promethazine suppository
Promethazine (Promethegan) is a rectal suppository. It's used to treat different conditions in adults and children, such as allergy symptoms and motion sickness. It can also help with nausea and vomiting from certain procedures. Promethazine (Promethegan) works by blocking several chemicals, including histamine, dopamine, and acetylcholine. This medication is inserted into the rectum, multiple times a day as needed. Promethazine (Promethegan) suppository is an alternative option to the promethazine tablets for people who can't take medications by mouth. Common side effects include drowsiness and dizziness. This medication is available as both brand-name and generic versions.
What is Promethazine (Promethegan)?
What is Promethazine (Promethegan) used for?
- Runny nose, watery eyes, and other symptoms of allergies
- Runny or stuffy nose that isn't caused by allergies
- Rash, swelling, anaphylaxis, and other symptoms of an allergic reaction
- Dermographism
- Treatment or prevention of nausea and vomiting before and after surgery
- Treatment or prevention of motion sickness
- Treatment of pain along with other pain medications after surgery
- Help to relax your body and produce a light sleep, particularly before a procedure
How Promethazine (Promethegan) works
Promethazine (Promethegan) is an antihistamine and an anticholinergic medication. It also blocks a chemical called dopamine.
When promethazine (Promethegan) blocks histamine, it relieves symptoms of allergy, such as rash, watery eyes, and runny nose. It can also cause you to feel drowsy and calm before a surgery.
When promethazine (Promethegan) blocks acetylcholine and dopamine, it helps to relieve symptoms of nausea, vomiting, and motion sickness.
Drug facts
Side effects of Promethazine (Promethegan)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Feeling drowsy or tired
- Dizziness
- Confusion
- Dry mouth
- Nervousness
- blurry vision
Less Common Side Effects
- Tremors
- Nausea
- Vomiting
- Uncontrollable tongue thrusting
- Feeling agitated
- Sensitivity to light
- Hives
- Nightmares
- Trouble sleeping
Promethazine (Promethegan) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Neuroleptic malignant syndrome (NMS): stiff muscles, high fever, sweating, changes in heartbeat, changes in heart rhythm, confusion
- Breathing problems: slowed breathing, breathing repeatedly stops
- Excessive drowsiness
- Seizures
The following Promethazine (Promethegan) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Stop taking this medicine and get emergency help immediately if any of the following effects occur:
Rare
Symptoms of neuroleptic malignant syndrome; two or more occur together; most of these effects do not require emergency medical attention if they occur alone
Convulsions (seizures)
difficult or unusually fast breathing
fast heartbeat or irregular pulse
high fever
high or low (irregular) blood pressure
increased sweating
loss of bladder control
severe muscle stiffness
unusually pale skin
unusual tiredness or weakness
Incidence not known
Abdominal or stomach pain
black, tarry stools
bleeding gums
blood in urine or stools
bloody nose
blurred vision
chest pain or discomfort
chills
clay-colored stools
confusion as to time, place, or person
cough or hoarseness
dark urine
decreased awareness or responsiveness
difficulty or troubled breathing
double vision
fast, pounding, or irregular heartbeat or pulse
fever with or without chills
fixed position of eye
headache
heavier menstrual periods
high fever
holding false beliefs that cannot be changed by fact
hyperexcitability
increased or decreased blood pressure
increased sweating
irregular, fast or slow, or shallow breathing
large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
lightheadedness, dizziness, or fainting
loss of appetite
loss of bladder control
lower back or side pain
mimicry of speech or movements
mutism
nasal stuffiness
negativism
nightmares
noisy breathing
not breathing
painful or difficult urination
pale or blue lips, fingernails, or skin
peculiar postures or movements, mannerisms or grimacing
pinpoint red spots on skin
seeing double
seeing, hearing, or feeling things that are not there
seizures
severe muscle stiffness
severe sleepiness
shortness of breath
skin rash
slow or irregular heartbeat
sores, ulcers, or white spots on lips or in mouth
sticking out of tongue
swollen glands
tightness in chest
uncontrolled twisting movements of neck
unpleasant breath odor
unusual bleeding or bruising
unusual excitement, nervousness, or restlessness
unusual tiredness or weakness
vomiting of blood
yellow eyes or skin
Symptoms of overdose
Discouragement
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
excessive muscle tone
feeling of warmth
feeling sad or empty
irritability
lack of appetite
loss of interest or pleasure
muscle tension or tightness
overactive reflexes
pupils of eyes large and not moving or responding to light
redness of the face, neck, arms and occasionally, upper chest
shakiness and unsteady walk
sudden death
trouble concentrating
trouble sleeping
unconsciousness
unsteadiness, trembling, or other problems with muscle control or coordination
unusual paleness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
blistering, crusting, irritation, itching, or reddening of skin
continuing ringing or buzzing or other unexplained noise in ears
cracked, dry, scaly skin
dizziness
drowsiness
excitation
false or unusual sense of well-being
hearing loss
hives or welts
increased sensitivity of skin to sunlight
lack of coordination
loss of strength or energy
muscle pain or weakness
redness or other discoloration of skin
relaxed and calm
sunburn
swelling
unable to sleep
vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Promethazine (Promethegan)
Pros
- Good option for people who have trouble swallowing pills or taking injections
- Can be used in people 2 years and older
- Available in multiple strengths
Cons
- Might be uncomfortable to use
- Can cause drowsiness
- Higher risk of side effects in older adults
Pharmacist tips for Promethazine (Promethegan)
- Before using promethazine (Promethegan), it's best to have a bowel movement. Also, wash your hands well with soap and water.
- Unwrap the promethazine (Promethegan) suppository before using it. To make it easier to insert the promethazine (Promethegan) suppository, you can lubricate the tip.
- When you're ready to insert promethazine (Promethegan) suppository, lie on your side and bend your upper leg towards your stomach. Lift your buttock and use your finger to insert the suppository with the tip going in first. Hold your buttocks together for a few seconds afterwards.
- Talk to your primary care provider first before using promethazine (Promethegan) if you're taking or have recently taken medications for Parkinson's disease or depression that are known as monoamine oxidase inhibitors (MAOIs). These medications can sometimes interact with promethazine (Promethegan) and cause uncontrollable body movements.
- Promethazine (Promethegan) can cause you to sunburn more easily. To lower your risk, make sure to limit or avoid sun exposure during treatment with promethazine (Promethegan). Wear sunscreen and protective clothing when outside, even on overcast days.
- Promethazine (Promethegan) can cause dizziness or drowsiness. Don't drive a car or perform dangerous activities until you know how promethazine (Promethegan) affects you. Avoid taking promethazine (Promethegan) with alcohol since this combination can slow down your brain activity, which might lead to slow breathing and excessive sleepiness.
- Promethazine (Promethegan) can affect the results of certain lab tests, such as glucose or pregnancy tests. Talk with your prescriber if you have concerns about the results of any lab tests while using this medication.
- Store promethazine (Promethegan) in the refrigerator and only take it out when you're ready to use it. Put the package back in the refrigerator after removing your dose to prevent the suppositories from melting.
Common questions about Promethazine (Promethegan)
Promethazine (Promethegan) should start to work to relieve your symptoms within a few hours after your dose. For example, if you're taking promethazine (Promethegan) to prevent motion sickness, your healthcare professional (HCP) will ask you to take it 30-60 minutes before you travel.
Before inserting promethazine (Promethegan) suppositories, wash your hands and put on gloves if desired. Be sure to unwrap the suppository you're going to use. Apply a lubricant to the suppository to make it easier to insert it into your rectum. Next, lie on your side and bend your top leg. While lifting your buttock, insert the suppository (pointed end first) into your rectum, using your finger to push it in about 1 inch (not as far in for children). Wash your hands again afterwards. If you have questions about how to use promethazine (Promethegan), contact your HCP.
Follow your HCP's instructions on what promethazine (Promethegan) dose you should take and when. Taking more than what your HCP tells you can lead to serious side effects, including breathing problems and heart problems. If you or a loved one might have taken too much promethazine (Promethegan), contact a Poison Control Center at 1-800-222-1222 or go to the nearest emergency room.
It's best to try to have a bowel movement before your dose. This is so your body can better absorb promethazine (Promethegan). If you have a bowel movement too soon after inserting this medication, it could come out again before the medication has had the chance to get absorbed into your body. Ask your HCP how long you have to wait to have a bowel movement after inserting promethazine (Promethegan).
Yes. It's recommended to store promethazine (Promethegan) suppositories in the refrigerator, between 36 and 46 degrees Fahrenheit.
Don't keep suppositories outside of the refrigerator for too long. It's best to take them out only when you need a dose. Otherwise, they could get too warm and start to melt. This would make it harder to insert your dose, and it could affect how well the medication works for you.
Promethazine (Promethegan) suppositories haven't been well studied in pregnancy. But HCPs sometimes prescribe promethazine (Promethegan) off-label (not FDA-approved) for relieving nausea and vomiting in pregnancy. Please note that the American College of Obstetricians and Gynecologists only suggests promethazine (Promethegan) if Diclegis (doxylamine / pyridoxine) or first-choice options aren't working well. Always discuss with your obstetrician-gynecologist (OB-GYN) to see what treatment is the best option for you.
Promethegan and Phenergan are two brand name medications that contain the same active ingredient: promethazine. The main difference is how they're taken. Promethegan (promethazine) is a rectal suppository that's inserted into the rectum, while Phenergan (promethazine) is an injection that's typically given deep into the muscles. The brand name Phenergan used to also include the tablets and oral liquid, but those are now only available as generic medications.
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Risks and warnings for Promethazine (Promethegan)
Promethazine (Promethegan) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Potentially life-threatening slow breathing (respiratory depression)
- Risk factors: Children under 2 years old | History of breathing problems (e.g., sleep apnea, asthma) | Taking other medications that slow down breathing
In rare cases, promethazine (Promethegan) can significantly slow down breathing, which can be life-threatening. The risk is higher for children under 2 years old, people with a history of breathing problems, or if you're taking other medications that can cause breathing problems. For this reason, promethazine (Promethegan) isn't recommended for children if they're under the age of 2. If you regularly take medications that can slow your breathing, discuss alternatives with your healthcare team as there might be safer options to treat your condition. If you notice you or your child has slow and shallow breathing, get medical attention right away.
Excessive sleepiness
- Risk factors: Drinking alcohol | Taking other medications that cause drowsiness
Promethazine (Promethegan) can make you feel very sleepy and affect your ability to think. The risk is higher if you drink alcohol or if you take medications that make you drowsy, such as opioids, sleep medications, or certain antidepressants. Don't drive a car or operate machinery right after using this medication. If you experience symptoms such as slurred speech, lightheadedness, confusion, dizziness, or excessive drowsiness, get medical attention right away.
Worsening of certain health problems
- Risk factors: Glaucoma | Heart problems | Enlarged prostate | Breathing problems | Bladder problems | Stomach ulcer | Liver problems
Before taking promethazine (Promethegan), be sure to discuss all of your medical conditions with your primary care provider. Promethazine (Promethegan) can make certain problems worse.
Higher risk of seizures
- Risk factors: Taking medications that make seizures more likely | History of seizures
Promethazine (Promethegan) can cause people with a history of seizures to have more frequent episodes. Promethazine (Promethegan) can also raise the risk of seizures in people who take medications that lower seizure threshold, such as tramadol (Ultram). If you have one of the risk factors, talk to your prescriber before using promethazine (Promethegan). Get medical attention right away if you have symptoms such as uncontrolled body movements, repeated eye blinking, tingling in your body, blurry vision, or feeling confused.
Higher risk of infection (from low white blood cell count)
- Risk factor: Taking anticancer medications
In some rare cases, promethazine (Promethegan) can lower your white blood cell (WBC) count. This is more likely to happen if you are going through chemotherapy or other anticancer treatments. WBCs are responsible for fighting infections in your body. Low levels of WBC can cause you to get sick more easily. Let a member of your healthcare team know if you have symptoms of an infection, such as fever, chills, or cough, and they'll let you know if you need more medical attention.
Risk of serious nerve problems (neuroleptic malignant syndrome)
- Risk factor: Taking antipsychotic medications
Promethazine (Promethegan) can cause a rare, but serious, medical condition called neuroleptic malignant syndrome (NMS). This condition happens when dopamine (a chemical in your body) is not transported correctly in the brain. Certain medications, such as antipsychotics, can raise your risk of NMS. If you take medications for mental health, please talk with your prescriber before taking promethazine (Promethegan). Please get medical attention right away if you notice signs and symptoms such as high fever, fast heartbeat, rapid breathing, stiff muscles, excessive sweating, or confusion. Don't use promethazine (Promethegan) if you have a history of NMS.
Uncontrollable body movements
- Risk factors: Children who are sick and dehydrated | Taking an MAOI
Promethazine (Promethegan) can cause involuntary muscle movements including sticking out your tongue and twisting your neck. This risk is higher if you're taking MAOIs or if the medication is given to children who are sick and dehydrated (low fluids in the body). Notify your or your child's pediatrician right away if any of these symptoms develop while using promethazine (Promethegan).
Promethazine (Promethegan) dosage
Suppository| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 12.5mg | 12 suppositories | $35.64 | $2.97 |
| 25mg | 12 suppositories | $35.64 | $2.97 |
| 50mg | 12 suppositories | $102.80 | $8.57 |
Typical dosage for Promethazine (Promethegan)
Allergy symptoms
- Adults and children 2 years and older: The typical dose is 25 mg inserted rectally once daily at bedtime. An alternative dosing is 6.25 mg to 12.5 mg up to three times daily.
Motion sickness
- Adults: The typical dose is 25 mg inserted rectally 2 times daily. Take your first dose 30 to 60 minutes before you travel, and take the second dose 8 to 12 hours later if needed.
- Children 2 years and older: The typical dose is 12.5 mg to 25 mg inserted rectally 2 times daily.
Nausea and vomiting
- Adults: The typical dose is 12.5 mg to 25 mg inserted rectally every 4 to 6 hours as needed.
- Children 2 years and older: Your child's pediatrician will determine the dose for your child based on their body weight. The typical dose is 0.5 mg/lb of body weight inserted rectally every 4-6 hours as needed.
"Light" sleep before or during a procedure
- Adults: The typical dose is 25 mg to 50 mg inserted rectally once at bedtime the night before the procedure.
- Children 2 years and older: The typical dose is 12.5 mg to 25 mg inserted rectally once at bedtime the night before the procedure.
Pain relief before and after surgery
- Adults: Before surgery, the typical dose is 50 mg inserted rectally and used in combination with other pain medication(s). After surgery, the typical dose is 25 mg to 50 mg taken together with other pain medication(s).
- Children 2 years and older: Your child's pediatrician will determine the dose for your child based on their body weight. The typical dose before surgery is 0.5 mg/lb of body weight, in combination with other pain medication(s). The typical dose after surgery is 12.5 mg to 25 mg inserted rectally and taken together with other pain medication(s).
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Interactions between Promethazine (Promethegan) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Bromopride
- Calcium Oxybate
- Cisapride
- Dronedarone
- Magnesium Oxybate
- Mesoridazine
- Pimozide
- Piperaquine
- Potassium Oxybate
- Saquinavir
- Sodium Oxybate
- Sparfloxacin
- Terfenadine
- Thioridazine
- Tranylcypromine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Alfuzosin
- Alprazolam
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Anagrelide
- Apomorphine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Asenapine
- Astemizole
- Azithromycin
- Benzhydrocodone
- Bromazepam
- Buprenorphine
- Bupropion
- Buserelin
- Butorphanol
- Cannabidiol
- Carbinoxamine
- Ceritinib
- Cetirizine
- Chloroquine
- Chlorpromazine
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clobazam
- Clofazimine
- Clomipramine
- Clozapine
- Codeine
- Crizotinib
- Dabrafenib
- Dasatinib
- Degarelix
- Delamanid
- Desipramine
- Deslorelin
- Deutetrabenazine
- Dihydrocodeine
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Doxylamine
- Droperidol
- Efavirenz
- Encorafenib
- Entrectinib
- Epinephrine
- Erythromycin
- Escitalopram
- Esketamine
- Fentanyl
- Fingolimod
- Flecainide
- Flibanserin
- Fluconazole
- Fluoxetine
- Formoterol
- Foscarnet
- Fostemsavir
- Gabapentin
- Gabapentin Enacarbil
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Histrelin
- Hydrocodone
- Hydromorphone
- Hydroxychloroquine
- Hydroxyzine
- Ibutilide
- Iloperidone
- Imipramine
- Inotuzumab Ozogamicin
- Isradipine
- Ivabradine
- Ivosidenib
- Ketamine
- Ketoconazole
- Lapatinib
- Lefamulin
- Lemborexant
- Lenvatinib
- Levocetirizine
- Levofloxacin
- Levorphanol
- Lithium
- Lofexidine
- Lopinavir
- Loxapine
- Lumefantrine
- Macimorelin
- Meclizine
- Mefloquine
- Meperidine
- Methacholine
- Methadone
- Metoclopramide
- Metrizamide
- Metronidazole
- Midazolam
- Mifepristone
- Mirtazapine
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nafarelin
- Nalbuphine
- Nilotinib
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxycodone
- Oxymorphone
- Ozanimod
- Paliperidone
- Panobinostat
- Pasireotide
- Pazopanib
- Pentamidine
- Pentazocine
- Periciazine
- Pimavanserin
- Pitolisant
- Ponesimod
- Porfimer
- Posaconazole
- Pregabalin
- Procainamide
- Procarbazine
- Prochlorperazine
- Propafenone
- Protriptyline
- Quetiapine
- Quinine
- Ranolazine
- Remifentanil
- Remimazolam
- Revefenacin
- Ribociclib
- Scopolamine
- Secretin Human
- Selpercatinib
- Sertraline
- Sevoflurane
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Solifenacin
- Sorafenib
- Sotalol
- Sufentanil
- Sulpiride
- Sunitinib
- Tacrolimus
- Tapentadol
- Telavancin
- Telithromycin
- Tetrabenazine
- Tiotropium
- Toremifene
- Tramadol
- Trazodone
- Triclabendazole
- Trifluoperazine
- Trimipramine
- Triptorelin
- Vandetanib
- Vardenafil
- Vemurafenib
- Vinflunine
- Voclosporin
- Voriconazole
- Zolpidem
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aminolevulinic Acid
- Belladonna
- Belladonna Alkaloids
- Betel Nut
- Evening Primrose
- Midodrine
- Phenylalanine
How much does Promethazine (Promethegan) cost?
Promethazine (Promethegan) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Promethazine (Promethegan) will not be safe for you to take.
- Children younger than 2 years old
- People in a coma
- Treatment of lower respiratory tract problems, such as asthma
- Allergic to phenothiazines
What are alternatives to Promethazine (Promethegan)?
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