Phenylephrine + Promethazine interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Concurrent use of ethanol and phenothiazines may result in additive CNS depression and psychomotor impairment. Also, ethanol may precipitate dystonic reactions in patients who are taking phenothiazines. The two drugs probably act on different sites in the brain, although the exact mechanism of the interaction is not known.

  What to do: Patients should be advised to avoid alcohol during phenothiazine therapy.

  2 sources

  1. Lutz EG "Neuroleptic-induced akathisia and dystonia triggered by alcohol." JAMA 236 (1976): 2422-3
  2. Freed E "Alcohol-triggered-neuroleptic-induced tremor, rigidity and dystonia." Med J Aust 2 (1981): 44-5

Conditions

Conditions in which Phenylephrine + Promethazine needs care, as documented in this source.

• Alcoholic Intoxication

  Major

  The use of phenothiazines is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of phenothiazines may be additive with those of alcohol. Severe respiratory depression and respiratory arrest may occur. Therapy with phenothiazines should be administered cautiously in patients who might be prone to acute alcohol intake.

  13 sources

  1. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  2. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  3. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  4. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  5. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  6. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  7. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  8. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):

  Show all 13 sourcesShow fewer sources

  9. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  10. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  11. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  12. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  13. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):

• Asthma

  Major

  Promethazine is contraindicated for use in the treatment of lower respiratory tract symptoms including asthma. Furthermore, promethazine tablets may lead to potentially fatal respiratory depression, and its use should be avoided in patients with compromised respiratory function such as patients with COPD, and sleep apnea.

  1 source

  1. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):

• Cardiovascular Diseases

  Major

  Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

  58 sources

  1. Humberstone PM "Hypertension from cold remedies." Br Med J 1 (1969): 846
  2. Mariani PJ "Pseudoephedrine-induced hypertensive emergency: treatment with labetalol." Am J Emerg Med 4 (1986): 141-2
  3. Rosen RA "Angina associated with pseudoephedrine ." Ann Emerg Med 10 (1981): 230-1
  4. Wiener I, Tilkian AG, Palazzolo M "Coronary artery spasm and myocardial infarction in a patient with normal coronary arteries: temporal relationship to pseudoephedrine ingestion." Cathet Cardiovasc Diagn 20 (1990): 51-3
  5. Gordon RD, Ballantine DM, Bachmann AW "Effects of repeated doses of pseudoephedrine on blood pressure and plasma catecholamines in normal subjects and in patients with phaeochromocytoma." Clin Exp Pharmacol Physiol 19 (1992): 287-90
  6. Loizou LA, Hamilton JG, Tsementzis SA "Intracranial haemorrhage in association with pseudoephedrine overdose." J Neurol Neurosurg Psychiatry 45 (1982): 471-2
  7. Dickerson J, Perrier D, Mayersohn M, Bressler R "Dose tolerance and pharmacokinetic studies of L (+) pseudoephedrine capsules in man." Eur J Clin Pharmacol 14 (1978): 253-9
  8. Wooten MR, Khangure MS, Murphy MJ "Intracerebral hemorrhage and vasculitis related to ephedrine abuse." Ann Neurol 13 (1983): 337-40

  Show all 58 sourcesShow fewer sources

  9. To LB, Sangster JF, Rampling D, Cammens I "Ephedrine-induced cardiomyopathy." Med J Aust 2 (1980): 35-6
  10. Bruno A, Nolte KB, Chapin J "Stroke associated with ephedrine use." Neurology 43 (1993): 1313-6
  11. Stoessl AJ, Young GB, Feasby TE "Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics." Stroke 16 (1985): 734-6
  12. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  13. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome (2001):
  14. Kizer KW "Intracranial hemorrhage associated with overdose of decongestant containing phenylpropanolamine" Am J Emerg Med 2 (1984): 180-1
  15. Edwards M, Russo L, Harwood-Nuss A "Cerebral infarction with a single oral dose of phenylpropanolamine." Am J Emerg Med 5 (1987): 163-4
  16. Lake CR, Gallant S, Masson E, Miller P "Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports." Am J Med 89 (1990): 195-208
  17. Lake CR, Zaloga G, Bray J, Rosenberg D, Chernow B "Transient hypertension after two phenylpropanolamine diet aids and the effects of caffeine: a placebo-controlled follow-up study." Am J Med 86 (1989): 427-32
  18. Lake CR, Zaloga G, Clymer R, Quirk RM, Chernow B "A double dose of phenylpropanolamine causes transient hypertension." Am J Med 85 (1988): 339-43
  19. Bernstein E, Diskant BM "Phenylpropanolamine: a potentially hazardous drug." Ann Emerg Med 11 (1982): 311-5
  20. Kroenke K, Omori DM, Simmons JO, Wood DR, Meier NJ "The safety of phenylpropanolamine in patients with stable hypertension." Ann Intern Med 111 (1989): 1043-4
  21. Pentel PR, Mikell FL, Zavoral JH "Myocardial injury after phenylpropanolamine ingestion." Br Heart J 47 (1982): 51-4
  22. Howrie DL, Wolfson JH "Phenylpropanolamine-induced hypertensive seizures." J Pediatr 102 (1983): 143-5
  23. Horowitz JD, Lang WJ, Howes LG, Fennessy MR, Christophidis N, Rand MJ, Louis WJ "Hypertensive responses induced by phenylpropanolamine in anorectic and decongestant preparations." Lancet 1 (1980): 60-1
  24. Johnson DA, Etter HS, Reeves DM "Stroke and phenylpropanolamine use" Lancet 2 (1983): 970
  25. McEwen J "Phenylpropanolamine-associated hypertension after the use of "over- the-counter" appetite-suppressant products." Med J Aust 2 (1983): 71-3
  26. Elliott CF, Whyte JC "Phenylpropanolamine and hypertension." Med J Aust 1 (1981): 715
  27. Maher LM, Peterson PL, Dela-Cruz C "Postpartum intracranial hemorrhage and phenylpropanolamine use" Neurology 37 (1987): 1686
  28. Kase CS, Foster TE, Reed JE, Spatz EL, Girgis GN "Intracerebral hemorrhage and phenylpropanolamine use." Neurology 37 (1987): 399-404
  29. Kikta DG, Devereaux MW, Chandar K "Intracranial hemorrhages due to phenylpropanolamine." Stroke 16 (1985): 510-2
  30. Clark JE, Simon WA "Cardiac arrhythmias after phenylpropanolamine ingestion." Drug Intell Clin Pharm 17 (1983): 737-8
  31. Noble R "A controlled clinical trial of the cardiovascular and psychological effects of phenylpropanolamine and caffeine." Drug Intell Clin Pharm 22 (1988): 296-9
  32. O'Connell MB, Gross CR "The effect of multiple doses of phenylpropanolamine on the blood pressure of patients whose hypertension was controlled with beta blockers." Pharmacotherapy 11 (1991): 376-81
  33. O'Connell MB, Gross CR "The effect of single-dose phenylpropanolamine on blood pressure in patients with hypertension controlled by beta blockers." Pharmacotherapy 10 (1990): 85-91
  34. Chin C, Choy M "Cardiomyopathy induced by phenylpropanolamine." J Pediatr 123 (1993): 825-7
  35. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  36. Lee KY, Beilin LJ, Vandongen R "Severe hypertension after ingestion of an appetite suppressant (phenylpropanolamine) with indomethacin." Lancet 1 (1979): 1110-1
  37. Gibson GJ, Warrell DA "Hypertensive crises and phenylpropanolamine." Lancet 2 (1972): 492-3
  38. Frewin DB "Phenylpropanolamine. How safe is it?" Med J Aust 2 (1983): 54-5
  39. Lee KY, Beilin LJ, Vandongen R "Severe hypertension after administration of phenylpropanolamine" Med J Aust 1 (1979): 525-6
  40. Horowitz JD, McNeil JJ, Sweet B, Mendelsohn FA, Louis WJ "Hypertension and postural hypotension induced by phenylpropanolamine (Trimolets)." Med J Aust 1 (1979): 175-6
  41. Frewin DB, Leonello PP, Frewin ME "Hypertension after ingestion of Trimolets." Med J Aust 2 (1978): 497-8
  42. Teh AY "Phenylpropanolamine and hypertension" Med J Aust 2 (1979): 425-6
  43. Shapiro SR "Hypertension due to anorectic agent." N Engl J Med 280 (1969): 1363
  44. Maher LM, Peterson PL, Dela-Cruz C "Postpartum intracranial hemorrhage and phenylpropanolamine use." Neurology 37 (1987): 1886,1890
  45. Fallis RJ, Fisher M "Cerebral vasculitis and hemorrhage associated with phenylpropanolamine." Neurology 35 (1985): 405-7
  46. Caperton E "Raynaud's phenomenon. Role of diet pills and cold remedies." Postgrad Med 73 (1983): 291-2
  47. McDowell JR, LeBlanc HJ "Phenylpropanolamine and cerebral hemorrhage." West J Med 142 (1985): 688-91
  48. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
  49. Dowse R, Scherzinger SS, Kanfer I "Serum concentrations of phenylpropanolamine and associated effects on blood pressure in normotensive subjects: a pilot-study." Int J Clin Pharmacol Ther Toxicol 28 (1990): 205-10
  50. Pentel PR, Aaron C, Paya C "Therapeutic doses of phenylpropanolamine increase supine systolic blood pressure." Int J Obes 9 (1985): 115-9
  51. Finton CK, Barton M, Chernow B "Possible adverse effects of phenylpropanolamine (diet pills) on sympathetic nervous system function--caveat emptor!" Mil Med 147 (1982): 1072
  52. "Product Information. Adrenalin (EPINEPHrine)." Apothecon Inc (2022):
  53. Leo PJ, Hollander JE, Shih RD, Marcus SM "Phenylpropanolamine and associated myocardial injury." Ann Emerg Med 28 (1996): 359-62
  54. Gill ND, Shield A, Blazevich AJ, Zhou S, Weatherby RP "Muscular and cardiorespiratory effects of pseudoephedrine in human athletes." Br J Clin Pharmacol 50 (2000): 205-13
  55. Haller CA, Benowitz NL "Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids." N Engl J Med 343 (2000): 1833-8
  56. Mansoor GA "Herbs and alternative therapies in the hypertension clinic." Am J Hypertens 14(9 Pt 1) (2001): 971-5
  57. Samenuk D, Link MS, Homoud MK, et al. "Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine." Mayo Clin Proc 77 (2002): 12-6
  58. "Product Information. Akovaz (ephedrine)." Eclat Pharmaceuticals (2016):

• Cardiovascular Diseases

  Major

  Phenothiazines may cause hypotension (including orthostatic hypotension), reflex tachycardia, increased pulse rate, syncope, and dizziness, particularly after the first parenteral dose but rarely after the first oral dose. Low-potency agents such as chlorpromazine and thioridazine are more likely to induce these effects, which usually subside within the first couple of hours following administration. Tolerance to the hypotensive effects often develops after a few doses. Rarely, fatal cardiac arrest has occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include edema, thrombosis, and ECG abnormalities such as PR and QT interval prolongation, diffuse T-wave flattening, and ST segment depression. Therapy with phenothiazines should be avoided or otherwise administered cautiously in patients with severe cardiovascular disease, pheochromocytoma, a predisposition to hypotension, or conditions that could be exacerbated by hypotension such as a history of myocardial infarction, angina, or ischemic stroke. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. If parenteral therapy is given, patients should be in a supine position during administration and for at least 30 to 60 minutes afterwards. Patients who experience orthostatic hypotension should be cautioned not to rise too abruptly. Occasionally, when severe, hypotension may require treatment with vasoconstrictive agents such as norepinephrine or phenylephrine. Epinephrine should not be used, however, since phenothiazines can reverse its vasopressor effects and cause a further lowering of blood pressure.

  24 sources

  1. Varia I, Krishnan R, Davidson J "Deep-vein thrombosis with antipsychotic drugs." Psychosomatics 24 (1983): 1097-8
  2. Schreiber G, Belmaker R "In vivo differentiation of cardiac vagal blocking effects of chlorpromazine and haloperidol." Biol Psychiatry 22 (1987): 1417-21
  3. Witz L, Shapiro M, Shenkman L "Chlorpromazine induced fluid retention masquerading as idiopathic oedema." Br Med J 294 (1987): 807-8
  4. Dorson P, Crismon M "Chlorpromazine accumulation and sudden death in a patient with renal insufficiency." Drug Intell Clin Pharm 22 (1988): 776-8
  5. Fruncillo R, Gibbons W, Vlasses P, Ferguson R "Severe hypotension associated with concurrent clonidine and antipsychotic medication." Am J Psychiatry 142 (1985): 274
  6. Stevenson R, Blanshard C, Patterson D "Ventricular fibrillation due to lithium withdrawal: an interaction with chlorpromazine?" Postgrad Med J 65 (1989): 936-8
  7. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  8. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):

  Show all 24 sourcesShow fewer sources

  9. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  10. Fletcher GF, Kazamias TM "Cardiotoxic effects of Mellaril: conduction disturbances and supraventricular arrhythmias." Am Heart J 78 (1969): 135-8
  11. Margolis J "Massive edema induced by thioridazine (Mellaril): an unusual complication." J Am Geriatr Soc 20 (1972): 593-4
  12. Kumar BB "Letter: Acute hypotension from thioridazine." JAMA 234 (1975): 1321
  13. Jones J, Sklar D, Dougherty J, White W "Randomized double-blind trial of intravenous prochlorperazine for the treatment of acute headache." JAMA 261 (1989): 1174-6
  14. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  15. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  16. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  17. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  18. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  19. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  20. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  21. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  22. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  23. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):
  24. Talbert RL, Yee GC, DiPiro JT, Matzke GR, Posey LM, Wells BG "Pharmacotherapy: A Pathophysiologic Approach" Stamford, CT: Appleton & Lange (1999):

• Craniocerebral Trauma

  Major

  The use of phenothiazines is contraindicated in patients with suspected or established subcortical brain damage, with or without hypothalamic involvement. Phenothiazines can interfere with thermoregulatory mechanisms, and a hyperthermic reaction with temperatures in excess of 104 F may occur in such patients, sometimes not until 14 to 16 hours after drug administration.

  13 sources

  1. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  2. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  3. Dilsaver SC "Effects of neuroleptics on body temperature" J Clin Psychiatry 49 (1988): 78-9
  4. Caroff S, Rosenberg H, Gerber JC "Neuroleptic malignant syndrome and malignant hyperthermia" Lancet 1 (1983): 244
  5. Keshavan MS, Kambhampati RK "Prolonged fever without extrapyramidal symptoms during neuroleptic treatment" J Clin Psychopharmacol 9 (1989): 230-1
  6. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  7. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  8. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):

  Show all 13 sourcesShow fewer sources

  9. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  10. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  11. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  12. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  13. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):

• Respiratory Insufficiency

  Major

  The use of phenothiazines is contraindicated in comatose patients and patients with severe central nervous system depression. Phenothiazines may potentiate the CNS and respiratory depression in these patients.

  13 sources

  1. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  2. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  3. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  4. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  5. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  6. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  7. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  8. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):

  Show all 13 sourcesShow fewer sources

  9. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  10. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  11. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  12. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  13. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):

• Anticholinergic Syndrome

  Moderate

  Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.

  20 sources

  1. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  3. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  4. "Product Information. Periactin (cyproheptadine)." Merck & Co., Inc (2002):
  5. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  6. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  8. "Product Information. Antivert (meclizine)." Roerig Division (2001):

  Show all 20 sourcesShow fewer sources

  9. "Product Information. Marezine (cyclizine)." Glaxo Wellcome (2001):
  10. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  11. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC (2001):
  12. "Product Information. Zyrtec (cetirizine)." Pfizer U.S. Pharmaceuticals (2001):
  13. "Product Information. Drixoral (dextromethorphan)." Schering-Plough (2001):
  14. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
  15. Watemberg NM, Roth KS, Alehan FK, Epstein CE "Central anticholinergic syndrome on therapeutic doses of cyproheptadine." Pediatrics 103 (1999): 158-60
  16. "Product Information. Vistaril (hydroxyzine)." Pfizer U.S. Pharmaceuticals (2001):
  17. "Product Information. Dramamine (dimenhydrinate)." Pharmacia and Upjohn (2001):
  18. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  19. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  20. Talbert RL, Yee GC, DiPiro JT, Matzke GR, Posey LM, Wells BG "Pharmacotherapy: A Pathophysiologic Approach" Stamford, CT: Appleton & Lange (1999):

• Asthma

  Moderate

  It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.

  17 sources

  1. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  3. "Product Information. Periactin (cyproheptadine)." Merck & Co., Inc (2002):
  4. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  5. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  6. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  7. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  8. "Product Information. Antivert (meclizine)." Roerig Division (2001):

  Show all 17 sourcesShow fewer sources

  9. "Product Information. Marezine (cyclizine)." Glaxo Wellcome (2001):
  10. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  11. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC (2001):
  12. "Product Information. Drixoral (dextromethorphan)." Schering-Plough (2001):
  13. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
  14. "Product Information. Vistaril (hydroxyzine)." Pfizer U.S. Pharmaceuticals (2001):
  15. "Product Information. Dramamine (dimenhydrinate)." Pharmacia and Upjohn (2001):
  16. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  17. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):

• Breast Neoplasms

  Moderate

  The chronic use of phenothiazines is associated with persistent elevations in prolactin levels. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Therapy with phenothiazines should be administered cautiously in patients with existing or suspected malignancy of the breast.

  16 sources

  1. Ash PR, Bouma D "Exaggerated hyperprolactinemia in response to thiothixene ." Arch Neurol 38 (1981): 534-5
  2. Ristic PI, Ory SJ, Lurain JR "Endometrial adenocarcinoma associated with drug-induced hyperprolactinemia." Obstet Gynecol 67 (1986): s86-8
  3. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  4. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  5. Kane JM "Antipsychotic drug side effects: their relationship to dose." J Clin Psychiatry 46 (1985): 16-21
  6. Gift T, Plum K, Price M "Depot fluphenazine and plasma prolactin." Prog Neuropsychopharmacol Biol Psychiatry 9 (1985): 407-12
  7. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  8. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  10. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  11. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  12. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  13. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  14. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  15. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  16. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):

• Diabetes Mellitus

  Moderate

  Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.

  6 sources

  1. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  2. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome (2001):
  3. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  4. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
  5. "Product Information. Adrenalin (EPINEPHrine)." Apothecon Inc (2022):
  6. "Product Information. Akovaz (ephedrine)." Eclat Pharmaceuticals (2016):

• Dystonic Disorders

  Moderate

  Phenothiazines may cause acute, dose-related dystonic reactions secondary to central dopaminergic blockade. These reactions are characterized by spastic contraction of discrete muscle groups and may include torticollis, opisthotonos, carpopedal spasm, trismus, difficulty swallowing, perioral spasms with protrusion of the tongue, and oculogyric crisis. Onset is usually within 24 to 96 hours following initiation of therapy or an increase in dosage. Risk factors include young age, male gender, use of high-potency agents (e.g., fluphenazine, perphenazine, trifluoperazine), high dosages, and IM administration. Therapy with phenothiazines should be administered cautiously in patients, particularly children, with hypocalcemia or severe dehydration, since these patients may be more susceptible to dystonic reactions. Most symptoms subside within a few hours and are almost always reversible within 24 to 48 hours following withdrawal of therapy. However, severe reactions such as laryngospasm may be life-threatening and require appropriate supportive therapy. Parenteral administration of an anticholinergic antiparkinsonian agent (e.g., benztropine, trihexyphenidyl) or diphenhydramine usually produces a prompt response and may be given orally for short-term maintenance to prevent recurrence of symptoms if phenothiazine therapy must be continued.

  31 sources

  1. Wood G, Waters A "Prolonged dystonic reaction to chlorpromazine in myxoedema coma." Postgrad Med J 56 (1980): 192-3
  2. Nahata MC, Clotz MA, Krogg EA "Adverse effects of meperidine, promethazine, and chlorpromazine for sedation in pediatric patients." Clin Pediatr (Phila) 24 (1985): 558-60
  3. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  4. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  5. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  6. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  8. Idzorek S "Antiparkinsonian agents and fluphenazine decanoate." Am J Psychiatry 133 (1976): 80-2

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  9. Bailie GR, Nelson MV, Krenzelok EP, Lesar T "Unusual treatment response of a severe dystonia to diphenhydramine." Ann Emerg Med 16 (1987): 705-8
  10. West D "Dangers of fluphenazine." Br J Psychiatry 117 (1970): 718-9
  11. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  12. Singh H, Levinson DF, Simpson GM, Lo ES, Friedman E "Acute dystonia during fixed-dose neuroleptic treatment." J Clin Psychopharmacol 10 (1990): 389-96
  13. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  14. Reecer MV, Clinchot DM, Tipton DB "Drug-induced dystonia in a patient with C4 quadriplegia. Case report." Am J Phys Med Rehabil 72 (1993): 97-8
  15. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  16. Lamont S "Acute reactions to phenothiazine derivatives." Br J Anaesth 44 (1972): 539-40
  17. Schumock GT, Martinez E "Acute oculogyric crisis after administration of prochlorperazine." South Med J 84 (1991): 407-8
  18. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  19. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  20. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  21. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  22. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  23. Harries JR "Oculogyric crises due to phenothiazines." Br Med J 3 (1967): 241
  24. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  25. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  26. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  27. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  28. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  29. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  30. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):
  31. Talbert RL, Yee GC, DiPiro JT, Matzke GR, Posey LM, Wells BG "Pharmacotherapy: A Pathophysiologic Approach" Stamford, CT: Appleton & Lange (1999):

• Epilepsy

  Moderate

  Phenothiazines can lower the seizure threshold and induce seizures, particularly when dosages are high or increased rapidly and during the initiation of therapy. Of the phenothiazines used in the treatment of psychosis, chlorpromazine appears to have the greatest epileptogenic potential, while fluphenazine and thioridazine have the least. Therapy with phenothiazines should be administered cautiously in patients with a history of seizures or other factors predisposing to seizures such as abnormal EEG, preexisting CNS pathology, or head trauma. Adequate anticonvulsant therapy should be maintained during administration of phenothiazines.

  18 sources

  1. Markowitz J, Brown R "Seizures with neuroleptics and antidepressants." Gen Hosp Psychiatry 9 (1987): 135-41
  2. Waterhouse RG "Epileptiform convulsions in children following premedication with Pamergan SP100." Br J Anaesth 39 (1967): 268-70
  3. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  4. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  7. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  8. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):

  Show all 18 sourcesShow fewer sources

  9. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  10. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  11. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  12. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  13. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  14. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  15. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  16. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  17. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):
  18. Talbert RL, Yee GC, DiPiro JT, Matzke GR, Posey LM, Wells BG "Pharmacotherapy: A Pathophysiologic Approach" Stamford, CT: Appleton & Lange (1999):

• Glaucoma

  Moderate

  Sympathomimetic agents can induce transient mydriasis via stimulation of alpha-1 adrenergic receptors. In patients with anatomically narrow angles or narrow-angle glaucoma, pupillary dilation can provoke an acute attack. In patients with other forms of glaucoma, mydriasis may occasionally increase intraocular pressure. Therapy with sympathomimetic agents should be administered cautiously in patients with or predisposed to glaucoma, particularly narrow-angle glaucoma.

  3 sources

  1. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  2. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome (2001):
  3. Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects" Boston, MA: Butterworth-Heinemann (2001):

• Hematologic Diseases

  Moderate

  Phenothiazines may infrequently cause hematologic toxicity, including agranulocytosis, thrombocytopenia, eosinophilia, aplastic anemia, purpura, granulocytopenia, and hemolytic anemia. Mild leukopenia may occur frequently with large doses over prolonged periods but is generally reversible despite continued treatment. Therapy with phenothiazines should be administered cautiously, if at all, in patients with preexisting blood dyscrasias or bone marrow suppression. Complete blood counts should be obtained regularly, and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, bleeding, pallor, dizziness, or jaundice. Most cases of agranulocytosis have occurred between the fourth and tenth weeks of therapy.

  21 sources

  1. Stein P, Inwood M "Hemolytic anemia associated with chlorpromazine therapy." Can J Psychiatry 25 (1980): 659-61
  2. Holt R "Neuroleptic drug-induced changes in platelet levels." J Clin Psychopharmacol 4 (1984): 130-2
  3. Yassa R "Agranulocytosis in the course of phenothiazine therapy." J Clin Psychiatry 46 (1985): 341-3
  4. Zengotita H, Holt R "Neuroleptic drug-induced coagulopathy: mechanism of reaction and duration of effect." J Clin Psychiatry 47 (1986): 35-7
  5. Aram H "Henoch-Schonlein purpura induced by chlorpromazine." J Am Acad Dermatol 17 (1987): 139-40
  6. Young A, Kehoe R "Two cases of agranulocytosis on addition of a butyrophenone to a long-standing course of phenothiazine treatment." Br J Psychiatry 154 (1989): 710-12
  7. Ben-Yehuda A, Bloom A, Lijhovetzky G, et al. "Chlorpromazine-induced liver and bone marrow granulomas associated with agranulocytosis." Isr J Med Sci 26 (1990): 449-51
  8. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):

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  9. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  10. Rosenthal DS, Stein GF, Santos JC "Thioridazine agranulocytosis." JAMA 200 (1967): 81-2
  11. Holt RJ "Fluphenazine decanoate-induced cholestatic jaundice and thrombocytopenia." Pharmacotherapy 4 (1984): 227-9
  12. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  13. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  14. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  15. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  16. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  17. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  18. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  19. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  20. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  21. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):

• Kidney Diseases

  Moderate

  Phenothiazines and their metabolites are excreted by the kidney. There are very limited data concerning the use of phenothiazines in patients with renal disease. Therapy with phenothiazines should be administered cautiously in patients with significantly impaired renal function. The manufacturers recommend periodic renal function tests for all patients during prolonged therapy.

  16 sources

  1. Dorson P, Crismon M "Chlorpromazine accumulation and sudden death in a patient with renal insufficiency." Drug Intell Clin Pharm 22 (1988): 776-8
  2. Taylor G, Houston JB, Shaffer J, Mawer G "Pharmacokinetics of promethazine and its sulphoxide metabolite after intravenous and oral administration to man." Br J Clin Pharmacol 15 (1983): 287-93
  3. Fabre J, Freudenreich J, de Duckert A, Pitton JS, Rudhardt M, Virieux C "Influence of renal insufficiency on the excretion of chloroquine, phenobarbital, phenothiazines and methacycline." Helv Med Acta 33 (1967): 307-16
  4. McAllister CJ, Scowden EB, Stone WJ "Toxic psychosis induced by phenothiazine administration in patients with chronic renal failure." Clin Nephrol 10 (1978): 191-5
  5. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  6. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  8. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  10. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  11. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  12. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  13. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  14. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  15. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  16. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):

• Liver Diseases

  Moderate

  Phenothiazines are extensively metabolized by the liver and may accumulate in patients with hepatic impairment. In addition, the use of some phenothiazines has been associated with adverse hepatic effects including cholestatic jaundice and elevated liver enzymes, generally within the first few months of therapy. Cholestatic jaundice usually occurs between the second and fourth weeks of therapy in approximately 0.1% to 4% of all patients. Therapy with phenothiazines should be administered cautiously in patients with preexisting liver disease, liver enzyme abnormalities, or hepatitis. Liver function and urine bilirubin tests should be performed periodically during prolonged therapy, and patients should be instructed to immediately report any signs or symptoms suggestive of cholestatic jaundice such as upper abdominal pain, nausea, yellow skin, influenza-like symptoms, rash, and fever. Phenothiazine therapy should be discontinued, preferably permanently, if jaundice occurs and is attributable to the drug. Clinical recovery is usually observed within a few weeks following withdrawal of therapy, although histopathologic changes may persist for longer periods.

  28 sources

  1. Seeff L "Drug-induced chronic liver disease, with emphasis on chronic active hepatitis." Semin Liver Dis 1 (1981): 104-15
  2. Dossing M, Andreasen B "Drug-induced liver disease in Denmark." Scand J Gastroenterol 17 (1982): 205-11
  3. Bach N, Thung S, Schaffner F, Tobias H "Exaggerated cholestasis and hepatic fibrosis following simultaneous administration of chlorpromazine and sodium valproate." Dig Dis Sci 34 (1989): 1303-7
  4. Maxwell JD, Carrella M, Parkes JD, et al. "Plasma disappearance and cerebral effects of chlorpromazine in cirrhosis." Clin Sci 43 (1972): 143-51
  5. Whitfield LR, Kaul PN, Clark ML "Chlorpromazine metabolism IX: pharmacokinetics of chlorpromazine following oral administration in man." J Pharmacokinet Biopharm 6 (1978): 187-96
  6. Simpson GM, Yadalam KG, Levinson DF, et al. "Single-dose pharmacokinetics of fluphenazine after fluphenazine decanoate administration." J Clin psychopharmacol 10 (1990): 417-21
  7. Hu OY, Tang H-S, Sheeng T-Y, et al. "Pharmacokinetics of promazine I: disposition in patients with acute viral hepatitis B." Biopharm Drug Dispos 11 (1990): 557-68
  8. Taylor G, Houston JB, Shaffer J, Mawer G "Pharmacokinetics of promethazine and its sulphoxide metabolite after intravenous and oral administration to man." Br J Clin Pharmacol 15 (1983): 287-93

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  9. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  10. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  11. Derby LE, Gutthann SP, Jick H, Dean AD "Liver disorders in patients receiving chlorpromazine or isoniazid." Pharmacotherapy 13 (1993): 353-8
  12. Chetty M, Moodley SV, Miller R "Important metabolites to measure in pharmacodynamic studies of chlorpromazine." Ther Drug Monit 16 (1994): 30-6
  13. Barancik M, Brandborg LL, Albion MJ "Thioridazine-induced cholestasis." JAMA 200 (1967): 69-70
  14. Reinhart MJ, Benson RM, Kwass SK, Storey WF "Suggestive evidence of hepatotoxicity concomitant with thioridazine hydrochloride use." JAMA 197 (1966): 767-9
  15. Snyder S "Fluphenazine jaundice. Report of a case." Am J Gastroenterol 73 (1980): 336-40
  16. Holt RJ "Fluphenazine decanoate-induced cholestatic jaundice and thrombocytopenia." Pharmacotherapy 4 (1984): 227-9
  17. Lok AS, Ng IO "Prochlorperazine-induced chronic cholestasis." J Hepatol 6 (1988): 369-73
  18. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  19. Moradpour D, Altorfer J, Flury R, Greminger P, Meyenberger C, Jost R, Schmid M "Chlorpromazine-induced vanishing bile duct syndrome leading to biliary cirrhosis." Hepatology 20 (1994): 1437-41
  20. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  21. Podevin P, Biour M "Drug-induced ''allergic hepatitis''." Clin Rev Allergy Immunol 13 (1995): 223-44
  22. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  23. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  24. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  25. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  26. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  27. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  28. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):

• Neuroleptic Malignant Syndrome

  Moderate

  The central dopaminergic blocking effects of phenothiazines may precipitate or aggravate a potentially fatal symptom complex known as Neuroleptic Malignant Syndrome (NMS). NMS is observed most frequently when high-potency neuroleptic agents like haloperidol or fluphenazine are administered intramuscularly but may occur with any agent possessing neuroleptic activity given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Phenothiazine therapy should not be initiated in patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of phenothiazines should be carefully considered, since NMS may recur.

  24 sources

  1. Morris H, McCormick W, Reinarz J "Neuroleptic malignant syndrome." Arch Neurol 37 (1980): 462-3
  2. Price W, Giannini A "A paradoxical response to chlorpromazine: a possible variant of the neuroleptic malignant syndrome." J Clin Pharmacol 23 (1983): 567-9
  3. Tenenbein M "The neuroleptic malignant syndrome: occurrence in a 15-year-old boy and recovery with bromocriptine therapy." Pediatr Neurosci 12 (1985): 161-4
  4. Caroff SN "The neuroleptic malignant syndrome." J Clin Psychiatry 41 (1980): 79-83
  5. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  6. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  7. Zubenko G, Pope HG, Jr "Management of a case of neuroleptic malignant syndrome with bromocriptine." Am J Psychiatry 140 (1983): 1619-20
  8. Granato JE, Stern BJ, Ringel A, Karim AH, Krumholz A, Coyle J, Adler S "Neuroleptic malignant syndrome: successful treatment with dantrolene and bromocriptine." Ann Neurol 14 (1983): 89-90

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  9. Grunhaus L, Sancovici S, Rimon R "Neuroleptic malignant syndrome due to depot fluphenazine." J Clin Psychiatry 40 (1979): 99-100
  10. Dhib-Jalbut S, Hesselbrock R, Brott T, Silbergeld D "Treatment of the neuroleptic malignant syndrome with bromocriptine" JAMA 250 (1983): 484-5
  11. Caroff S, Rosenberg H, Gerber JC "Neuroleptic malignant syndrome and malignant hyperthermia" Lancet 1 (1983): 244
  12. Rampertaap MP "Neuroleptic malignant syndrome." South Med J 79 (1986): 331-6
  13. West D "Dangers of fluphenazine." Br J Psychiatry 117 (1970): 718-9
  14. Manser TJ, Warner JF "Neuroleptic malignant syndrome associated with prochlorperazine." South Med J 83 (1990): 73-4
  15. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  16. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  17. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  18. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  19. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  20. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  21. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  22. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  23. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  24. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):

• Parkinsonian Disorders

  Moderate

  The use of phenothiazines is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Propylamino derivatives such as chlorpromazine, promazine, and triflupromazine may be more likely to induce these effects. Therapy with phenothiazines should be administered cautiously in patients with Parkinson's disease or parkinsonian symptoms.

  24 sources

  1. Rajput A, Rozdilsky B, Hornykiewicz O, et al. "Reversible drug-induced parkinsonism." Arch Neurol 39 (1982): 6446
  2. Mariani P "Adverse reactions to chlorpromazine in the treatment of migraine." Ann Emerg Med 17 (1988): 380-1
  3. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  4. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  5. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  6. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  8. Lamb P, Mindham RH, Ezzat MA "Letter: Parkinsonism induced by fluphenazine decanoate." Lancet 1 (1976): 484

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  9. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  10. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  11. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  12. Edelstein H, Knight RT "Severe parkinsonism in two AIDS patients taking prochlorperazine." Lancet 2 (1987): 341-2
  13. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  14. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  15. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  16. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  17. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  18. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  19. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  20. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  21. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  22. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  23. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  24. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):

• Prostatic Hyperplasia

  Moderate

  Sympathomimetic agents may cause or worsen urinary difficulty in patients with prostate enlargement due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate.

  4 sources

  1. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  2. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome (2001):
  3. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
  4. "Product Information. Akovaz (ephedrine)." Eclat Pharmaceuticals (2016):

• Tardive Dyskinesia

  Moderate

  Phenothiazines may commonly precipitate symptoms of tardive dyskinesia (TD), a syndrome consisting of rhythmic involuntary movements variously involving the tongue, face, mouth, lips, jaw, and/or trunk and extremities, following chronic use of at least several months but often years. Elderly patients, particularly women, are most susceptible. Also, propylpiperazine derivatives like fluphenazine, perphenazine, prochlorperazine, and trifluoperazine may be more likely to induce this syndrome. Both the risk of developing TD and the likelihood that it will become irreversible increase with the duration and total cumulative dose of phenothiazine therapy administered. However, patients may infrequently develop symptoms after relatively brief treatment periods at low dosages. If TD occurs during phenothiazine therapy, prompt withdrawal of the offending agent or at least a lowering of the dosage should be considered. TD symptoms usually become more severe after drug discontinuation or a dosage reduction, but may gradually improve over months to years. In patients with preexisting drug-induced TD, initiating or increasing the dosage of phenothiazine therapy may temporarily mask the symptoms of TD but may eventually worsen the condition. The newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine) tend to be associated with a substantially reduced risk of inducing TD and are considered the drugs of choice in patients being treated for psychosis.

  30 sources

  1. Yassa R, Dimitry R "Single phenothiazines and tardive dyskinesia." J Clin Psychiatry 44 (1983): 233-4
  2. Mariani P "Adverse reactions to chlorpromazine in the treatment of migraine." Ann Emerg Med 17 (1988): 380-1
  3. Yesavage JA, Tanke ED, Sheikh JI "Tardive dyskinesia and steady-state serum levels of thiothixene." Arch Gen Psychiatry 44 (1987): 913-5
  4. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  5. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  6. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  7. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories (2001):
  8. Csernansky JG, Grabowski K, Cervantes J, Kaplan J, Yesavage JA "Fluphenazine decanoate and tardive dyskinesia: a possible association." Am J Psychiatry 138 (1981): 1362-5

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  9. Perenyi A, Arato M "Fluphenazine and tardive dyskinesia" Arch Gen Psychiatry 41 (1984): 727
  10. Mukherjee S, Rosen AM, Cardenas C, Varia V, Olarte S "Tardive dyskinesia in psychiatric outpatients: a study of prevalence and association with demographic, clinical, and drug history variables." Arch Gen Psychiatry 39 (1982): 466-9
  11. Kolakowska T, Williams AO, Ardern M "Tardive dyskinesia and current dose of neuroleptic drugs" Arch Gen Psychiatry 42 (1985): 925
  12. Glazer WM, Moore DC "The diagnosis of rapid abnormal involuntary movements associated with fluphenazine decanoate." J Nerv Ment Dis 168 (1980): 439-41
  13. McClelland HA, Metcalfe AV, Kerr TA, Dutta D, Watson P "Facial dyskinesia: a 16-year follow-up study" Br J Psychiatry 158 (1991): 691-6
  14. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  15. Yassa R, Iskandar H, Ally J "The prevalence of tardive dyskinesia in fluphenazine-treated patients." J Clin Psychopharmacol 8 (1988): 17S-20S
  16. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  17. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  18. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  19. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  20. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb (2001):
  21. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  22. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation (2001):
  23. "Product Information. Serentil (mesoridazine)." Boehringer-Ingelheim (2001):
  24. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc (2001):
  25. "Product Information. Trilafon (perphenazine)." Schering Corporation (2001):
  26. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  27. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  28. "Product Information. Stelazine (trifluoperazine)." SmithKline Beecham (2001):
  29. "Product Information. Vesprin (triflupromazine)." Bristol-Myers Squibb (2001):
  30. Talbert RL, Yee GC, DiPiro JT, Matzke GR, Posey LM, Wells BG "Pharmacotherapy: A Pathophysiologic Approach" Stamford, CT: Appleton & Lange (1999):

Therapeutic duplication

Drug classes that overlap with Phenylephrine + Promethazine, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• antiemetics

  The recommended maximum number of medicines in the 'antiemetics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antiemetics' category.

  Example product in the source data (US market): Fosnetupitant/palonosetron

• antiemetics

  The recommended maximum number of medicines in the 'antiemetics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antiemetics' category.

  Example product in the source data (US market): Netupitant/palonosetron

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): All day allergy-d

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Pro-chlo

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Lodrane d

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Notuss-forte

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Sutan-dm

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Norel sr

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Dexbrompheniramine/phenylephrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Dallergy

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Resperal-dm

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Diphenhydramine/naproxen

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Chlorpheniramine/methscopolamine/phenylephrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Coldcough syrup

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Mucinex nightshift sinus clear & cool

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Bromhist-pdx

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Nasopen

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Supress a pediatric

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Rescon

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Dextromethorphan/diphenhydramine/phenylephrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Theraflu nighttime severe cold & cough

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Chlorpheniramine/ibuprofen/pseudoephedrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Robitussin peak cold nighttime nasal relief

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Phenylephrine/pyrilamine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Sympak ii

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Chlorpheniramine/pseudoephedrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Doxylamine/pyridoxine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Pheniramine/phenylephrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Dextromethorphan/pyrilamine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Premsyn pms

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Acetaminophen/chlorpheniramine/dextromethorphan/pseudoephedrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Nohist dm

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Drixoral cold and allergy

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Tannic-12 s

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Coricidin hbp cold & flu

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Poly-tussin ac

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Brompheniramine/dextromethorphan/phenylephrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): First mouthwash blm

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Theraflu sinus & cold

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Diabetic tussin night time formula

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Nohist-a

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Percogesic original strength

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Diphenhydramine/ibuprofen

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Tuzistra xr

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Hyoscyamine/phenyltoloxamine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Triaminic

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Diphenhydramine/phenylephrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Vicks nyquil cold & flu nighttime relief

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): M-end dmx

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Tussionex pennkinetic

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Aspirin/chlorpheniramine/dextromethorphan/phenylpropanolamine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Codeine/pseudoephedrine/triprolidine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Semprex-d

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Doans pm

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Dologesic df

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Mucinex nightshift cold & flu

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Rymed

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Robitussin children's cough & cold long-acting

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Chlorpheniramine/dextromethorphan/pseudoephedrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Pseudoephedrine/triprolidine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Vicks nyquil severe cold & flu

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Vicks nyquil cough

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Betatan

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Sinarest

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Aspirin/chlorpheniramine/phenylephrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Vanacof

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Histex-ac

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Poly hist forte

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Rynex pe

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Chlorpheniramine/phenylephrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Chlorpheniramine/ibuprofen/phenylephrine

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Vicks nyquil d cold and flu nighttime relief

• antihistamines

  The recommended maximum number of medicines in the 'antihistamines' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antihistamines' category.

  Example product in the source data (US market): Flextra

• antivertigo agents

  The recommended maximum number of medicines in the 'antivertigo agents' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antivertigo agents' category.

  Example product in the source data (US market): Phenohytro

• decongestants

  The recommended maximum number of medicines in the 'decongestants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'decongestants' category.

  Example product in the source data (US market): Triaminic

• decongestants

  The recommended maximum number of medicines in the 'decongestants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'decongestants' category.

  Example product in the source data (US market): Aspirin/chlorpheniramine/dextromethorphan/phenylpropanolamine

• decongestants

  The recommended maximum number of medicines in the 'decongestants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'decongestants' category.

  Example product in the source data (US market): Hycomine