Phenergan Drug Warning

Phenergan (Promethazine) Side Effects and Alternatives for Vomiting

mother trying to give son medication
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When your child is sick and vomiting, parents and pediatricians both want to reach for a medication that can help them keep down food and, especially, fluids. Dehydration is a serious risk of vomiting.

The drug Phenergan (promethazine) stops vomiting and has been around for a long time, but it could be dangerous for your children, especially if they're under age 2. In fact, it even carries a black-box warning, the most serious type of warning put out by the U.S. Food and Drug Administration (FDA).

Phenergan (Promethazine) for Vomiting

Phenergan (promethazine) is an antiemetic drug used for vomiting as well as an antihistamine (allergy pill) and a sedative (sleeping pill). It's available as tablets, suppositories, injectables, or syrups.

While it comes in preparations that can be used by young children, it should never be used in children less than 2 years of age. You and your pediatrician should consider alternatives in children over age 2, as well, due to the risk of dangerous side effects.

Phenergan Side Effects and Warnings

Two major warnings are associated with the use of Phenergan.

One warning is about the risk of respiratory depression—which can be fatal—in children.

The FDA in 2005 added a boxed warning to Phenergan stating that the drug is contraindicated (should absolutely not be used) in children under the age of 2 and should be used cautiously in children over the age of 2.

The warning came out after several children stopped breathing or went into cardiac arrest after taking the drug.

Other side effects experienced by children on Phenergan include:

  • Agitation
  • Hallucinations
  • Seizures
  • Dystonic reactions in children (muscle spasms or contractions causing involuntary movements)

These side effects occurred at a wide variety of doses.

Even if your child does not have serious respiratory depression, drowsiness related to the medication can go against your goal with vomiting. If your child is sleeping, he isn't drinking fluids and can become even more dehydrated.

In 2009, another warning was given for the use of Phenergan. In this one, injections of the drug were associated with severe tissue injury, sometimes giving rise to gangrene or necrosis (tissue death), requiring amputation.

Alternatives To Phenergan

Fortunately, when it comes to a vomiting child, you have a lot of alternatives that appear to be much safer. These include both things you can do yourself at home and different medications.

Home Remedies for Vomiting in Children

Home measures can be very helpful and are recommended by the World Health Organization.

With mild dehydration, your child may act thirsty and have a dry mouth. The first thing to try is oral rehydration solutions that restore fluids and replace lost electrolytes. You can buy products such as Enfalyte, Pedialyte, or Gatorade, or you can make your own rehydration solution from ingredients in your kitchen.

Not only are homemade solutions just as effective as store-bought options, but they're much cheaper and allow you to avoid the food dyes present in many from the store.

One of the biggest mistakes in encouraging your child to drink fluids is to give them too much too fast. It's hard not to give them all they want, especially if they're complaining about thirst, but going slow will help the fluids "stay down."

Moderate or Severe Dehydration

With moderate or severe dehydration, you may notice fewer wet diapers, sunken eyes, a lack of tears when she cries, and listlessness. These are serious signs and you should get medical attention right away.

For vomiting, it's recommended that you begin by providing 1 teaspoon up to 1 tablespoon (3 teaspoons) of an oral electrolyte solution every five to 10 minutes.

The total amount of fluid your child will need depends on her degree of dehydration and can be estimated with a simple formula.

As your child's nausea improves, and especially if she has diarrhea, you may wish to slowly introduce foods back into her diet. You can give foods like bread, potatoes, or rice along with lean meat, yogurt, fruits, and vegetables. Avoid foods high in fat as they are harder to digest.

If your child also has diarrhea, the BRAT diet (bananas, rice, applesauce, toast) may help firm the stool, but it doesn't have enough nutrients to be used for any length of time. (The American Academy of Pediatrics no longer recommends this diet and favors oral hydration.)

Alternative Medications for Vomiting in Children

If an antiemetic medication is necessary, there are now many alternatives.

One of the most commonly used alternative medications for children is Zofran (ondansetron). Zofran is approved for the treatment of chemotherapy-induced nausea and vomiting but is often used "off-label" for treating the "stomach flu," medically known as acute gastroenteritis in children. When used for children with the stomach flu, Zofran has been found to reduce the chance that a child will need intravenous fluids (hospitalization). Zofran can be used even in younger children for whom Phenergan is not recommended.

Zofran comes with a warning as well: the injectable form can change the electrical activity of the heart, which can increase the risk of a potentially fatal heart rhythm. However, that only happens with the much higher doses required for chemotherapy, not the doses used for stomach flu.

This medication can also be quite expensive, as well.

When Should You Call Your Doctor?

It's important to call your doctor if you are concerned about your child's vomiting, no matter how mild or severe it appears to be. Trust your gut as a parent. If your child is vomiting and goes without drinking any fluid for more than a few hours, call your doctor.

Other reasons to call the doctor right away, if they occur along with vomiting, include:

  • Green-tinged or blood-tinged vomit
  • Blood in the vomit or stool
  • Abdominal pain that starts near the navel and spreads to the lower right abdomen

These could be signs of appendicitis, which is a medical emergency.

A Word From Verywell

Learning about the warnings for the use of Phenergan in children is frightening as a parent, but there are plenty of alternatives that do not carry the same risks. The benefit of any medication needs to be weighed against potential risks. If your child is able to tolerate oral rehydration solution and is only mildly dehydrated, these home remedies can be very effective at preventing dehydration until the virus passes.

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Article Sources

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  2. U.S. National Library of Medicine, DailyMed. Label: Phenergan-promethazine hydrochloride injection. Updated December 11, 2018.

  3. U.S. National Library of Medicine, StatPearls. Pediatric Dehydration. Updated February 3, 2019.

  4. Churgay CA, Aftab Z. Gastroenteritis in children: Part II. Prevention and management. Am Fam Physician. 2012;85(11):1066–1070. 

  5. Fedorowicz Z, Jagannath VA, Carter B. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database of Systematic Reviews. July 2011. doi:10.1002/14651858.cd005506.pub5

  6. U.S. Food and Drug Administration. FDA Drug Safety Communication: New Information Regarding QT Prolongation with Ondansetron (Zofran). Published June 29, 2012.

  7. Standford Children's Health, Lucile Packard Children's Hospital. Could That Stomachache in Your Child Be Appendicitis?

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