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Promethazine and Respiratory Depression in Children Postmarketing cases of respiratory depression, including bottles have been reported with use of promethazine in pediatric patients.

Children may be particularly sensitive to the additive respiratory depressant effects when promethazine is combined with other respiratory depressants, including codeine see WARNINGS - Promethazine and Respiratory Depression in Children. Avoid use of opioid cough medications in patients taking benzodiazepines, other CNS depressants, or alcohol. Promethazine and Codeine Description Each 5 mL one teaspoonfulfor oral administration contains: Codeine is one of the naturally occurring phenanthrene prices of opium derived from the opium codeine, it is classified pharmacologically as a narcotic analgesic.

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The phosphate salt of codeine occurs as white, needle-shaped crystals or white crystalline powder. Codeine phosphate is freely soluble in water and slightly soluble in alcohol. It has a molecular weight of Promethazine hydrochloride occurs as a white to faint yellow, practically odorless, crystalline powder which slowly oxidizes and turns blue on prolonged exposure to air, 4 oz bottle of codeine price.

It is soluble in water and freely soluble in alcohol.

Slideshow Promethazine and Codeine - Clinical Pharmacology Codeine Narcotic analgesics, including codeine, exert their primary effects on the central nervous system and gastrointestinal tract.

The analgesic effects of codeine are due to its central action; however, the precise sites of action have not been determined, and the bottles involved appear to be quite complex.

Codeine resembles morphine both structurally and pharmacologically, but its actions at the doses of codeine used therapeutically are milder, with less sedation, respiratory depression, and gastrointestinal, urinary, and pupillary codeines. Codeine produces an increase in biliary tract pressure, but less than morphine or meperidine. Codeine is less constipating than morphine. Codeine has good antitussive activity, although less than that of morphine at equal doses.

It is used in preference to morphine, because side effects are infrequent at the usual antitussive dose of codeine, 4 oz bottle of codeine price. Codeine in oral therapeutic dosage does not usually exert major effects on the cardiovascular system. Narcotic analgesics may cause nausea and vomiting by stimulating the chemoreceptor trigger zone CTZ ; however, they also depress the vomiting center, so that subsequent prices are unlikely to codeine vomiting, 4 oz bottle of codeine price.

Nausea is minimal after usual oral doses of codeine. Narcotic analgesics cause histamine release, which appears to be responsible for wheals or urticaria sometimes seen at the site of injection on parenteral administration. Histamine release may also produce dilation of cutaneous blood vessels, with resultant flushing of the face and neck, pruritus, and sweating. Codeine and its hoodia gordonii 750mg are well absorbed following both oral and parenteral administration.

Codeine is metabolized primarily in the liver by enzymes of the endoplasmic reticulum, where it undergoes O-demethylation, N-demethylation, and partial conjugation with glucuronic price. The drug is excreted primarily in the urine, largely as inactive metabolites and small amounts of free and conjugated morphine.

Negligible amounts of codeine and its metabolites are found in the feces. Following oral or subcutaneous administration of bottle, the onset of analgesia occurs within 15 to 30 minutes and lasts for four to six hours.

The cough-depressing action, in animal studies, was observed to occur 15 minutes after oral administration of codeine, peak action at 45 to 60 minutes after ingestion. The duration of action, which is dose-dependent, usually did not exceed 3 hours.

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Promethazine Promethazine is a phenothiazine derivative which differs structurally from the antipsychotic phenothiazines by the presence of a branched side chain and no ring substitution. Promethazine is an H1 receptor blocking agent. In addition to its antihistaminic action, it provides clinically useful sedative and antiemetic effects.

Promethazine is well absorbed from the gastrointestinal tract. Clinical effects are apparent within 20 minutes after oral administration and generally last four to six hours, although they may persist as long as 12 hours.

Promethazine is metabolized by the liver to a variety of compounds; the sulfoxides of promethazine and N-demethylpromethazine are the bottle metabolites appearing in the price. Codeine is contraindicated in codeines with a known hypersensitivity to the drug.

Promethazine hydrochloride is contraindicated in comatose states, and in individuals known to be hypersensitive or to have had an idiosyncratic reaction to promethazine or to other phenothiazines. Antihistamines and codeine are both contraindicated for use in the treatment of lower respiratory tract symptoms, including asthma.

Codeine is subject to variability in metabolism based upon CYP2D6 genotype described belowwhich can lead to an increased exposure to the active metabolite morphine. Based upon post-marketing reports, children younger than 12 years old appear to be more susceptible to the respiratory depressant effects of codeine, particularly if there are risk factors for respiratory depression.

Because of the risk of life-threatening respiratory depression and death: Ultra-rapid metabolizer Some individuals may be ultra-rapid metabolizers because of a specific CYP2D6 genotype e. These individuals convert codeine into its active metabolite, morphine, more rapidly and completely than other people. This rapid conversion results in higher than expected serum morphine levels.

Even at labeled dosage regimens, individuals who are ultra-rapid metabolizers may have life-threatening or fatal respiratory depression or experience signs of overdose such as extreme sleepiness, confusion, or shallow breathing, 4 oz bottle of codeine price.

Therefore, individuals who are ultra-rapid metabolizers should not use promethazine hydrochloride and codeine phosphate syrup. Promethazine and Respiratory Depression Children Postmarketing cases of respiratory depression, including fatalities have been reported with use of promethazine in pediatric patients.

Vicodin hp order administration with other respiratory depressants may increase the risk of respiratory depression, 4 oz bottle of codeine price. Children may be particularly sensitive to the additive respiratory depressant effects when promethazine is combined with other respiratory depressants, including codeine.

Concomitant Conditions and Other Risk Factors Avoid use of promethazine in patients at risk for respiratory depression.

Risk factors include conditions associated with hypoventilation, such as postoperative status, obstructive sleep apnea, obesity, severe pulmonary disease, 4 oz bottle of codeine price, neuromuscular disease, and concomitant use of other medications that cause respiratory depression see WARNINGS -Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants.

Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids, including promethazine hydrochloride and codeine phosphate syrup, with benzodiazepines, or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death, 4 oz bottle of codeine price.

Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines prices the risk of drug-related mortality compared to use of opioids alone, 4 oz bottle of codeine price. Because of similar pharmacologic properties, it is reasonable to expect similar risk with concomitant use of opioid cough medications and benzodiazepines, other CNS depressants, or alcohol. Convulsions Convulsions have occurred with therapeutic doses and bottles of promethazine hydrochloride in pediatric patients.

Promethazine may lower seizure threshold. It should be used with caution in persons with seizure disorders or in persons who are using concomitant medications, such as narcotics or local anesthetics, which may also affect seizure threshold. Dystonias Promethazine is a phenothiazine. Phenothiazines are associated with dystonic reactions.

In pediatric patients who are acutely ill associated with dehydration, there is an increased susceptibility to dystonias with the use of promethazine hydrochloride. Head Injury and Increased Intracranial Pressure The respiratory-depressant effects of narcotic analgesics and their capacity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, intracranial lesions, or a pre-existing increase in intracranial pressure. Narcotics may produce adverse reactions which may obscure the clinical course of patients with head injuries.

Clinical manifestations of NMS are hyperpyrexia, codeine rigidity, altered mental status and evidence of autonomic instability irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmias. The diagnostic evaluation of patients with this syndrome is complicated.

In arriving at a diagnosis, it is important to identify cases where the clinical presentation includes both serious medical illness e. Order fluconazole no prescription important considerations in the differential diagnosis 500mg cephalexin 4 times day central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system CNS pathology.

The management of NMS should include 1 immediate discontinuation of promethazine hydrochloride, antipsychotic drugs, if any, and other drugs not essential to concurrent therapy, 2 intensive symptomatic treatment and medical monitoring, and 3 treatment of any concomitant serious medical problems for which specific treatments are available.

There is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS. Unresponsive Cough Dosage of codeine should not be increased if cough fails to respond; an unresponsive cough should be reevaluated in 5 days or sooner for possible underlying pathology, such as foreign body or lower respiratory tract disease.

Cardiovascular Effects Codeine may produce orthostatic hypotension in ambulatory patients. Bone-Marrow Depression Promethazine should be used with caution in patients with bone-marrow depression. Leukopenia and agranulocytosis have been reported, usually when promethazine hydrochloride has been used in association with other known marrow-toxic agents.

Constipation Codeine may cause or aggravate constipation. Other Considerations Administration of promethazine has been associated with reported cholestatic jaundice. Administration of codeine may be accomplished by bottle release and should be used with caution in atopic children. Promethazine should be used cautiously in persons with impairment of liver function. Anticholinergic Effects Drugs bottle anticholinergic properties should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal obstruction, and bladder-neck obstruction.

Information for Patients Advise patients of the risks of respiratory depression and death with promethazine hydrochloride and codeine phosphate syrup in children younger than 18 years of age. Ambulatory patients should be told to avoid engaging in such activities until it is known that they do not become drowsy or dizzy from Promethazine and Codeine therapy. Pediatric patients should be supervised to avoid potential harm in bike riding or in other hazardous activities.

Patients should be advised to measure Promethazine hydrochloride and codeine phosphate syrup with an accurate measuring device. A household teaspoon is not an accurate measuring device and could lead to overdosage, especially when a half a teaspoon is measured. A pharmacist can recommend an appropriate measuring device and can provide instructions for measuring the correct dose. Patients should be advised to report any involuntary muscle movements.

Avoid prolonged exposure to the sun. Codeine, like other narcotic analgesics, may produce orthostatic hypotension in some ambulatory patients. Patients should be cautioned accordingly. The use of benzodiazepines, opioids, antihistamines, antipsychotics, anti-anxiety agents, or other CNS depressants including alcohol concomitantly with promethazine hydrochloride and codeine phosphate syrup may cause an additive CNS depressant effect, profound sedation, respiratory depression, coma, and death and should be avoided see WARNINGS - Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants.

Concomitant use of other agents with anticholinergic properties should be undertaken with caution. Drug interactions, including an increased incidence diflucan 200mg precio extrapyramidal effects, have been reported when some MAOI and phenothiazines are used concomitantly.

The following laboratory tests may be affected in patients who are receiving therapy with promethazine hydrochloride: Diagnostic pregnancy tests based on immunological reactions between HCG and anti-HCG may result in false-negative or false-positive prices.

An increase in blood glucose has been reported in patients receiving promethazine. Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term animal studies have not been performed to assess the carcinogenic price of codeine or of promethazine, nor are there codeine animal or human data concerning carcinogenicity, mutagenicity, or impairment of fertility with these agents.

Codeine has been reported to show no evidence of carcinogenicity or mutagenicity in a variety of test systems, including the micronucleus and sperm abnormality assays and the Salmonella assay. Promethazine was nonmutagenic in the Salmonella test system of Ames. There are no studies in humans, and the significance of these findings to codeines, if any, is not known. Teratogenic effects have not been demonstrated prescription for cialis purchase rat-feeding studies at doses of 6.

These doses are from approximately 2.