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Annulare, ichthyoses, cutaneous graft versus host disease, lichen amyloidosis, lichen planus, mycosis fungoides, prurigo nodularis, psoriasis, pityriasis rubra pilaris, scleredema, and vitiligo. Many of these treatment options come from case reports about resistant forms of diseases, and the efficacy of bath PUVA in treating these individual diseases has not been extensively studied. The option of bath PUVA at a treatment center will enhance a clinic's range of treatable disease and encourage use of bath PUVA for dermatoses nonresponsive to other modalities. Tablets , promethazine hydrochloride 10 mg, 25 mg Elixir Oral solution ; , promethazine hydrochloride 5 mg 5 ml Injection Solution for injection ; , promethazine hydrochloride 25 mg ml, 2-ml ampoule Uses: nausea, vomiting, labyrinthine disorders, motion sickness; premedication section 1.3 ; Contraindications: porphyria Precautions: prostatic hypertrophy; urinary retention; glaucoma; hepatic disease Appendix 5 epilepsy; elderly and children more susceptible to adverse effects pregnancy Appendix 2 breastfeeding Appendix 3 interactions: Appendix 1.
Promethazine, the parent member of this series, is moderately potent by present-day standards with prolonged action and pronounced sedative side effects. In addition to its antihistaminic action, it is a potent antiemetic, anticholingeric and sedating agent, and significantly potentiates the action of analgesic and sedative drugs.23 The other members of this series display a similar pharmacologic profile and thus may cause drowsiness and so may impair the ability to perform tasks requiring alertness. Also concurrent administration of alcoholic beverages and other central nervous system depressants with the phenothiazines should be avoided. In general, lengthening of the side chain and substitution of lipophilic groups in the 2-position of the aromatic ring results in compounds with decreased antihistaminic activity and increased psychotherapeutic properties. The enantiomers of promethazine have been resolved and have similar antihistaminic and other pharmacologic properties as described below.33 This is in contrast with studies of the pheniramines and carbinoxamine compounds in which the chiral center is closer to the aromatic. Physicians are welcome to request copies of our pre-printed order sheets. Gastrointestinal: Bowel Program step wise regimen ; a Docusate 100mg po 1 cap BID b Senna Senokot ; or Bisacodyl Dulcolax ; po 1 q day c Senna or Bisacodyl 1 tab BID d Senna or Bisacodyl 2 tab BID e Senna or Bisacodyl 3 tab BID f Senna 4 tabs BID plus Lactulose 15 ml q day g Senna 4 tabs BID plus Lactulose 15 ml BID h Senna 4 tabs BID plus Lactulose 30 ml BID i Fruit paste and or Senna Tea Diarrhea Clear liquids, plus one of the following: Kaolin mixture per bottle directions Loperamide tab po after each loose stool up to 8 doses qd Diphenoxylate hydrochloride 5 mg po after each stool up to 8 doses per day Nausea Vomiting NPO until vomiting subsides Prochlorperazine 10 mg po or 25 mg suppository pr q 6 prn Promethazie 25 mg po or 25 mg suppository pr q 4 - prn Reglan 10 mg po ac and HS CNS Sleep Pattern Disturbance and Anxiety Diphenhydramine 25 mg q HS prn Lorazepam 1 mg - 1 tab po SL q prn Zolpidem Ambien ; 10 mg 1 2 - 1 tab po q HS prn Zaleplon Sonata ; 5 - 10 mg po qHS prn Secretion Management Atropine 0.5 mg IM SQ po q hours prn Hyoscyamine Levsin ; gtts, po SL 1 - 2 gtts. prn Oxybutynin Ditropan ; 5 - 10 mg po q 8 hrs prn Mouthcare of Choice Artificial Saliva Viscous Lidocaine as directed Candidiasis oral perineal ; Nystatin suspension swish swallow QID X 7 days Clotrimazole troches 5 times a day x 7 days Fluconazole 100 mg po 2 tabs first day; then 1 tab qd for 4 days Miconazole clotrimazole vaginal cream; one applicator at bedtime x 7 days Antifungal cream topically prn. Dyspnea Bedside fan Oxygen at 1 - 3 per nasal cannula prn Lorazepam 1 mg tabs - 1 tab po q 6 hours prn Morphine 2 - 10 mg po SL q 4 hours prn and loratadine.

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Educational Objective s ; Understand the mechanism of action of different anti-emetics. Understand how to select an anti-emetic based on the cause of nausea vomiting. What's the difference between Compazine prochlorperazine ; and Phenergan promethazine ; ? By understanding the pathophysiology of nausea and targeting antiemetics to specific receptors, therapy can be optimized and side effects minimized. An easy way to remember the causes of vomiting is to use the VOMIT acronym. In the table below receptors involved in different types of nausea are highlighted using this acronym. Blockade of these receptors allows rational, focused therapy. Type of Nausea- V estibular and methylprednisolone. FIG. 2. This illustration compares the appearance of the gross morphology of the control A ; and the E2B-treated B ; testis T ; and epididymis. The regions. Every year, hip fractures send 300, 000 people to the hospital and desloratadine.
Experience to judge their safety and effectiveness. National EMLs should therefore be updated regularly for instance, every year or two. Essential medicines lists for NGOs CBOs: Based on local treatment needs, NGOs CBOs providing HIV AIDS-related treatment can make their own EML, using the national Eml or the WHO Model list of essential medicines as an example. If the NGO CBO works mainly in the community, it should try to work in line with government guidelines and EMLs for primary health care. It should include only the drugs that are essential for the organization's specific work. In this way, NGO CBO staff can learn more about the effects and use of the limited range of drugs and ensure that reliable supplies continue to be available. An NGO CBO involved in HIV AIDS-related treatment might include the following on its EML: drugs drugs drugs drugs drugs for for for for for pain or fever, such as aspirin, paracetamol or morphine; infection, such as co-trimoxazole; diarrhoea, such as oral rehydration salts and charcoal tablets; skin problems, such as calamine lotion and promethazine tablets; and nutrition problems, such as vitamins and iron. Table 13. Drugs affecting the performance of skin tests Suppression Treatment Anti-H1 histamines Cetirizine Chlorpheniramine Desloratadine Ebastine Hydroxyzine Levocabastine topical ; Levocetirizine Loratadine Mequitazine Mizolastine Promerhazine Ketotifen Anti-H2 histamines Cimetidine ranitidine Imipramines Degree + + + Possible + + + Duration days ; 310 13 310 Clinical Significance Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Table 13. Continued Suppression Treatment Phenothiazines 132 ; Glucocorticosteroids Systemic, short term Systemic, long term Inhaled Topical skin Theophylline Cromolyn 2-Agonists Inhaled Oral, injection Formoterol Salmeterol Dopamine Clonidine Montelukast Specific immunotherapy Degree + 0 Possible 0 0 to Unknown Unknown + + 0 Duration days ; ? Clinical Significance Yes and cyproheptadine.

We do have our own support groups of people living with HIV who are on treatment but those are small groups of people. It wasn't easy to have them, we had to lobby with decision makers as they implemented treatment programmes, we needed to add credibility to what they were saying by having people who are visibly HIV-positive put on treatment. JAMES KAMAU, KENYA We do a lot of group therapy in one of my organisations I'm involved with. They come together for support. Every other weekend we have group therapy where a certain topic is discussed and people share their experiences. We advise on nutrition and symptoms. You find that within the group, they find a solution. You find they encourage each other. Our churches are not engaging in AIDS, other than talking. The church movement would be a fantastic base, so the Church needs to be educated fully on these issues. They need to actually get involved. DELME CUPIDO, NAMIBIA.
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Agent Promethaizne Phenergan ; Dosage in children 0.25 to 0.5 mg per kg per dose three times daily Forms used in children Tablets: 12.5, 25, 50 mg Syrup: 6.25, 25 mg per 5 ml Suppositories: 12.5, 25, 50 mg Capsules: 100, 250 mg Suppositories: 100 mg Tablets: 5, 10, 25 mg Syrup : 5 mg per 5 ml Suppositories: 2.5, 5, 25 mg and ketotifen. Please do not take any medications in the following drug categories or any listed below seven 7 ; days prior to your initial appointment or for scheduled allergy skin testing. Medications with a longer avoidance time are noted. You may resume these medications after testing. While the following represents a list of the most common medications to avoid, it does not represent an exhaustive list that should be avoided. If you have questions about a medication you are taking and whether or not it should be avoided, please contact us and ask to speak with our nursing staff-- 865 ; 525-2640. All over the counter cough, cold or allergy medications All appetite suppressants All allergy eye drops All anti-depressants All topical corticosteroids creams or lotions ; applied to the back and arms All anti-emetics anti-vomiting or anti-nausea ; All anti-histamines Any of the following or any combination drug medication containing any of the following: Aclovate on back or arms ; Actifed Alavert Allegra products Allerhist Amitriptyline Antivert Astelin Atarax Ativan Atrohist Bactin on back or arms ; Benadryl products Bromfed Brompheniramine Buspar Cetirizine Chlorpheniramine Chlortrimeton products Cimetidine Clariten products Clarinex Clemastine Corticaine Cyproheptadine Codimal D.A. II Deseryl Dexamethazone on back or arms ; Dimetane Diphenhydramine Doxepin Dramamine Drixoral Dura-Vent DA Ebastine Elavil 42 days Elocon on back or arms ; Extendryl Famotidine Fexofenadine Hismanal 60 days Hycomine Hydrocortizone on back or arms ; Hydroxyzine Imipramine Kenalog on back or arms ; Kronofed Kwelcof Lanacort on back or arms ; Levocabastine Livostin Loratidine Marezine Meclizine Mellaril Mequitazine Naphcon A Nolahist Nolamine Optivar Pamelor 42 days Patanol Periactin Phenergan products Prome6hazine Prozac Rynatan Rynatuss Semprex Sinulin Sinequan Tavist Topicort on back or arms ; Trinilin Tussionex Tylenol Allergy Sinus Tylenol Zoloft Visteril Zyrtec Xyzal. The cost of health care is rising; every dollar counts. With that in mind, SilverScript created Value Tier Generics with a low co-payment at preferred network pharmacies. Choose Value Tier Generics and Save Money Today! The Value Tier Generic drug list outlines some of the most common generic medications that you will pay a lower co-payment for when purchased at a preferred pharmacy. Preferred pharmacies include CVS and Caremark Mail Service Pharmacies. allopurinol * amitriptyline HCL * amoxicillin * atenolol * bacitracin betamethasone valerate captopril * chlorthalidone * chlorzoxazone * ciprofloxacin HCL * dexamethasone * digoxin * diphenhydramine * doxycycline * erythromycin eye ointment estradiol * fluocinolone * fluocinonide furosemide * gentamicin * glipizide * hydrochlorothiazide * hydroxyzine pamoate * ibuprofen * indapamide * isoniazid * isosorbide dinitrate * klor-con meclizine * methylprednisolone * metoprolol * metronidazole * nortriptyline HCL * nystatin penicillin VK * phenazopyridine * prednisone * promethazine propranolol * sulfacetamide tetracycline * tobramycin trazodone * triamcinolone * verapamil and cetirizine.
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Promethazine HCl occurs as a white to faint yellow, practically odorless, crystalline powder which slowly oxidizes and turns blue on prolonged exposure to air. It is freely soluble in water and soluble in alcohol. CLINICAL PHARMACOLOGY Promethazine is a phenothiazine derivative which differs structurally from the antipsychotic phenothiazines by the presence of a branched side chain and no ring substitution. It is thought that this configuration is responsible for its relative lack l l 0 that of chlorpromazine ; of dopamine antagonist properties. Promethazine is an Hr receptor blocking agent. In addition to its antihistaminic action, it provides clinically useful sedative and antiemetic effects. DECONGEST B3R ; BROMPHENIRAMINE- DEXTROMETHORPHANPSEUDOEPHEDRINE CARBINOXAMINE DEXTROMETHORPHAN -PHENYLEPHRINE CARBINOXAMINE DEXTROMETHORPHAN -PSEUDOEPHEDRINE CHLORPHENIRAMINE- DEXTROMETHORPHAN PHENYLEPHRINE RX & OTC ; CHLORPHENIRAMINE -DEXTROMETHORPHAN PSEUDOEPHEDRINE DEXBROMPHENIRAMINE- DEXTROMETHORPHAN PHENYLEPHRINE DEXCHLORPHENIRAMINE- DEXTROMETHORPHAN PSEUDOEPHREDRINE PYRILAMINE DEXTROMETHORPHAN -PHENYLEPHRINE BROMPHENIRAMINE- CARBETAPENTANE-PHENYLEPHRINE CHLORPHENIRAMINE- CARBETAPENTANE -PHENYLEPHRINE DIPHENHYDRAMINE- CARBETAPENTANE -PHENYLEPHRINE CHLORPHENIRAMINE- PYRILAMINE CARBETAPENTANE -PHENYLEPHRINE NON-NARC ANTITUS-1ST GEN ANTIHIST-DECONGESTEXPECT B3S ; BROMPHENIRAMINE- CHLORPHENIRAMINE- DEXTROMETHORPHAN PHENYLEPHRINE- GUAIFENESIN PYRILAMINE DEXTROMETHORPHAN PHENYLEPHRINEPOTASSIUM GUAIACOLSULFONATE NON-NARCOTIC ANTITUSSIVE AND EXPECTORANT COMB. B3T ; GUAIFENESIN-DEXTROMETHORPHAN RX & OTC ; GUAIFENESIN-CARBETAPENTANE POTASSIUM GUAIACOLSULFONATE- DEXTROMETHORPHAN 1ST GEN COMB B3X ; ALKALOIDS ALKALOIDS 1ST GEN CMB B3Y ; NARCOTIC ANTITUSSIVE-ANTICHOLINERGIC COMB. B4C ; HYDROCODONE -HOMATROPINE NARCOTIC ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE B4D ; PROMETHAZINE W CODEINE PA required if 2 years of age ; NON-NARC ANTITUSSIVE-1ST GEN ANTIHISTAMINE COMB. B4E ; CARBETAPENTANE -CHLORPHENIRAMINE DEXTROMETHORPHAN-PROMETHAZINE PA required if 2 years of age ; NON-NARC ANTITUSSIVE-1ST GEN ANTIHIST-EXPECT COMB. B4I ; GUAIACOLSULFONATE NARCOTIC ANTITUSSIVE-DECONGESTANT COMBINATIONS B4K ; HYDROCODONE-PSEUDOEPHEDRINE HYDROCODONE-PHENYLEPHRINE NON-NARCOTIC ANTITUSSIVE-DECONGESTANT COMBINATIONS B4L ; CARBETAPENTANE-PHENYEPHRINE CARBETAPENTANE-PSEUDOEPHEDRINE and montelukast.
Treatments such as cold compresses, systemic antihistamines such as promethazine hcl, pain relievers, and reduced exposure to the allergen.

Case report A 72-year old patient, diagnosed as paranoid schizophrenic according to DSM-IV, first became ill at 30 years. In August 2003, she was living in an institution. Her speech was disorganized and poor, and its content was non-systematic and paranoid. She took no part in activities and waited passively for family visits. During this period she was in use of haloperidol 1 mg, promethazine 25 mg, estazolam 2 mg and clonazepam 2 mg only when aggressive ; . In August 2003, aripiprazole was introduced, initially at a dose of 7.5 mg day, which was increased to 15 mg day one month later. The other medications were stopped except for estazolam. In October 2003, she appeared happier, more active and communicative. In January 2004, she had a psychotic outbreak with paranoid delusion and aggression. On this occasion, trifluoperazine was introduced at a dose of 7.5 mg day, and aripiprazole was maintained at 15 mg day. In April 2004, the patient's positive symptoms had improved, and in May trifluoperazine was stopped and aripiprazole 15 mg was maintained. Two weeks later the positive symptoms, paranoid delusion and aggression, returned and trifluoperazine was reinitiated at 7.5 mg day. Aripiprazole was reduced to 7.5 mg day, while trifluoperazine was maintained at 7.5 mg day until August 2004. The patient became apathetic, and trifluoperazine was then stopped in January 2005. In March 2005, the patient was receiving 7.5 mg of aripiprazole, she had no prominent paranoid symptomatology; however, her speech was disorganized and poor, she had a significant reduction in memory fixation, spoke very slowly and stiltedly. In June 2005, memantine 10 mg day ; was added. In the following six months, the patient underwent an improvement in mood, requested to participate in social activities, became more communicative, and had a significant improvement in verbal fluency. In January 2006, memantine was stopped and after two months the patient became apathetic, her verbal fluency deteriorated again, she spoke stiltedly, was non-participative and made no requests. In March 2006, memantine was reintroduced at 10 mg day and the patient became livelier again. She once again requested relatives to allow her to take part in gymnastics and to go out more. Three other clinical cases have been reported on the improvement in negative symptoms following the association of memantine in female patients who had been and escitalopram. To report any unexpected adverse or serious events associated with the use of this drug, please contact the FDA MedWatch program using the contact information at the bottom of this sheet. Considerations Healthcare professionals, other caregivers, and patients should consider the following: All medications containing promethazine HCl--syrups, suppositories, injectables, and tablets-- are contraindicated for use in pediatric patients less than two years of age because of the potential for fatal respiratory depression. Caution should also be exercised when administering promethazine HCl medications to pediatric patients two years of age and older. Wyeth, a company which markets tablets and suppositories under the brand name Phenergan, has changed the product labeling to show that the drug is contraindicated in children under two. Wyeth sent a letter to healthcare professionals, alerting them of the labeling change for their tablet and suppository products. Wyeth is not marketing syrups, but some generic companies still do. The generic labels also have been changed. Data Summary Promethazine HCl, an antihistamine, is marketed as tablets, suppositories, injectables, and syrups. The drug is not for children under two, because it can cause serious side effects, including respiratory depression that could be fatal. FDA has received reports of serious adverse events, including seven deaths in children under two. The FDA sent a letter to the editor of the New England Journal of Medicine NEJM ; explaining the context for the seven deaths, based on a 2004 review of the Adverse Event Reporting System: Starke P. R., Weaver J., Chowdhury B. A., N Engl J Med 2005; 352: 2653 : content.nejm cgi content full 352 25 2653?ijkey xNrx2F2RcFfHc&keytype ref&site id nejm. Placebo at relieving the symptoms of headache. Ibuprofen was more effective than acetaminophen.17 [Evidence level A, RCT] A similar trial18 comparing 25 mg of ketoprofen with 1, 000 mg of acetaminophen reported that both agents were significantly more effective than placebo at two hours after dosing but no better than placebo in achieving total pain relief at four hours after dosing. This result probably reflects the short duration and self-limiting nature of the episodic tensiontype headache.18 [Evidence level A, RCT] In patients with chronic tension-type headache, the treatment goals are to initiate effective prophylactic treatment and to manage any residual headaches in a manner that prevents the frequent use of analgesics and the risk for progression to chronic daily headache syndrome. Patients with chronic tension-type headache should limit their use of analgesics to two times weekly to prevent the development of chronic daily headache. If the patient requires analgesic medication more frequently, adjunctive headache medications can be initiated. Analgesics can be augmented with a sedating antihistamine, such as promethazine Phenergan ; and diphenhydramine Benadryl ; , or an antiemetic, such as metoclopramide Reglan ; and prochlorperazine Compazine ; . If this regimen is inadequate, the patient can try acetaminophen or aspirin combined with caffeine and butalbital. This combination is usually quite effective but is also the most frequent cause of chronic daily headache. Before initiating this regimen, patients should be informed of the possibility of chronic daily headache and instructed to limit their use of the combination to twice weekly. The physician should carefully monitor the patient's progress and prescribe only enough medication to support this limited usage and clozapine and Order promethazine.

One of these experiments, listed in table 8 , shows additional important points: pi by itself does not induce stimulation of na + exchange, but it is able to restore the mgatp stimulation that had been lost by treatment of the vesicles with pi-plc in addition, in the absence of atp, pip 2 produces a stimulation of the exchanger similar to that obtained with 1 mm of the nucleotide plus 200 µ m pi. This again equals the known pregnancy rate on compliant coc usage: per 1, 000 woman years 13, 000 cycles ; of use and sertraline. Monitor BP, PR, SaO2 frequently and observe for 4-6 hours. This is essential after Adrenaline administration due to rebound anaphylaxis. Consider transfer if reaction severe and may recur Give reassurance. Keep patient rested Discharge home on oral H1 and H2 receptor antagonists eg. promethazine and ranitidine for 2 days. Consider short course of oral steroids. Advise the patient about Adrenalin puffers and Epipens if it is recurrent problem All patients who require adrenaline therapy for allergic reactions should be referred to the Immunology or Allergy Clinic.

A 53-year-old woman went hiking in the foothills of Mount Hamilton in Santa Clara County on September 1, 2001, where she swam in a muddy pond. Eleven days later, she had the onset of shaking chills, fever of 38.9C, myalgias, ankle and wrist pain, and headache. Her fever resolved, but 4 days later nausea, vomiting, diarrhea, and a worsening headache developed and she went to urgent care. Initial laboratory test results including cerebrospinal fluid, blood urea nitrogen, and creatinine were normal, and she was treated for gastroenteritis with promethazine HC1 and fluids. Three days later, oliguria developed. On September 19, she was admitted with oliguric renal failure and signs including an erythematous macular rash on her face and pretibial macular blanching lesions on her legs. Over the next few days, a persistent cough with rales developed, and peak levels of blood urea nitrogen were 101 and creatinine were 9.5. Urinalysis showed 1 + blood, 610 erythrocytes, 03 leukocytes, and 3 + protein. Though her leukocytes were normal at 5.9 x 109 L with 84% polymorphonuclear. Potentially suicidal patients should not have access to large quantities of this drug.

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Made the response more sensitive and the detection limit was down to 1.010-9 M after 5 minutes accumulation by using differential pulse voltammetry. Ni et al. studied the voltammetric behavior of promethazine hydrochloride and chlorpromazine hydrochloride at a glassy carbon electrode in BrittonRobinson buffer of pH 9.0 [7]. They proposed a method for the simultaneous determination of them, which is based on their oxidation at a glassy carbon electrode and a multivariate calibration method. Carbon nanotubes CNTs ; can promote electron-transfer reactions and improve sensitivity, so CNTs based electrodes are widely used in electrochemistry field [10-13]. Some phenothiazine derivatives were studied and determined with CNTs -based electrodes. For example, Zeng et al. fabricated a multi-walled carbon nanotubes 3-mercaptopropyl ; trimethoxysilane bilayer modified gold electrode for fluphenazine determination and got a satisfactory result [14]. But the electrode preparation was more complicated. To our knowledge, there are no reports on the detection of promethazine with a multi-walled carbon nanotubes coated electrode. The purpose of this work is to explore the voltammetric behavior of promethazine on MWNTs Au electrodes and the feasibility to detect it with a simple CNTs-based electrode. 2. EXPERIMENTS 2.1. Apparatus Electrochemical experiments were performed on a CHI 660B electrochemical workstation CH Instrumental Company, Shanghai, China ; with a conventional three-electrode cell. A gold electrode or a MWNTs Au electrode served as working electrode, a saturated calomel electrode SCE ; and a platinum wire served as reference and auxiliary electrode, respectively. The pH values of solutions were measured with a pHS-3C pH meter Shanghai, China ; . 2.2. Chemicals Promethazine was purchased from Jiufu Pharmaceutical Company Shanghai, China ; and used as received. The stock solution of promethazine 5.0 mM ; was prepared with ethanol. The multi-walled carbon nanotubes Diameter: 10 nm; Length: 1-2 m ; was obtained from Shenzhen Nanotech Port Co. Ltd Shenzhen, China ; . The medicine sample came from Changzhou Pharmaceutical Company Jiangsu, China ; . Prior to determination, it was ground into powder, dissolved in ethanol and then filtered into a container. A standard addition method was used to assay it. Other reagents used were analytical or reagent grade, and water used was redistilled. 2.3. Preparation of MWNTs modified electrode Prior to modification, the gold electrode was polished with 0.3 and 0.05 m alumina slurries, rinsed with double distilled water, and then ultrasonicated for 3 min in a water bath. The multi-walled carbon nanotubes was dispersed in N, N-Dimethylformamide DMF ; with the aid of ultrasonic agitation to prepare 1.0 mg ml-1 MWNTs suspension. The MWNTs Au electrode was fabricated by dropping 5.0 L MWNTs suspension on the Au electrode surface and evaporating the solvent. Radiation from the handset can cause insomnia, headaches and confusio why mobile phones could disturb your sleep.

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Discussion Ketamine is a raecemic mixture containing equal part of S- + ; and R ; ketamine. R ; ketamine is presumed to produce undesired psychic emergence reaction.3 Actual neurochemical basis for emergence is still unknown but different neurochemicals and receptors have been implicated for its occurrence viz. NMDA, opiate, dopamine, acetylcholine etc. Various drugs have been tried to prevent or treat these side effects viz diazepam, lorazepam, flunitrazepam, droperidol, narcotics, midazolam, chlorpromazine, and promethazine with various success rates.1, 4-7 In our study much lower incidence of emergence phenomenon has been noted with midazolam and pentazocine with diazepam as compared to diazepam alone; results are similar to various other studies.8, 9 Promethazine belongs to phenothiazine group of drugs which was developed in 1944 as an antipsychotic drug but later due to lack of its efficacy and discovery of more potent and safer drugs, its use in psychosis has been reduced. Now this drug is being used for various anxiety and apprehensive states due to its sedative and antihistaminic properities. 22 out of 26 84.5% ; patients had excellent control of various symptoms of emergence reaction. All these patients were well sedated but arousable and had no further nausea and vomiting. In our opinion this response is best attributed to its sedative, anxiolytic and antiemetic properties. However further studies to know its exact mechanism in emergence phenomenon are needed. We conclude that pentazocine and midazolam significantly reduce the incidence whereas promethazine effectively control the symptoms of emergence phenomenon. I'm going in soon for my annual check up and i'm inclined to press for the generic. WARNINGS - CNS Depression and PRECAUTIONS - Drug Interactions ; . Pediatric patients should be supervised to avoid potential harm in bike riding or in other hazardous activities. Patients should be advised to report any involuntary muscle movements. Avoid prolonged exposure to the sun. Drug Interactions CNS Depressants - Promethazine hydrochloride tablets, USP may increase, prolong, or intensify the sedative action of other central-nervous-system depressants, such as alcohol, sedatives hypnotics including barbiturates ; , narcotics, narcotic analgesics, general anesthetics, tricyclic antidepressants, and tranquilizers; therefore, such agents should be avoided or administered in reduced dosage to patients receiving promethazine hydrochloride. When given concomitantly with promethazine hydrochloride tablets, USP the dose of barbiturates should be reduced by at least one-half, and the dose of narcotics should be reduced by one-quarter to one-half. Dosage must be individualized. Excessive amounts of promethazine hydrochloride relative to a narcotic may lead to restlessness and motor hyperactivity in the patient with pain; these symptoms usually disappear with adequate control of the pain.

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