Promethazine Group Research Articles

The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: A randomized, double-blind, controlled study

Objective: The study compared the efficacy of methylprednisolone with that of promethazine for the treatment of hyperemesis gravidarum. Study Design: Patients with a normal-appearing intrauterine pregnancy of ≤16 weeks’ gestation with hyperemesis gravidarum (persistent vomiting and large ketonuria despite outpatient therapy) were admitted to the hospital for continuous intravenous hydration and offered participation in the study. Patients meeting study criteria were randomly assigned to receive (from identical-appearing dispensers packaged in advance with a 2-week supply) oral methylprednisolone, 16 mg 3 times daily, or oral promethazine, 25 mg 3 times daily. After 3 days the methylprednisolone was tapered completely during the course of 2 weeks whereas the promethazine was continued without change for 2 weeks. For patients who continued to vomit after 2 days the study medication was discontinued. Patients receiving study medication at discharge continued to take the remainder of the assigned medication from the packaged pill dispensers. Patients were followed up weekly. The study outcomes, as established in advance, were (1) improvement of symptoms within 2 days of starting therapy and (2) readmission for hyperemesis within 2 weeks of starting the study. Results: Forty patients were enrolled in the course of 11 months (20 per group). There were no significant differences between the groups with respect to maternal age, gravidity, parity, gestational age at entry, number of previous admissions, or >5% body weight loss. Three patients in the methylprednisolone group and 2 in the promethazine group failed to stop vomiting within 2 days. One patient from the promethazine group was unavailable for follow-up. No patient from the methylprednisolone group but 5 of the 17 patients receiving promethazine were readmitted for hyperemesis within 2 weeks of discharge (P = .0001). There were no adverse effects noted for either drug. Conclusion: A short course of methylprednisolone is more effective than promethazine for the treatment of hyperemesis. (Am J Obstet Gynecol 1998;179:921-4.)

IMMEDIATE AND DELAYED POST-OPERATIVE VOMITING IN PEDIATRIC STRABISMUS SURGERY. EFFECTS OF ANTIEMETIC THERAPY

S394 INTRODUCTION: Postoperative vomiting (POV) in children undergoing eye muscle surgery continues to cause patient discomfort and unanticipated hospitalization. [1] Despite many strabismus/POV studies, there are few prospective studies incorporating controls dealing with this issue. We sought to document the incidence of immediate and delayed POV in this population, both in the absence of antiemetic pretreatment and following pretreatment, with either droperidol, promethazine, or ondansetron. METHODS: Following institutional approval and parental informed consent, 104 healthy children for strabismus surgery, ages 3-12 years, were enrolled in the study. Randomization and drug preparation was done by a pharmacist and administered by anesthesiologists blinded to drug group. The anesthetic inductions were either by mask or IV means and the patients were intubated following muscle relaxants or deep inhalation anesthesia. Maintenance was with inhaled agents. Propofol was not used. During anesthesia, patients received intravenously either droperidol 75 mcg/kg (Group 1), promethazine 0.5 mg/kg (Group 2), ondansetron 100 mcg/kg (Group 3), or saline controls (Group 4). Acetaminophen and/or opioids were used perioperatively as needed. Initial POV was assessed by the PACU nursing staff and subsequently by clinic staff on POD #1. Data were analyzed using ANOVA, CHI Square, and unpaired t tests. RESULTS: 102 completed the protocol (Table 1). The four groups were comparable with respect to age, sex, and opioid usage. The incidence of immediate POV in the control group was 36%. In the droperidol and ondansetron group, the incidence was 11% and 12% respectively. No patients vomited in the immediate post-op period in the promethazine group. The difference among the 3 drugs and control was significant (p=.0031). There was no significant difference among any of the 3 drugs. Delayed vomiting after discharge occurred in 33% of the saline group, 44% of the ondansetron group, 15% of the droperidol group, and 8% of the promethazine group. These differences were not significant (p=.46). There were no significant differences in discharge time from the PACU.Table 1CONCLUSIONS: These results support the work of Blanc, et al [2] which showed promethazine to be an effective antiemetic in this type of surgery in children. Promethazine was at least as effective as either droperidol or ondansetron in our study. Since there were no significant differences in discharge times, promethazine appears to be equally effective as droperidol or ondansetron for control of post-op emesis in strabismus patients at our institution. Our cost for ondansetron 4 mg is $16.70; for droperidol 5 mg $.90; for promethazine 25 mg $.39. The cost savings are obvious. Supported in part by grant "Research To Prevent Blindness" #70-260-2256

The effects of morphine, morphine plus scopolamine, midazolam and promethazine on cerebrospinal fluid histamine concentration and postoperative analgesic consumption

The effects of morphine (0.14 mg/kg), morphine (0.14 mg/kg plus scopolamine (0.042 mg/kg), midazolam (0.015 mg/kg) and promethazine (0.08 mg/kg) on cerebrospinal fluid histamine (CSF-HA) and CSF-methylhistamine were investigated in 44 healthy patients. CSF-HA was determined by HPLC. CSF-HA was found to be increased after all premedications with great individual variation (range 0.07-7.4 pmol/ml). The highest values were found in the promethazine group (1.83 +/- 2.2 (SD) pmol/ml and the lowest in the control group (0.63 +/- 0.42 pmol/ml). Measurable concentrations of CSF-methylhistamine were found in 13 patients without correlation with HA. Postoperative need for analgesics was reduced in all premedicated groups. A significant correlation existed between HA and need for postoperative analgesics in the morphine plus scopolamine group. It is concluded that the histamine system plays a role in central nociception.

Crystal structure of the charge-transfer complex promethazine picrate

Abstract Promethazine picrate (C23H23N5O7S) crystallises in the triclinic space group P[unk] with a = 8.137(1), b = 8.144(3), c = 19.224(6) A…, I± = 87.78(3), ? = 79.97(2), ? = 70.57(2)° and two molecules per unit cell. The structure was solved by direct methods (MULTAN 80) using 2438 observed reflections [I > 2.5 Iƒ(I)]. Refinement was carried out by block-diagonal least-squares methods to a final R = 0.052. The picrate group is planar and is almost perpendicular to the promethazine plane. The two groups are joined by a hydrogen bond. The pairs of molecules related by a centre of symmetry make a molecular arrangement where promethazine and picrate groups are packed in sheets in three dimensions.Abstract Promethazine picrate (C23H23N5O7S) crystallises in the triclinic space group P[unk] with a = 8.137(1), b = 8.144(3), c = 19.224(6) A…, I± = 87.78(3), ? = 79.97(2), ? = 70.57(2)° and two molecules per unit cell. The structure was solved by direct methods (MULTAN 80) using 2438 observed reflections [I > 2.5 Iƒ(I)]. Refinement was carried out by block-diagonal least-squares methods to a final R = 0.052. The picrate group is planar and is almost perpendicular to the promethazine plane. The two groups are joined by a hydrogen bond. The pairs of molecules related by a centre of symmetry make a molecular arrangement where promethazine and picrate groups are packed in sheets in three dimensions.

Effect of promethazine on double tetracycline bone labeling in old mice

Twenty-five-month-old female B6AF 1 mice were injected intramuscularly (i.m.) with declomycin (75 mg/kg) 50 days and 2 days, or 20 days and 2 days, before sacrifice, and cross-sections of their femoral shafts were examined quantitatively for areas of tetracycline fluorescence. Two groups of mice received promethazine HCl in their drinking water (12 mg/dl) for 1 year, and the control groups were untreated. It was found that: (a) the number of discrete areas of cortical and endosteal tetracycline deposition was increased slightly in the groups given promethazine; (b) the length of the endosteal and cortical tetracycline deposits were 2–3 times greater, respectively, in the promethazine treated groups; and (c) the distance between the cortical tetracycline deposits and the endosteum was 2.5 times greater in the promethazine groups. These results support the view that net bone deposition in osteopenic old mice is enhanced by promethazine.

Neonatal electroencephalographic patterns as affected by maternal drugs administered during labor and delivery.

Effects of drugs used during labor and delivery on spontaneous (resting) and evoked brain electrical activity were studied in 45 normal human newborns 48 hours after delivery. Mothers received either anesthesia (general plus local) alone (group 1), anesthesia plus meperidine (group 2), anesthesia plus meperidine and promethazine (group 3), or anesthesia plus meperidine and diazepam (group 4). Autoregressive spectral analyses and subsequent stepwise discriminant analyses showed no differences in spontaneous brain electrical activity in the infants related to the type of drugs given to the mother. However, when auditory stimuli were reduced in intensity from 80 dB to 63 dB, a significant effect was found in newborn brain electrical activity between the anesthetic-only drug pattern (group 1) and the drug patterns of anesthetics with meperidine (group 2) and anesthetics with meperidine plus diazepam (group 4). The data suggest that this effect diminishes in the presence of promethazine (group 3). Evoked responses to visual, tactile, and olfactory stimuli remained unaffected.