Daily Bolus of LR: Black Box Warning on Promethazine

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August 25, 2011 by dailybolusoflr

Promethazine (Phenergan)


·         In 2009, a black box warning was issued by the FDA due to serious tissue injury that was caused by the drug when given in its injectable form

·         Issues arose from high concentration, fast administration (these increase risk of extravasation) and use in peripheral lines that were mistakenly arterial or non-functioning and led to extravasation

·         Patients experienced tissue damage, including gangrene and need for amputation

·         The recommended route of administration for promethazine is deep tissue IM injection

·         It is contraindictated to be given as a subcutaneous or known intra-arterial injection

·         If a patient complains of pain or burning while this medication is being given, the infusion should be immediately stopped and the vein should be checked for integrity

·         The drug comes in two concentrations: 25mg/mL and 50mg/mL

·         The 50mg/mL concentration is NOT for peripheral vein use

·         The maximum rate of infusion is 25mg/minute









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