Phenergan Plus
Generic Name
Promethazine Hydrochloride & Dextromethorphan Hydrobromide
Manufacturer
Sanofi
Country
France (originator), Global presence
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Description
Overview of the medicine
Phenergan Plus is a combination medicine containing Promethazine Hydrochloride, an antihistamine, and Dextromethorphan Hydrobromide, a cough suppressant. It is used for the symptomatic relief of coughs and upper respiratory tract symptoms associated with colds and allergies.
Uses & Indications
Dosage
Adults
10 ml (2 teaspoonfuls) every 4-6 hours, not exceeding 4 doses in 24 hours.
Elderly
Lower doses may be required due to increased sensitivity and potential for adverse effects.
Renal_impairment
Use with caution; dose adjustment may be necessary. Consult a physician.
How to Take
For oral use only. Measure the dose accurately using a measuring spoon or cup. May be taken with or without food.
Mechanism of Action
Promethazine acts as an H1-receptor antagonist, blocking histamine's effects, leading to anticholinergic and sedative actions. Dextromethorphan acts centrally on the cough center in the medulla, elevating the cough threshold.
Pharmacokinetics
Onset
Promethazine: 20-60 minutes; Dextromethorphan: 15-30 minutes.
Excretion
Both are primarily excreted through urine.
Half life
Promethazine: 10-14 hours; Dextromethorphan: 1.4-3.9 hours.
Absorption
Both promethazine and dextromethorphan are well absorbed orally. Promethazine undergoes rapid and extensive first-pass metabolism.
Metabolism
Promethazine is extensively metabolized in the liver to various inactive metabolites. Dextromethorphan is primarily metabolized in the liver by CYP2D6 to dextrorphan (active metabolite).
Side Effects
Contraindications
- Hypersensitivity to promethazine, dextromethorphan, or any component.
- Children under 2 years (due to respiratory depression risk).
- Patients taking MAO inhibitors or within 14 days of stopping them.
- Severe respiratory depression or acute asthmatic attack.
Drug Interactions
MAO Inhibitors
Concurrent use can lead to serious, potentially fatal reactions (serotonin syndrome).
Anticholinergics
Increased anticholinergic effects (dry mouth, blurred vision, urinary retention).
CNS Depressants (alcohol, sedatives, tranquilizers)
Increased sedation and respiratory depression.
Storage
Store below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms include severe drowsiness, confusion, hallucinations, seizures, respiratory depression, and coma. Management involves supportive care, gastric lavage/activated charcoal, and monitoring vital signs. Naloxone may be used for respiratory depression in adults if dextromethorphan overdose is significant.
Pregnancy & Lactation
Pregnancy Category C. Use only if clearly needed and the benefit outweighs the risk. Promethazine can cause respiratory depression in newborns. Dextromethorphan is generally considered low risk but consult a doctor. Avoid during breastfeeding as both components pass into breast milk.
Side Effects
Contraindications
- Hypersensitivity to promethazine, dextromethorphan, or any component.
- Children under 2 years (due to respiratory depression risk).
- Patients taking MAO inhibitors or within 14 days of stopping them.
- Severe respiratory depression or acute asthmatic attack.
Drug Interactions
MAO Inhibitors
Concurrent use can lead to serious, potentially fatal reactions (serotonin syndrome).
Anticholinergics
Increased anticholinergic effects (dry mouth, blurred vision, urinary retention).
CNS Depressants (alcohol, sedatives, tranquilizers)
Increased sedation and respiratory depression.
Storage
Store below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms include severe drowsiness, confusion, hallucinations, seizures, respiratory depression, and coma. Management involves supportive care, gastric lavage/activated charcoal, and monitoring vital signs. Naloxone may be used for respiratory depression in adults if dextromethorphan overdose is significant.
Pregnancy & Lactation
Pregnancy Category C. Use only if clearly needed and the benefit outweighs the risk. Promethazine can cause respiratory depression in newborns. Dextromethorphan is generally considered low risk but consult a doctor. Avoid during breastfeeding as both components pass into breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months from manufacturing date
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Expired
Clinical Trials
Extensive clinical data available for individual components (Promethazine and Dextromethorphan) regarding efficacy and safety in cough and cold symptoms.
Lab Monitoring
- No routine lab monitoring is generally required.
- Complete Blood Count (CBC) if long-term use or suspected blood dyscrasias.
Doctor Notes
- Caution in patients with glaucoma, prostatic hypertrophy, urinary retention, and asthma.
- Advise patients about potential for significant sedation and avoidance of hazardous activities.
- Risk of respiratory depression, especially in young children and with concomitant CNS depressants.
Patient Guidelines
- Do not exceed the recommended dose.
- Avoid alcohol while taking this medicine.
- May cause drowsiness; avoid driving or operating heavy machinery.
- Report any unusual side effects to your doctor.
Missed Dose Advice
If a dose is missed, take it as soon as you remember. If it is close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Driving Precautions
This medicine can cause significant drowsiness and impair judgment. Avoid driving or operating machinery until you know how it affects you.
Lifestyle Advice
- Ensure adequate hydration by drinking plenty of fluids.
- Get plenty of rest to aid recovery.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.