Promethazine IV Question

I don't think it is a policy to dilute here..but I always dil in 10 of NS and give over atleast 1 or 2 minutes. I usually put this one on the pump though.
We are doing away w/ phenergan shortly..we had some type of undisclosed "sentinel event" ...thus we are getting rid of this med.
We will resort to zofran or reglan

What if you can't finish the Liter bolus? What if the pt gets fluid overloaded, or the MIV needs to be changed due to their pH or Na levels? Then how would you chart the medication? Because it wasn't given until the whole liter goes in.

I'm not a fan of that method. I can see if the pt is coming into the ER and is fluid deficient due to the vomiting, but most of my pts who are awake and Nauseated can't always tolerate a bolus.

sorry, I'll clarify...

strictly ER/UC pts that are acutely dehydrated...

and pts that are ordered a litre for nvd, won't likely get overloaded...

Docs usually order 1-3 litres...mix phenergan in the first litre...

though never have had the problem (s) you describe...

easy solution...

if pt received 400 CCs of bolus, then 40% of 25 mg infused (10 mg)


either give the rest, or chart what was given

i don't care if this thread is over 5.5 yrs old.
i found a wonderful resource for the op.

Medscape: Free CME, Medical News, Full-text Journal Articles & More
search "promethazine inj" under drug reference.

go to:
detailed monograph,
click on 'cautions'.

there's a huge blurb under "local reactions".

"Severe chemical irritation and damage to tissues (e.g., burning, pain, erythema, swelling, severe spasm of distal vessels, thrombophlebitis, venous thrombosis, phlebitis, abscesses, tissue necrosis, gangrene) may occur with administration of promethazine injection, regardless of the route of administration...."

fyi, incase someone else finds this info useful?

I'm not wild about the idea of adding it to the primary bag and just letting the fluids run open. Way too many variables.

I don't think it will be long before giving Phenergan IV is contraindicated just as Vistaril is. There are better alternatives. One of the anti-emetics (I can't remember at the moment if it's Zofran or Anzimet) is going to be available in generic form very soon. The plan where I work is that when this happens, we will no longer be allowed to accept orders for Phenergan IV, period.

I gave Phenergan for the first time on my last clinical day of the semester a few weeks ago. The pt was an LPN. I diluted it and pushed it over 2 minutes. She said it was the first time she'd had it since her stay that it did not burn (about the 4th dose of it) She noticed I'd diluted and said during the night the nurses didn't dilute it
I diluted it in 5cc NS but next time I'll be even safer and dilute it in 10.

Our hospital just changed its policy on the administration of Phenergan since it is a vesicant. We put it in a 20 ml syringe with 19 cc of it being NS. I place the syringe on the secondary connection and infuse it over 15 minutes. Have not had a complaint since we started doing this. It is a bit more work but sure saves the vein.

our hospital's policy is max dose of phenergan is 12.5.if an md orders 25mg, our pharmacy sends a change of dose to 12.5mg.

yeah, i don't think more is better with phenergan. alot of the time, 12.5 is very effective.

We just got a memo at work; it's Zofran that is going generic as of January.