I'm sure most of you know epinephrine and adrenaline are synonymous, but did you know this: Epinephrine is derived from the greek 'epi-' meaning above, and 'nephros' regarding the kidney. so at face value, epinephrine means above the kidney. Adrenalin  is derived from the Latin roots ''ad- and 'renes' and literally means on the kidney. 

So both adrenalin and epinephrine mean the exact same thing in 2 different languages


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## Lifeguards For Life (Dec 20, 2009)

MrBrown said:


> Maybe not the bendaryl itself but they could be allergic to the dye, flavour etc or a compound it is bound to



true. Benadryl is also sold in a dye-free version, and there have been reported "allergic reactions" to this dye free form.

Benadryl contains sulfur, perhaps these patients have a sulfur allergy?


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## stonez (Dec 21, 2009)

Out of my protocol book:

PHARMACOLOGICAL ACTION
·	Promethazine is a non selective antihistamine with considerable activity at other receptor sites: It combines potent H¹-antagonism with antiemetic, anticholinergic, and marked sedative activities, and some hypotensive effects.
·	The role of Promethazine in acute anaphylaxis is adjunctive to other core resuscitative approaches.


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