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ANTIHISTAMINES, PHENOTHIAZINE-DERIVATIVE (Systemic)
Some commonly used brand names are:
In the U.S.—
Another commonly used name for trimeprazine is alimemazine .
Phenothiazine (FEE-noe-THYE-a-zeen)-derivative antihistamines are used to relieve or prevent the symptoms of hay fever and other types of allergy. They work by preventing the effects of a substance called histamine, which is produced by the body. Histamine can cause itching, sneezing, runny nose, and watery eyes. Also, in some persons histamine can close up the bronchial tubes (air passages of the lungs) and make breathing difficult.
Some of these antihistamines are also used to prevent motion sickness, nausea, vomiting, and dizziness. In addition, some of them may be used to help people go to sleep and control their anxiety before or after surgery.
Phenothiazine-derivative antihistamines may also be used for other conditions as determined by your doctor.
In the U.S. these antihistamines are available only with your doctor"s prescription. In Canada some are available without a prescription. However, your doctor may have special instructions on the proper dose of the medicine for your medical condition.
These medicines are available in the following dosage forms:
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For phenothiazine-derivative antihistamines, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to these medicines or to phenothiazines. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy—Methdilazine, promethazine, and trimeprazine have not been studied in pregnant women. In animal studies, promethazine has not been shown to cause birth defects. However, other phenothiazine medicines caused jaundice and muscle tremors in a few newborn babies whose mothers received these medicines during pregnancy. Also, the newborn baby may have blood clotting problems if promethazine is taken by the mother within 2 weeks before delivery. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.
Breast-feeding—Small amounts of antihistamines pass into the breast milk. Use by nursing mothers is not recommended since babies are more sensitive to the side effects of antihistamines, such as unusual excitement or irritability. Also, with the use of phenothiazine-derivative antihistamines there is the chance that the nursing baby may be more at risk of having difficulty in breathing while sleeping or of the sudden infant death syndrome (SIDS). However, more studies are needed to confirm this.
In addition, since these medicines tend to decrease the secretions of the body, it is possible that the flow of breast milk may be reduced in some patients.
Children—Serious side effects, such as convulsions (seizures), are more likely to occur in younger patients and would be of greater risk to infants than to older children or adults. In general, children are more sensitive to the effects of antihistamines. Also, nightmares or unusual excitement, nervousness, restlessness, or irritability may be more likely to occur in children. The use of phenothiazine-derivative antihistamines is not recommended in children who have a history of difficulty in breathing while sleeping, or a family history of sudden infant death syndrome (SIDS) .
Children younger than 2 years of age should not take promethazine because it may cause severe and sometimes fatal breathing and lung problems. Check with your doctor or pharmacist right away if you are unsure about whether or not your child or infant should be taking promethazine.
Children who show signs of Reye"s syndrome should not be given phenothiazine-derivative antihistamines, especially by injection. Uncontrolled movements that may occur with phenothiazine-derivative antihistamines may be mistakenly confused with symptoms of Reye"s syndrome.
Adolescents—Adolescents who show signs of Reye"s syndrome should not be given phenothiazine-derivative antihistamines, especially by injection. Uncontrolled movements that may occur with phenothiazine-derivative antihistamines may be mistakenly confused with symptoms of Reye"s syndrome.
Older adults—Elderly patients are especially sensitive to the effects of antihistamines. Confusion; difficult or painful urination; dizziness; drowsiness; feeling faint; or dryness of the mouth, nose, or throat may be more likely to occur in elderly patients. Also, nightmares or unusual excitement, nervousness, restlessness, or irritability may be more likely to occur in elderly patients. In addition, uncontrolled movements may be more likely to occur in elderly patients taking phenothiazine-derivative antihistamines.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When taking phenothiazine-derivative antihistamines, it is especially important that your health care professional know if you are taking/receiving any of the following:
Other medical problems—The presence of other medical problems may affect the use of antihistamines. Make sure you tell your doctor if you have any other medical problems, especially:
Proper Use of This Medicine
Antihistamines are used to relieve or prevent the symptoms of your medical problem. Take them only as directed . Do not take more of them and do not take them more often than recommended on the label, unless otherwise directed by your doctor. To do so may increase the chance of side effects.
For patients taking this medicine by mouth :
For patients taking promethazine for motion sickness :
For patients using the suppository form of this medicine :
For patients using the injection form of this medicine :
Dosing—The dose of an antihistamine will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of antihistamines. If your dose is different, do not change it unless your doctor tells you to do so.
The number of capsules or tablets or teaspoonfuls of liquid that you take depends on the strength of the medicine. Also, the number of doses you take each day and the time between doses depends on whether you are taking a short-acting or long-acting form of antihistamine .
Missed dose—If you are taking this medicine regularly and you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage—To store this medicine:
Precautions While Using This Medicine
Tell the doctor in charge that you are taking this medicine before you have any skin tests for allergies. The results of the tests may be affected by this medicine.
When taking phenothiazine-derivative antihistamines on a regular basis, make sure your doctor knows if you are taking large amounts of aspirin at the same time (as for arthritis or rheumatism). Effects of too much aspirin, such as ringing in the ears, may be covered up by the antihistamine.
Phenothiazine-derivative antihistamines will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine .
Check with your doctor right away if you have symptoms of pale or blue lips, fingernails, or skin, difficult or troubled breathing, irregular, fast, slow or shallow breathing or shortness of breath. These could be signs of a condition called respiratory depression.
Check with your doctor right away and stop taking your medicine (if directed by your doctor) if you have muscle rigidity, fever, difficult or fast breathing, seizures, fast heartbeat, increased sweating, loss of bladder control, unusually pale skin, or tiredness or weakness. These may be symptoms of a serious condition called neuroleptic malignant syndrome.
This medicine may cause some people to become drowsy or less alert than they are normally. Even if taken at bedtime, it may cause some people to feel drowsy or less alert on arising. Make sure you know how you react to the phenothiazine-derivative antihistamine you are taking before you drive, use machines, or do anything else that could be dangerous if you are not alert .
Phenothiazine-derivative antihistamines may cause dryness of the mouth, nose, and throat. For temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.
This medicine controls nausea and vomiting. For this reason, it may cover up some of the signs of overdose caused by other medicines or the symptoms of appendicitis. This will make it difficult for your doctor to diagnose these conditions. Make sure your doctor knows that you are taking this medicine if you have other symptoms of appendicitis such as stomach or lower abdominal pain, cramping, or soreness. Also, if you think you may have taken an overdose of any medicine, tell your doctor that you are taking this medicine.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Less common or rare
Sore throat and fever; unusual bleeding or bruising; unusual tiredness or weakness
Incidence not known
Abdominal or stomach pain; area rash; black, tarry stools; bleeding gums; blood in urine or stools; bloody nose; bluish skin or lips; chest pain or discomfort; chills; clay-colored stools; confusion about identity, place, and time; continuing ringing or buzzing or other unexplained noise in ears; convulsions; cough or hoarseness; dark urine; decreased awareness or responsiveness; difficult or troubled breathing; difficulty in speaking; drooling; fainting; fever with or without chills; fixed position of eye; general feeling of tiredness or weakness; headache; hearing loss; heavier menstrual periods; high fever; high or low blood pressure; hives or welts; hysteria; irregular, fast, slow, or shallow breathing; itching; large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, sex organs; lightheadedness; loss of balance control; loss of bladder control; loss of strength or energy; lower back or side pain; menstrual periods; mimicry of speech or movements; muscle pain or weakness; muscle spasm or jerking of all extremities; muscle trembling, jerking or stiffness; mutism; nausea; negativism; not breathing; painful or difficult urination; pale or blue lips, fingernails, or skin; peculiar postures or movements, mannerisms, or grimacing; pinpoint red spots on skin; redness of skin; restlessness; seeing, hearing, or feeling things that are not there; severe muscle stiffness; severe muscle stiffness; severe sleepiness; shortness of breath; shuffling walk; slow or irregular heartbeat; sore throat; sores, ulcers, or white spots on lips or in mouth; sticking out of tongue; stiffness of limbs; sudden loss of consciousness; swollen glands; tiredness; trouble thinking, speaking, or walking; twisting movements of body; uncontrolled movements, especially of face, neck, and back; uncontrolled twisting movements of neck; unpleasant breath odor; unusual bleeding or bruising; unusual tiredness or weakness; unusual weak feeling; unusually pale skin; vomiting of blood; weakness, numbness or tingling in arms or legs; yellow eyes or skin
Symptoms of overdose
Clumsiness or unsteadiness; convulsions (seizures); drowsiness (severe); dryness of mouth, nose, or throat (severe); feeling faint; flushing or redness of face; hallucinations (seeing, hearing, or feeling things that are not there); muscle spasms (especially of neck and back); restlessness; shortness of breath or troubled breathing; shuffling walk; tic-like (jerky) movements of head and face; trembling and shaking of hands; trouble in sleeping
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your health care professional if any of the following side effects continue or are bothersome:
Drowsiness (less common with methdilazine); thickening of mucus
Less common or rare
Blurred vision or any change in vision; burning or stinging of rectum (with rectal suppository); confusion; difficult or painful urination; dizziness; dryness of mouth, nose, or throat; fast heartbeat; feeling faint; increased sensitivity of skin to sun; increased sweating; loss of appetite; nightmares; ringing or buzzing in ears; skin rash; unusual excitement, nervousness, restlessness, or irritability
Incidence not known
blistering, crusting, irritation, itching, or reddening of skin; cracked, dry, scaly skin; double vision; false or unusual sense of well being; lack of coordination; nasal stuffiness; nervousness; noisy breathing; relaxed and calm; seeing double; sleepiness or unusual drowsiness; sleeplessness; swelling; tightness in chest; trouble sleeping; unable to sleep; vomiting; wheezing
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your health care professional.
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