Injectable promethazine in clinics and hospitals: What's the alternative?

Area of Science:

• Pharmacology
• Patient Safety
• Clinical Practice

Background:

• Injectable promethazine use persists despite recommendations for removal by major health organizations.
• Significant risks associated with inadvertent subcutaneous or intra-arterial administration include tissue necrosis, gangrene, and potential amputation.

Purpose of the Study:

• To highlight the risks of injectable promethazine.
• To present alternative injectable medications for clinical use.
• To guide medication selection based on patient-specific factors.

Main Methods:

• Review of safety recommendations from the Institute for Safe Medication Practices and the American Society of Health-System Pharmacists.
• Identification and description of alternative injectable medications.
• Analysis of factors for selecting alternative medications, including patient comorbidities, indications, and clinician experience.

Main Results:

• Injectable promethazine carries severe risks when administered incorrectly.
• Viable alternative injectable medications exist for various clinical scenarios.
• Selection criteria for alternatives focus on optimizing patient outcomes and minimizing harm.

Conclusions:

• Clinicians should be aware of the severe risks associated with injectable promethazine.
• Alternative injectable medications offer safer options for patient care.
• Informed medication selection based on individual patient needs is crucial for enhancing safety and efficacy.