Table of ContentsView AllTable of ContentsWarning on Using Promethazine for KidsPhenergan for VomitingDosageSide Effects/WarningsAlternativesWhen to Call a Doctor
Table of ContentsView All
View All
Table of Contents
Warning on Using Promethazine for Kids
Phenergan for Vomiting
Dosage
Side Effects/Warnings
Alternatives
When to Call a Doctor
Phenergan (promethazine) is an antiemetic (a medication that helps stopvomiting). Healthcare providers may prescribe promethazine for kids when they are unable to keep fluids down and are at risk for dehydration.
Promethazine is approved for use in children over the age of 2 but carries a boxed warning that it may cause death in children and can slow or stop breathing. The medication can also cause serious side effects and hallucinations.
This article discusses promethazine for kids and adults. It explains the side effects of promethazine and dosing information. It also offers alternatives to promethazine to help stop vomiting and prevent dehydration.
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Promethazine use in children comes with a fewboxed warningsfrom the U.S. Food and Drug Administration (FDA):
Promethazine may cause respiratory depression (hypoventilation), which can cause slow heart rate, shortness of breath, coma, and death unless promptly treated. The FDA issued this warning after several children stopped breathing or went intocardiac arrestafter taking the drug.
Promethazine injections are also associated with severe tissue injury, that may give rise togangreneor necrosis (tissue death), requiring amputation.
Promethazine to Treat Vomiting
Promethazine is an antiemetic drug used for vomiting. It’s also used as an antihistamine (allergy pill) and a sedative (sleeping pill). It’s available as tablets, suppositories, injectables, or syrups.
Phenergan should never be used in children less than 2 years of age. You and your pediatrician should consider alternatives in children over age 2, as well, due to the risk of dangerous side effects.
Promethazine can be given as an oral tablet, liquid medication, suppository, or injection. Dosing is based on body weight. It comes in 12.5 milligrams (mg), 25 mg, or 50 mg tablets.
In children older than 2 years of age, the recommended dose is 0.5 mg of promethazine per pound of body weight. A typical dose is 25 mg taken every four to six hours as needed.
Is Promethazine Available OTC?Promethazine is not available over the counter. It can potentially cause life-threatening side effects and requires a prescription from a healthcare provider.
Is Promethazine Available OTC?
Promethazine is not available over the counter. It can potentially cause life-threatening side effects and requires a prescription from a healthcare provider.
Side Effects
Side effects of promethazine in kids include:
These side effects occurred at a wide variety of doses.
Even if your child does not have serious respiratory depression, drowsiness related to the medication can interfere with treatment of vomiting. If your child is sleeping, he isn’t drinking fluids and can become even more dehydrated.
Does Promethazine Affect Heart Rate?Both slow heart rate (bradycardia) and rapid heart rate (tachycardia) are possible side effects of Phenergen. Children are more at risk.
Does Promethazine Affect Heart Rate?
Both slow heart rate (bradycardia) and rapid heart rate (tachycardia) are possible side effects of Phenergen. Children are more at risk.
Alternatives to Promethazine
Fortunately, when it comes to a vomiting child, you have a lot of alternatives that appear to be much safer than promethazine. These include both things you can do yourself at home and different medications.
Home Remedies
Withmild dehydration, your child may act thirsty and have a dry mouth. The first thing to try is oral rehydration solutions that restore fluids and replace lost electrolytes. You can buy products such as Enfalyte, Pedialyte, or Gatorade, or you can make your own rehydration solution from ingredients in your kitchen.
Not only are homemade solutions just as effective as store-bought options, but they’re much cheaper and allow you to avoid the food dyes present in many from the store.
One of the biggest mistakes in encouraging your child to drink fluids is to give them too much too fast. It’s hard not to give them all they want, especially if they’re complaining about thirst, but going slow will help the fluids “stay down.”
Withmoderate or severe dehydration, you may notice fewer wet diapers, sunken eyes, a lack of tears when the child cries, and listlessness. These are serious signs and you should get medical attention right away.
The total amount of fluid your child will need depends on their degree of dehydration and can be estimated with a simple formula.
As your child’s nausea improves, and especially if they have diarrhea, you may wish to slowly introduce foods back into their diet. You can give foods like bread, potatoes, or rice along with lean meat, yogurt, fruits, and vegetables. Avoid foods high in fat as they are harder to digest.
If your child also has diarrhea, theBRAT diet(bananas, rice, applesauce, toast) may help firm the stool, but it doesn’t have enough nutrients to be used for an extended time. (The American Academy of Pediatrics no longer recommends this diet and favors oral hydration.)
Medications
If an antiemetic medication is necessary, there are now many alternatives.
One of the most commonly used alternative medications for children is Zofran (ondansetron). Zofran is approved for the treatment of chemotherapy-induced nausea and vomiting but is often used “off-label” for treating the “stomach flu,” medically known as acute gastroenteritis in children.
When used for children withstomach flu, Zofran has been found to reduce the chance that a child will need intravenous fluids (which requires hospitalization). Zofran can be used even in younger children for whom Phenergan is not recommended.
Zofran comes with a warning as well—the injectable form can change the electrical activity of the heart, which can increase the risk of a potentially fatal heart rhythm. However, that only happens with the much higher doses required for chemotherapy, not the doses used for stomach flu.
This medication can also be quite expensive, as well.
When to Call a Healthcare Provider
Promethazine can lead to serious side effects. Contact a healthcare provider right away for any of the following:
Seek emergency medical treatment for any of the following:
These could be signs of appendicitis, which is a medical emergency.
Summary
Promethazine is helpful for preventing severe dehydration from vomiting. However, it can also cause serious side effects and should be used with caution in children. It can lead to respiratory failure and death, should not be given to children under the age of 2, and should not be taken with opioids in children under age 16.
If your child is vomiting and at risk of dehydration, another antiemetic Zofran is considered a safer alternative to promethazine. Talk to your child’s healthcare provider about any concerns you have with this or any other medications.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. National Library of Medicine: MedlinePlus.Promethazine.U.S. National Library of Medicine, DailyMed.Label: Phenergan-promethazine hydrochloride injection.U. S. Food and Drug Administration, Access Data. Wyeth Pharmaceuticals, Inc.Phenergan (promethazine HCI) Tablets and Suppositories.Vega RM, Avva U.Pediatric dehydration. StatPearls.Churgay CA, Aftab Z.Gastroenteritis in children: Part II. Prevention and management.Am Fam Physician. 2012;85(11):1066–1070.Fedorowicz Z, Jagannath VA, Carter B.Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd005506.pub5U.S. Food and Drug Administration.FDA Drug Safety Communication: New information regarding QT prolongation with ondansetron (Zofran).Stanford Children’s Health, Lucile Packard Children’s Hospital.Could that stomachache in your child be appendicitis?Additional ReadingLorenzo C.Patient education: Nausea and vomiting in infants and children (Beyond the Basics).
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. National Library of Medicine: MedlinePlus.Promethazine.U.S. National Library of Medicine, DailyMed.Label: Phenergan-promethazine hydrochloride injection.U. S. Food and Drug Administration, Access Data. Wyeth Pharmaceuticals, Inc.Phenergan (promethazine HCI) Tablets and Suppositories.Vega RM, Avva U.Pediatric dehydration. StatPearls.Churgay CA, Aftab Z.Gastroenteritis in children: Part II. Prevention and management.Am Fam Physician. 2012;85(11):1066–1070.Fedorowicz Z, Jagannath VA, Carter B.Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd005506.pub5U.S. Food and Drug Administration.FDA Drug Safety Communication: New information regarding QT prolongation with ondansetron (Zofran).Stanford Children’s Health, Lucile Packard Children’s Hospital.Could that stomachache in your child be appendicitis?Additional ReadingLorenzo C.Patient education: Nausea and vomiting in infants and children (Beyond the Basics).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
U.S. National Library of Medicine: MedlinePlus.Promethazine.U.S. National Library of Medicine, DailyMed.Label: Phenergan-promethazine hydrochloride injection.U. S. Food and Drug Administration, Access Data. Wyeth Pharmaceuticals, Inc.Phenergan (promethazine HCI) Tablets and Suppositories.Vega RM, Avva U.Pediatric dehydration. StatPearls.Churgay CA, Aftab Z.Gastroenteritis in children: Part II. Prevention and management.Am Fam Physician. 2012;85(11):1066–1070.Fedorowicz Z, Jagannath VA, Carter B.Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd005506.pub5U.S. Food and Drug Administration.FDA Drug Safety Communication: New information regarding QT prolongation with ondansetron (Zofran).Stanford Children’s Health, Lucile Packard Children’s Hospital.Could that stomachache in your child be appendicitis?
U.S. National Library of Medicine: MedlinePlus.Promethazine.
U.S. National Library of Medicine, DailyMed.Label: Phenergan-promethazine hydrochloride injection.
U. S. Food and Drug Administration, Access Data. Wyeth Pharmaceuticals, Inc.Phenergan (promethazine HCI) Tablets and Suppositories.
Vega RM, Avva U.Pediatric dehydration. StatPearls.
Churgay CA, Aftab Z.Gastroenteritis in children: Part II. Prevention and management.Am Fam Physician. 2012;85(11):1066–1070.
Fedorowicz Z, Jagannath VA, Carter B.Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd005506.pub5
U.S. Food and Drug Administration.FDA Drug Safety Communication: New information regarding QT prolongation with ondansetron (Zofran).
Stanford Children’s Health, Lucile Packard Children’s Hospital.Could that stomachache in your child be appendicitis?
Lorenzo C.Patient education: Nausea and vomiting in infants and children (Beyond the Basics).
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