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Overdose management options
Signs and symptoms of promethazine overdose include mild depression of the central nervous system and cardiovascular system, which can sometimes lead to severe hypotension, respiratory depression, confusion, and even sudden death .
Other reported responses include hyperreflexia, hypertonia, ataxia, athetosis, and extensor-plantar reflex (Babinski reflex).
Reactions after overdose can be significant, especially in pediatric and elderly patients. A paradoxical presentation characterized by hyperexcitability and nightmares, atropine-like signs and symptoms, dry mouth, mydriasis, Flushing, etc., as well as gastrointestinal symptoms and, less often, convulsions may occur.
What if I have an overdose?
Treatment of promethazine overdose is essentially symptomatic and supportive. Monitoring of vital signs, including respiration, pulse, blood pressure, temperature, and electrocardiogram (ECG), is only necessary in cases of extreme overdose or individual sensitivity.
Pay attention to keep the airway open and use assisted or controlled ventilation to maintain breathing if necessary. Acidosis and electrolyte loss should be corrected, and convulsions can be controlled with the anticonvulsant diazepam. It should be noted that any inhibitory effect of promethazine hydrochloride injection is not reversed by naloxone.
Avoid stimulants as they may cause convulsions. Intravenous fluids can be selected to treat hypotension caused by overdose of promethazine, and if indicated, reduction surgery should be performed in time.
If vasopressors are required to treat severe hypotension unresponsive to IV fluids and repositioning, norepinephrine or phenylephrine should be considered,< /strong>Adrenaline should not be used.
Because some patients with adrenergic blockade may lower blood pressure further when given epinephrine. Extrapyramidal reactions from promethazine overdose can be treated with anticholinergic and antiparkinsonian drugs, diphenhydramine or barbiturates, and oxygen can also be given.
Limited experience suggests that dialysisdialysis is not helpful for promethazine overdose [1-5].
References:
[1]Product Information:PROMETHAZINE HYDROCHLORIDE injection, solution, XGen Pharmaceuticals DJB, Inc, Updated September 1,2021.
[2]Product Information: PROMETHAZINE HYDROCHLORIDE solution, QUAGEN PHARMACEUTICALS LLC, Updated July 22,2021.
[3]Product Information: PROMETHAZINE-promethazine hydrochloride suppository, PD-Rx Pharmaceuticals, Inc, Updated December 9,2021.
[4]Product Information: PROMETHAZINE HYDROCHLORIDE syrup, Tris Pharma Inc, Updated October 25, 2021.
[5]Product Information: PROMETHAZINE HYDROCHLORIDE tablet, Marlex Pharmaceuticals Inc, Updated February 24,2021.
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