Avoid drinking alcohol. It can increase some of the side effects of dextromethorphan and promethazine. Avoid taking diet pills, caffeine pills, or other stimulants such as ADHD medications without your doctor's advice.
Taking a stimulant together with cough medicine can increase your risk of unpleasant side effects. Avoid using other drugs that make you sleepy such as cold medicine, sleeping pills, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety. Dextromethorphan is contained in many medicines available over the counter.
If you take certain products together you may accidentally take too much of this medicine. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using dextromethorphan and promethazine and call your doctor at once if you have any of these serious side effects:.
Keep taking dextromethorphan and promethazine and talk with your doctor if you have any of these less serious side effects:.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. Before taking dextromethorphan and promethazine, tell your doctor if you are using any of the following drugs:. If you are using any of these drugs, you may not be able to use dextromethorphan and promethazine, or you may need dosage adjustments or special tests during treatment.
There may be other drugs not listed that can affect dextromethorphan and promethazine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Your pharmacist has information about dextromethorphan and promethazine written for health professionals that you may read.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Every effort has been made to ensure that the information provided by Cerner Multum, Inc. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.
Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient.
Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.
If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine, and others.
Taking this medicine during the last 2 weeks of pregnancy may increase the risk of bleeding in the newborn baby. Ask a doctor before giving this medicine to a child younger than 12 years old. Get emergency medical help if you have signs of an allergic reaction : hives; difficult breathing; swelling of your face, lips, tongue, or throat. This is not a complete list of side effects and others may occur.
Call your doctor for medical advice about side effects. Avoid driving, riding a bike, or any other hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.
Ask a doctor or pharmacist before using other cough or cold medicines that may contain dextromethorphan. Avoid sunlight, and wear protective clothing and use sunscreen SPF 30 or higher when you are outdoors. Use Promethazine DM Dextromethorphan And Promethazine exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow all directions on your prescription label and read all medication guides or instruction sheets.
Use the medicine exactly as directed. Do not use this medicine in a child younger than 2 years old, and carefully follow all dosing directions about use in a child 2 years or older.
Promethazine can slow the breathing, which has caused death in very young children. Dextromethorphan should be used with caution in sedated patients, in the debilitated, and in patients confined to the supine position.
Drugs having anticholinergic properties should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal obstruction, and bladder-neck obstruction. Promethazine should be used cautiously in persons with cardiovascular disease or with impairment of liver function. Dextromethorphan hydrobromide occasionally causes slight drowsiness, dizziness, and gastrointestinal disturbances.
Sedation, somnolence, blurred vision, dizziness; confusion, disorientation, and extrapyramidal symptoms such as oculogyric crisis, torticollis, and tongue protrusion; lassitude, tinnitus, incoordination, fatigue, euphoria, nervousness, diplopia, insomnia, tremors, convulsive seizures, excitation, catatonic-like states, hysteria. Hallucinations have also been reported. Respiratory — Asthma, nasal stuffiness, respiratory depression potentially fatal and apnea potentially fatal.
Other — Angioneurotic edema. Neuroleptic malignant syndrome potentially fatal has also been reported. Paradoxical Reactions — Hyperexcitability and abnormal movements have been reported in patients following a single administration of promethazine HCl. Consideration should be given to the discontinuation of promethazine HCl and to the use of other drugs if these reactions occur.
Respiratory depression, nightmares, delirium, and agitated behavior have also been reported in some of these patients. Dextromethorphan may produce central excitement and mental confusion. Very high doses may produce respiratory depression. One case of toxic psychosis hyperactivity, marked visual and auditory hallucinations after ingestion of a single dose of 20 tablets mg of dextromethorphan has been reported.
Signs and symptoms of overdosage with promethazine HCl range from mild depression of the central nervous system and cardiovascular system to profound hypotension, respiratory depression, unconsciousness, and sudden death.
Other reported reactions include hyperreflexia, hypertonia, ataxia, athetosis, and extensor-plantar reflexes Babinski reflex. Stimulation may be evident, especially in children and geriatric patients. Convulsions may rarely occur. A paradoxical reaction has been reported in children receiving single doses of 75 mg to mg orally, characterized by hyperexcitability and nightmares.
Atropine-like signs and symptoms — dry mouth, fixed dilated pupils, flushing, as well as gastrointestinal symptoms, may occur. The treatment of overdosage with promethazine and dextromethorphan is essentially symptomatic and supportive. Only in cases of extreme overdosage or individual sensitivity do vital signs including respiration, pulse, blood pressure, temperature, and EKG need to be monitored. Activated charcoal orally or by lavage may be given, or sodium or magnesium sulfate orally as a cathartic.
Attention should be given to the re-establishment of adequate respiratory exchange through provision of a patent airway and institution of assisted or controlled ventilation. Diazepam may be used to control convulsions. Acidosis and electrolyte losses should be corrected. The antidotal efficacy of narcotic antagonists to dextromethorphan has not been established; note that any of the depressant effects of promethazine are not reversed by naloxone.
Avoid analeptics, which may cause convulsions. Severe hypotension usually responds to the administration of norepinephrine or phenylephrine. This preparation is a clear syrup with yellow color and pineapple menthol odor, containing promethazine hydrochloride 6. Dispense in a tight, light-resistant container with a child-resistant closure as defined in the USP. Ambulatory patients should be told to avoid engaging in such activities until it is known that they do not become drowsy or dizzy from promethazine and dextromethorphan therapy.
Children should be supervised to avoid potential harm in bike riding or in other hazardous activities. The concomitant use of alcohol or other central nervous system depressants, including narcotic analgesics, sedatives, hypnotics, and tranquilizers, may have an additive effect and should be avoided or their dosage reduced.
Hyperpyrexia, hypotension, and death have been reported coincident with the coadministration of monoamine oxidase MAO inhibitors and products containing dextromethorphan.
When given concomitantly with promethazine, the dose of barbiturates should be reduced by at least one-half, and the dose of narcotics should be reduced by one-quarter to one-half. Dosage must be individualized. Excessive amounts of promethazine HCl relative to a narcotic may lead to restlessness and motor hyperactivity in the patient with pain; these symptoms usually disappear with adequate control of the pain. Because of the potential for promethazine to reverse epinephrine's vasopressor effect, epinephrine should NOT be used to treat hypotension associated with promethazine overdose.
Concomitant use of other agents with anticholinergic properties should be undertaken with caution. Drug interactions, including an increased incidence of extrapyramidal effects, have been reported when some MAOI and phenothiazines are used concomitantly. The following laboratory tests may be affected in patients who are receiving therapy with promethazine hydrochloride. Diagnostic pregnancy tests based on immunological reactions between HCG and anti-HCG may result in false-negative or false-positive interpretations.
Long-term animal studies have not been performed to assess the carcinogenic potential of promethazine or of dextromethorphan. There are no animal or human data concerning the carcinogenicity, mutagenicity, or impairment of fertility with these drugs. Promethazine was nonmutagenic in the Salmonella test system of Ames. Teratogenic effects have not been demonstrated in rat-feeding studies at doses of 6. These doses are from approximately 2.
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