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Phenothiazine-associated apnea in two siblings
1Department of Pharmacy, University of Virginia Health Sciences Center, Charlottesville 22908.
Insights
Promethazine hydrochloride in cough syrup may cause serious breathing problems like apnea and bradycardia in infants. This risk is also suggested in older siblings exposed to phenothiazines, warranting caution.
Area of Science:
- Pediatric Pharmacology
- Clinical Toxicology
- Respiratory Medicine
Background:
- Phenothiazines are a class of drugs with various therapeutic uses, including antihistaminic and antiemetic properties.
- Adverse drug reactions in pediatric populations require careful monitoring and documentation.
- Respiratory depression is a known potential side effect of certain medications in neonates and infants.
Observation:
- A two-month-old infant developed lethargy, apnea, and bradycardia after receiving promethazine hydrochloride cough syrup.
- A temporal correlation was observed between medication administration and the onset of severe respiratory symptoms.
- A sibling's history suggested potential phenothiazine-associated apnea following premedication.
Findings:
- The case highlights a potential link between promethazine hydrochloride and life-threatening respiratory events in infants.
- Phenothiazine-induced respiratory depression may occur in susceptible pediatric patients.
- Review of literature supports the association between phenothiazines and apnea.
Implications:
- Clinicians should exercise caution when prescribing phenothiazines, particularly promethazine hydrochloride, to infants.
- Enhanced vigilance for respiratory side effects is crucial in pediatric patients receiving these medications.
- Further research into the safety profile of phenothiazines in neonates and infants is warranted.
Abstract:
A two-month-old white girl presented to our facility with increasing lethargy and new onset apnea and bradycardia following a week of upper respiratory tract infection symptoms. The patient had been receiving a cough syrup containing promethazine hydrochloride during the previous five days, which was temporally correlated with the onset of lethargy and apneic episodes. Upon further investigation, it was discovered that the patient's older sibling also may have experienced phenothiazine-associated apnea after receiving a combination of meperidine hydrochloride, promethazine hydrochloride, and chlorpromazine as a premedication prior to an endoscopic examination. In addition to the presentation of these cases, the literature pertaining to phenothiazine-associated apnea is reviewed.