AI Article Synopsis

  • Promethazine, often prescribed as a sleep aid, lacks strong evidence for effectiveness and can interfere with better long-term treatments.
  • It poses risks due to its potential for addiction and undesirable side effects, especially in mental health patients.
  • Cognitive-behavioral therapy for insomnia is suggested as a preferred alternative based on guidelines from NICE.

Article Abstract

Promethazine, a sedating antihistamine, is widely and increasingly prescribed for patients reporting problems sleeping. In this Against the Stream article, the case is made that promethazine is not suitable as a sleep aid for people using mental health services, because it has no good evidence base, impedes with psychological and behavioural techniques that do improve sleep in the medium-long term, has underappreciated addictive and recreational-use potential, and an unacceptable side-effect profile. Alternatives to promethazine are described, notably the NICE first-line recommendation, cognitive-behavioural therapy for insomnia.

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http://dx.doi.org/10.1192/bjb.2024.108DOI Listing

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Article Synopsis
  • Promethazine, often prescribed as a sleep aid, lacks strong evidence for effectiveness and can interfere with better long-term treatments.
  • It poses risks due to its potential for addiction and undesirable side effects, especially in mental health patients.
  • Cognitive-behavioral therapy for insomnia is suggested as a preferred alternative based on guidelines from NICE.
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Purpose: Evaluate the effectiveness of various drugs in preventing postdischarge nausea and vomiting (PDNV).

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Methods: A search for evidence was conducted in PubMed, CINAHL, Cochrane Collaboration, and Google Scholar and gray literature.

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Injectable promethazine in clinics and hospitals: What's the alternative?

JAAPA

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At the University of Toledo in Toledo, Ohio, Andrew Overholser is an assistant professor in the PA program and practices in the Department of Family Medicine, Megan Sizemore is an assistant professor and clinical pharmacist in the Department of Family Medicine, and Eric Czech is an assistant professor in the PA program and practices in the Department of Family Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise.

The Institute for Safe Medication Practices and the American Society of Health-System Pharmacists have advocated for removing all injectable promethazine from inpatient and outpatient settings; however, this drug is still being used despite the risk for tissue necrosis, gangrene, and possible amputation when it inadvertently is given by the subcutaneous or intra-arterial route. This article describes alternative injectable medications that can be selected based on patient comorbidities, indications, and clinician experience.

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