Label: PROMETHAZINE HYDROCHLORIDE solution

Rx only

Each 5 mL unit dose of Promethazine HCl Oral Solution contains 6.25 mg promethazine HCl in a flavored syrup base with a pH between 4.7 and 5.2. Alcohol 7%. The inactive ingredients present are ascorbic acid, citric acid, D&C Yellow No. 10, edetate disodium, ethyl alcohol, FD&C Blue No. 1, FD&C Red No. 40, glycerin, methylparaben, pineapple flavor, purified water, sodium benzoate, sodium citrate, sucralose, and sucrose.

Promethazine HCl is a racemic compound; the molecular formula is C 17H 20N 2S•HCl and its molecular weight is 320.89. Promethazine HCl, a phenothiazine derivative, is chemically designated as 10-[2- (Dimethylamino)propyl] phenothiazine monohydrochloride. Its structural formula is:

Promethazine HCl occurs as a white to faint yellow, practically odorless, crystalline powder which slowly oxidizes and turns blue on prolonged exposure to air. It is freely soluble in water and soluble in alcohol.

Promethazine is a phenothiazine derivative which differs structurally from the antipsychotic phenothiazines by the presence of a branched side chain and no ring substitution. It is thought that this configuration is responsible for its relative lack (1/10 that of chlorpromazine) of dopamine antagonist properties.

Promethazine is an H 1 receptor blocking agent. In addition to its antihistaminic action, it provides clinically useful sedative and antiemetic effects.

Promethazine is well absorbed from the gastrointestinal tract. Clinical effects are apparent within 20 minutes after oral administration and generally last four to six hours, although they may persist as long as 12 hours. Promethazine is metabolized by the liver to a variety of compounds; the sulfoxides of promethazine and N-desmethylpromethazine are the predominant metabolites appearing in the urine.

Promethazine HCl Oral Solution is useful for:

Perennial and seasonal allergic rhinitis.

Vasomotor rhinitis.

Allergic conjunctivitis due to inhalant allergens and foods.

Mild, uncomplicated allergic skin manifestations of urticaria and angioedema.

Amelioration of allergic reactions to blood or plasma.

Dermographism.

Anaphylactic reactions, as adjunctive therapy to epinephrine and other standard measures, after the acute manifestations have been controlled.

Preoperative, postoperative, or obstetric sedation.

Prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery.

Therapy adjunctive to meperidine or other analgesics for control of postoperative pain.

Sedation in both children and adults, as well as relief of apprehension and production of light sleep from which the patient can be easily aroused.

Active and prophylactic treatment of motion sickness.

Antiemetic therapy in postoperative patients.

Promethazine HCl Oral Solution is contraindicated for use in pediatric patients less than two years of age.

Promethazine HCl Oral Solution is contraindicated in comatose states, and in individuals known to be hypersensitive or to have had an idiosyncratic reaction to promethazine or to other phenothiazines.

Antihistamines are contraindicated for use in the treatment of lower respiratory tract symptoms, including asthma.

Central Nervous System –Drowsiness is the most prominent CNS effect of this drug. 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.

Cardiovascular –Increased or decreased blood pressure, tachycardia, bradycardia, faintness.

Dermatologic– Dermatitis, photosensitivity, urticaria.

Hematologic – Leukopenia, thrombocytopenia, thrombocytopenic purpura, agranulocytosis.

Gastrointestinal– Dry mouth, nausea, vomiting, jaundice.

Respiratory– Asthma, nasal stuffiness, respiratory depression (potentially fatal) and apnea (potentially fatal). (See WARNINGS-Respiratory Depression. )

Other– Angioneurotic edema. Neuroleptic malignant syndrome (potentially fatal) has also been reported. (See WARNINGS-Neuroleptic Malignant Syndrome. )

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-type reaction has been reported in children receiving single doses of 75 mg to 125 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.

It is important that Promethazine HCl Oral Solution is measured with an accurate measuring device (see PRECAUTIONS-Information for Patients). A household teaspoon is not an accurate measuring device and could lead to overdosage, especially when half a teaspoon is to be measured. It is strongly recommended that an accurate measuring device be used. A pharmacist can provide an appropriate device and can provide instructions for measuring the correct dose.

Promethazine HCl Oral Solution is contraindicated for children under 2 years of age (see WARNINGS – Boxed Warningand Use in Pediatric Patients).

Allergy

The average oral dose is 25 mg taken before retiring; however, 12.5 mg may be taken before meals and on retiring, if necessary. Single 25 mg doses at bedtime or 6.25 to 12.5 mg taken three times daily will usually suffice.

After initiation of treatment in children or adults, dosage should be adjusted to the smallest amount adequate to relieve symptoms.

The administration of promethazine HCl in 25 mg doses will control minor transfusion reactions of an allergic nature.

Motion Sickness

The average adult dose is 25 mg taken twice daily. The initial dose should be taken one-half to one hour before anticipated travel and be repeated 8 to 12 hours later, if necessary. On succeeding days of travel, it is recommended that 25 mg be taken on arising and again before the evening meal. For children, 12.5 to 25 mg, twice daily, may be administered.

Nausea and Vomiting

Antiemetics should not be used in vomiting of unknown etiology in children and adolescents (see WARNINGS- Use in Pediatric Patients).

The average effective dose of Promethazine HCl Oral Solution for the active therapy of nausea and vomiting in children or adults is 25 mg. When oral medication cannot be tolerated, the dose should be given parenterally (cf. Promethazine Hydrochloride Injection) or by rectal suppository. 12.5 to 25 mg doses may be repeated, as necessary, at 4 to 6 hour intervals.

For nausea and vomiting in children, the usual dose is 0.5 mg per pound of body weight, and the dose should be adjusted to the age and weight of the patient and the severity of the condition being treated.

For prophylaxis of nausea and vomiting, as during surgery and the postoperative period, the average dose is 25 mg repeated at 4 to 6 hour intervals, as necessary.

Sedation

This product relieves apprehension and induces a quiet sleep from which the patient can be easily aroused. Administration of 12.5 to 25 mg Promethazine HCl Oral Solution by the oral route at bedtime will provide sedation in children. Adults usually require 25 to 50 mg for nighttime, presurgical, or obstetrical sedation.

Pre- and Postoperative Use

Promethazine HCl Oral Solution in 12.5 to 25 mg doses for children and 50 mg doses for adults the night before surgery relieves apprehension and produces a quiet sleep. For preoperative medication children require doses of 0.5 mg per pound of body weight in combination with an appropriately reduced dose of narcotic or barbiturate and the appropriate dose of an atropine-like drug.

Usual adult dosage is 50 mg Promethazine HCl Oral Solution with an appropriately reduced dose of narcotic or barbiturate and the required amount of a belladonna alkaloid.

Postoperative sedation and adjunctive use with analgesics may be obtained by the administration of 12.5 to 25 mg in children and 25 to 50 mg doses in adults.

Promethazine HCl Oral Solution is contraindicated for children under 2 years of age.

Promethazine Hydrochloride Oral Solution USP, 6.25 mg/5 mL, is a clear, green oral solution supplied as follows:

NDC 81033-016-05: 5mL unit dose cup
NDC 81033-016-50: Carton containing 50 cups of 5mL each
Keep tightly closed.
This package is not child-resistant. Keep out of reach of children.
Store at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]
Protect from light.

Manufactured by:
Kesin Pharma
Oldsmar, FL 34677
Rev. 01
Revised 11/2024

PROMETHAZINE HYDROCHLORIDE ORAL SOLUTION USP 6.25 mg/5 mL
(Promethazine Hydrochloride Syrup, 6.25 mg per 5 mL)

Rx Only

What Is Promethazine HCl Oral Solution?
Promethazine is an antihistamine which can be taken by mouth as an oral solution or tablet, rectally as a suppository, or by injection.
It can be used for:

• “hay fever,” or, a stuffy runny nose from allergy
• watery, itchy eyes due to inhaled allergies and foods
• mild allergic skin reactions with itching and swelling
• allergic reactions to blood or plasma
• dermographism, a form of hives known as “skin writing”
• serious allergic reactions along with epinephrine and other treatments
• sedation before or after surgery, or during childbirth
• prevention and control of nausea and vomiting after surgery
• along with meperidine (demerol) or other pain medicines
• sedation, relief of anxiety, and production of light sleep from which the patient can be easily aroused
• treatment and prevention of motion sickness

Who Should Not Use Promethazine HCl Oral Solution?
Promethazine should not be given to:

• children under two years of age
• patients who are unconscious
• patients who are allergic to promethazine, any of the ingredients in promethazine, or to other phenothiazines
• patients with lung symptoms including asthma
• children who are vomiting unless the vomiting is prolonged and there is a known cause

What Are The Risks?
The following are the major potential risks and side effects of Promethazine HCl Oral Solution therapy. However, this list is not complete.

• Severe drowsiness and reduced mental alertness. Promethazine HCl Oral Solution may cause drowsiness which may impair your ability to ride a bike, drive a car, or operate machinery. This may be worsened if taken with alcohol or other drugs that also cause central nervous system (CNS) slowing such as sedatives, pain medicines, tranquilizers or certain drugs for depression.
• Serious breathing problems. Promethazine HCl Oral Solution should not be used in patients with poor lung function such as chronic obstructive lung disease or breathing problems while sleeping (sleep apnea.)
• Increased risk of seizures. Promethazine HCl Oral Solution should be used with caution in patients with seizures or who are on other medicines which may also increase the risk of seizures.
• Bone-marrow problems and blood cell production. Promethazine HCl Oral Solution should not be used in patients with bone-marrow problems or used with other drugs that affect the bone marrow’s production of blood cells.
• Neuroleptic malignant syndrome. This potentially deadly syndrome includes symptoms such as fever, muscle rigidity, mental changes, changes in pulse or blood pressure, fast heartbeat, increased sweating or irregular heart rhythm.
• The most common side effects are drowsiness, changes in blood pressure, skin reactions, blood cell changes and breathing problems. Increased excitability or abnormal movements may occur after one dose of promethazine. If they do, consult your doctor about using another medicine.

What Should I Tell My Healthcare Professional?
Before you start taking Promethazine HCl Oral Solution, tell your healthcare professional if you:

• have narrow-angle glaucoma
• have an enlarged prostate
• have a stomach ulcer
• have an intestinal blockage
• have a bladder blockage
• have heart problems
• have liver problems
• have breathing or lung problems
• have sleep apnea (breathing problems when sleeping)
• have seizures
• drink alcohol
• are trying to become pregnant, are already pregnant, or are breast-feeding

Can Other Medicines Or Food Affect Promethazine?
Promethazine HCl Oral Solution and certain other medicines can interact with each other. Tell your healthcare professional about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Some medicines may affect how promethazine works or promethazine may affect how your other medicines work. Know the medicines you take. Keep a list of them with you to show your healthcare professional.
Especially tell your healthcare professional if you take:

• medicines that affect your brain such as anti-anxiety medicine, sleeping pills, pain medicines, sedatives, narcotics, antidepressants or tranquilizers
• epinephrine
• a monoamine oxidase inhibitor (MAOI) which is used to treat depression or other mental disorders
• medicines called anticholinergics

Storage
This package is not child-resistant. Keep out of reach of children.
Store at 20º to 25ºC (68º to 77ºF) [See USP Controlled Room Temperature.]
Protect from light.

Manufactured by
Kesin Pharma
Oldsmar, FL 34677
Rev. 01
Revised 11/2024

Delivers 5mL

NDC 81033-016-05

Promethazine HCl

Oral Solution, USP

6.25mg per 5mL

Contains 7% Alcohol

Store at 68ºF to 77ºF

Protect From Light

For Institutional Use Only

Rx Only

NDC 81033-016-50

Promethazine Oral Solution, USP

Delivers 6.25mg/5mL

RxOnly

FOR INSTITUTIONAL USE ONLY

50 x 6.25mg/5mL Unit Dose Cups

Store at 68ºF to 77ºF (20ºC to 25ºC)