Many injectable drugs cannot be mixed together in syringes or infusions. Incompatibility can involve precipitation, ionic reactions, evolution of gas and denaturation of biological molecules. The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. Detroit VAMC Dilution: [0 - 25 mg] [ 50 -100 ml] [ 15 - 30 min] Concentration studied in Trissel: (0.1 mg/ml) [12.5 mg] [ 125 ml] [ 15 to 30 min] [25 mg] [ 250 ml] [ 15 to 30 min] If a patient complains of pain during intended intravenous injection, stop the injection immediately. Irritation and damage can result from perivascular extravasation, unintentional intra-arterial injection, and intraneuronal or perineuronal infiltration (see WARNINGS - Severe Tissue Injury, Including Gangrene).
DO NOT GIVE IV PUSH - MUST DILUTE FIRST AND ADMINISTER BY SLOW IV INFUSION- SEE BELOW. Subcutaneous or intra-arterial injection is contraindicated as these routes of administration may cause tissue necrosis and gangrene of the affected extremity, respectively (Prod Info Phenergan(R),). Mc Auley): A 10-fold dilution will result in a neglible change in the p H ( ~ 0.3). -------------------------------------------------------------------------------- Background information: Source: Action needed to prevent serious tissue injury with IV promethazine. ) Y-site (partial list): Ciprofloxacin, cisplatin, cladribine, cyclophosphamide, cytarabine, fluconazole, gemcitabine, linezolid, teniposide Additive: Aminophylline, coramphenicol, corothiazide, floxacillin, furosemide, heparin, hydrocortisone sodium succinate, methohexital, penicillin G potassium (incompatible at promethazine 250 mg/L and penicillin 20 million units/L; may be compatible at lower concentrations), penicillin G sodium, pentobarbital, phenobarbital, thiopental Syringe: Cefotetan, coroquine, diatrizoate sodium 75%, diatrizoate meglumine/diatrizoate sodium, dimenhydrinate, heparin, iodipamide, iothalamate, ketorolac tromethamine, nalbuphine(? ), methotrexate, piperacillin/tazobactam, potassium coride(? Individual plans may vary and formulary information changes.
Problem: Promethazine (PHENERGAN) injection is a commonly used product that possesses antihistamine, sedative, anti-motion sickness, and antiemetic effects.
However, FDA states that deep IM injection is the preferred method for administration of promethazine hydrocoride injection because of risks associated with IV administration (see Warnings Regarding Parenteral Administration under Boxed Warning). Promethazine hydrocoride: use in patients with Rh isoimmunization. The drug is also a known vesicant which is hy caustic to the intima of blood vessels and surrounding tissue.
Sedation Confusion Disorientation Blurred vision Hallucinations Dystonias Catatonic states Euphoria Excitation Extrapyramidal symptoms Tachycardia Bradycardia Leukopenia (rare) Agranulocytosis (rare) Obstructive jaundice Photosensitivity Dry mouth Angioneurotic edema Tardive dyskinesia Urticaria Xerostomia Impotence Urinary retention IV administration can cause severe tissue injury, including burning, gangrene, or thrombopebitis, necessitating fasciotomy, skin graft, or amputation Severe tissue injury can occur from perivascular extravasation, unintentional intra-arterial injection, and intraneuronal or perineuronal infiltration Deep IM injection is preferred method of administration Intra-arterial and SC administration are contraindicated 25 mg/m L product may be administered by deep IM injection or IV infusion (at rate not to exceed 25 mg/min through flowing IV tubing) Monitor for sns and symptoms of potential tissue injury including burning or pain at site of injection, pebitis, swelling, and blistering Discontinue IV infusion immediately if patient complains of pain during injection Respiratory fatalities reported with use in children Use caution in asthma, hepatic impairment, peptic ulcer disease, respiratory impairment, bone marrow suppression, anaphylaxis in susceptible individuals May impair ability to drive or perform hazardous tasks May impair core body temperature regulation; caution when taking medications with anticholinergic effects, heat exposure, or strenuous exercise Depresses hypothalamic thermoregulatory mechanism; exposure to extreme temperatures may cause hypo- or hyperthermia May alter cardiac conduction (life-threatening arrhythmias reported) Antiemetic effect may obscure toxicity of chemotherapeutic drugs Monitor closely in patients with cardiovascular disease, hepatic impairment, Reye syndrome, or history of sleep apnea Has anticholinergic effects; use with caution in patients with decreased gastrointestinal motility or obstructions (partial or comlete), urinary retention, urinary obstructions, xerostomia, BPH, or visual problems May cause extrapyramidal symptoms including pseudoparkinsonism, acute dystonic reactions, tardive dyskinesia, and akathisia Neuroleptic malnant syndrome reported with use; monitor for fever, muscle ridity and/or autonomic instability, or mental status changes May cause orthostatic hypotension; use caution in patients at risk of experiencing hypotensive episodes (cardiovascular disease, cerebrovascular disease, hypovolemia or taking medications that may predispose to bradycardia or hypotension) May cause photosensitivity Pyloroduodenal obstruction, stenosing peptic ulcer disease, bladder neck obstruction Anticholinergic effects of promethazine may exacerbate condition in patients with narrow-angle glaucoma or myasthenia gravis Bioavailability: 25% (PO/PR) Onset (antihistaminic effect): 3-5 min (IV); 20 min (IM/PO/PR) Peak serum time: 6.7-8.6 hr (suppositories); 4.4 hr (syrup) Duration: PO (motion sickness), 4-6 hr; IV (nausea and vomiting), 4-6 hr; up to 12 hr Solution: Compatible with most common solvents Additive: Amikacin, ascorbic acid injection, coroquine, hydromorphone, netilmicin, vitamins B and C Syringe (partial list): Atropine, diphenhydramine, fentanyl, meperidine, morphine sulfate(? ) The above information is provided for general informational and educational purposes only. PURCHASE XENICAL ONLINE
Rating: 99 / 100
Overall: 92 Rates