Moving beyond promethazine: Advancing precision in antiemetic therapy
Abstract
Promethazine has long been a cornerstone in the management of nausea and vomiting (N/V) in emergency medicine; however, its safety profile-including risks of severe tissue injury and respiratory depression-has prompted renewed scrutiny. Nausea and vomiting arise from complex interactions between central and peripheral pathways involving the chemoreceptor trigger zone, vagal afferents, and multiple neurotransmitter systems, including dopamine (D2), serotonin (5-HT3), histamine (H1), muscarinic (M1), and neurokinin-1 (NK1) receptors. This manuscript presents a focused narrative review and expert commentary examining the evolving role of promethazine in modern clinical practice. Drawing on regulatory guidance, contemporary literature, and institutional experience, we evaluate the risks associated with injectable promethazine and the rationale for transitioning toward safer alternatives. At our institution, removal of injectable promethazine from the formulary was guided by multidisciplinary consensus and aligned with updated safety recommendations. Alternative agents, including dopamine antagonists and 5-HT3 receptor antagonists, provide comparable or superior efficacy with improved safety profiles. Advances in antiemetic therapy now support a multimodal, receptor-targeted approach, combining agents that act on complementary pathways to improve symptom control while minimizing adverse effects. While clinical contexts such as chemotherapy-induced and postoperative nausea and…
Read the paper
Related studies
- Patient-Centered Pharmaceutical Design to Improve Acceptability of Medicines: Similarities and Differences in Paediatric and Geriatric Populations
- Evidence-based clinical practice guidelines for irritable bowel syndrome 2020
- Phase 2b Study of Pimodivir (JNJ-63623872) as Monotherapy or in Combination With Oseltamivir for Treatment of Acute Uncomplicated Seasonal Influenza A: TOPAZ Trial
- Gastrointestinal manifestations in COVID-19
- COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist
- Persistent gut barrier damage and commensal bacterial influx following eradication of Giardia infection in mice
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.