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Updated: May 29, 2026
05:56
Acupoint Application Combined with Acupressure as an Adjunctive Therapy for Chemotherapy-Induced Nausea and Vomiting
Published on: June 21, 2024
Moving beyond promethazine: Advancing precision in antiemetic therapy
Matthew F Ryan1, Carrie Lagasse2
1Department of Emergency Medicine, University of Florida, Gainesville, FL, USA.
SAGE Open Medicine
|May 28, 2026
Summary
Injectable promethazine for nausea and vomiting is under scrutiny due to safety concerns. Safer alternatives with improved efficacy and targeted approaches are now recommended for antiemetic management.
Area of Science:
- Emergency Medicine
- Pharmacology
- Clinical Practice
Background:
- Promethazine is a traditional antiemetic for nausea and vomiting (N/V).
- Concerns regarding promethazine's safety profile, including tissue injury and respiratory depression, are increasing.
- N/V involves complex central and peripheral pathways with multiple neurotransmitter systems.
Purpose of the Study:
- To review the evolving role of promethazine in clinical practice.
- To evaluate the risks of injectable promethazine and the rationale for alternatives.
- To examine current antiemetic management strategies.
Main Methods:
- Focused narrative review and expert commentary.
- Analysis of regulatory guidance and contemporary literature.
- Evaluation of institutional experience and formulary changes.
Main Results:
- Injectable promethazine carries significant risks, prompting institutional removal from formularies.
- Alternative antiemetics (dopamine and 5-HT3 antagonists) offer comparable or better efficacy with improved safety.
- Multimodal, receptor-targeted approaches enhance symptom control and minimize adverse effects.
Conclusions:
- The routine use of injectable promethazine warrants critical reassessment due to safety data and available alternatives.
- A shift towards precision, safety, and evidence-based practice in antiemetic management is evident.
- Aligning clinical practice with contemporary pharmacologic understanding is crucial for optimal patient care.
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