Medication Safety Issues
Promethazine may be confused with chlorproMAZINE, predniSONE
Phenergan may be confused with PHENobarbital, Phrenilin, Theragran
The Institute for Safe Medication Practices (ISMP) includes this medication (injectable formulation) among its list of drugs that have a heightened risk of causing significant patient harm when used. ISMP strongly discourages use of injectable promethazine (any route) and suggests facilities remove from all areas (including pharmacy) and not allow practitioners to order (ISMP 2020).
Beers Criteria: Promethazine, a first-generation antihistamine, is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older (independent of diagnosis or condition) due to its potent anticholinergic properties resulting in increased risk of confusion, dry mouth, constipation, and other anticholinergic effects or toxicity; use should also be avoided due to reduced clearance with advanced age and tolerance associated with use as a hypnotic (Beers Criteria [AGS 2019]).
Pharmacy Quality Alliance (PQA): Promethazine, as a single agent or as part of a combination, is identified as a high-risk medication in patients 65 years and older on the PQA's Use of High-Risk Medications in the Elderly (HRM) performance measure, a safety measure used by the Centers for Medicare and Medicaid Services (CMS) for Medicare plans (PQA 2017).
KIDs List: Dopamine antagonists, when used in pediatric patients <18 years of age, are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list; use should be avoided in infants and used with caution in children and adolescents due to risk of acute dystonia (dyskinesia), and with intravenous administration an increased risk of respiratory depression, extravasation, and death (strong recommendation; moderate quality of evidence) (PPA [Meyers 2020]).
Sominex: Brand name for promethazine in Great Britain, but also is a brand name for diphenhydrAMINE in the US
