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What should I discuss with my health care provider before using rectal promethazine (Phenadoz, Promethegan)?

Promethazine should not be used in a child younger than 2 years old. Promethazine can cause severe breathing problems or death in a child younger than 2. Carefully follow your doctor's instructions when giving this medicine to a child of any age.

Do not use this medication if you have severe asthma, emphysema, or other breathing problem, or if you are allergic to promethazine or other phenothiazines such as chlorpromazine (Thorazine), fluphenazine (Permitil), perphenazine (Trilafon), prochlorperazine (Compazine, Compro), thioridazine (Mellaril), or trifluoperazine (Stelazine).

If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before using promethazine, tell your doctor if you have:

• a history of seizures;
• heart disease or high blood pressure;
• liver or kidney disease;
• severe asthma, emphysema, chronic obstructive pulmonary disease (COPD) or other breathing problem;
• sleep apnea (breathing stops during sleep);
• glaucoma;
• a stomach ulcer or digestive obstruction;
• bone marrow depression;
• adrenal gland tumor (pheochromocytoma);
• enlarged prostate or problems with urination;
• low levels of calcium in your blood (hypocalcemia); or
• if you have ever had a serious side effect while using promethazine or any other phenothiazine.

FDA pregnancy category C. It is not known whether promethazine is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether promethazine passes into breast milk or if it could harm a nursing baby. Do not use promethazine without telling your doctor if you are breast-feeding a baby.

Older adults may be more likely to have side effects from this medication.

How should I use rectal promethazine (Phenadoz, Promethegan)?

Use this medication exactly as it was prescribed for you. Do not use the medication in larger or smaller amounts, or use it for longer than recommended by your doctor.

This medication comes with patient instructions for using the rectal suppository. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Do not take promethazine by mouth. It is for use only in your rectum.

Try to empty your bowel and bladder just before using the promethazine suppository.

Remove the outer wrapper from the suppository before inserting it. Avoid handling the suppository too long or it will melt in your hands.

For best results from the suppository, lie down after inserting it and hold in the suppository for a few minutes. The suppository will melt quickly once inserted and you should feel little or no discomfort while holding it in. Avoid using the bathroom just after you have inserted the suppository.

Call your doctor if your symptoms do not improve, or if they get worse while using promethazine.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using promethazine.

Store the rectal suppositories in the refrigerator but do not allow them to freeze.

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