Paracetamol + Promethazine Pharmacology
Paracetamol + Promethazine
Paracetamol
It is more active on cyclo-oxygenase enzyme in brain. Peripherally it is a poor inhibitor of prostaglandin synthesis.
Analgesic action: Paracetamol raises the pain threshold and produces analgesic effect.
Antipyretic action: Paracetamol lowers fever by direct action on the thermoregulatory centre in the Hypothalamus and block the effects of endogenous pyrogen.
Distribution: It is distributed mostly in the body in unbound form.
Metabolism: It is extensively metabolised in the liver.
Excretion: Excreted in the urine.
2. Abdominal distress
3. Allergic reactions
4. Rash
2. Renal impairment
3. Hypertension
NEONATES : Contraindicated
2. Acute gout
3. Migraine
Charcoal: Activated, administered immediately reduces absorption of paracetamol.
Domperidone and metochlopramide: Enhance absorption of paracetamol.
Alcohol: Chronic excessive ingestion of alcohol potentiates hepatotoxicity of paracetamol.
Zidovudine: Effects zidovudine may be decreased.
500 - 1000 mg in 3 times daily
Maximum dose: 4 g / day
For migraine: 500 mg to be taken at the first sign of migraine attack and repeated 4 - 6 hourly until suppress mild attacks.
Children:
60 mg / kg body weight /day in 4 divided doses.
Maintenance dose: 75 mg / kg orally every 4 - 6 hours for 2 - 3 days. Haemodialysis can be done in emergency conditions.
Promethazine
Antiemetic and Antivertigo actions: The central antimuscarinic actions of antihistamines are responsible for their antivertigo and antiemetic effects. They suppress end organ receptors or inhibit central cholinergic action. It also acts on Chemoreceptor trigger zone.
Migraine: Promethazine is used in migraine due to its sedative as well as antiemetic actions.
Anaesthetic adjuncts: Promethazine is used as anaesthetic adjunct due to its sedative, antiemetic and anticholinergic properties.
2. Extrapyramidal reactions
3. Drowsiness
4. Sedation
5. Dizzines
6. Hypotension
7. Dry mouth
8. Constipation
9 .Blurred vision
10. Agranulocytosis
11. Photosensitivity
12. Insomnia
13. Weight gain
14. Cholestatic jaundice
2.Comatose
3.Blood dyscrasias
4.Patient taking antidepressants
5.Liver damage
2. Hepatic impairment
3. Cardiovascular disease
4. Pheochromocytoma
5. Hypocalcaemia
6. Epilepsy
7. Cholestatic jaundice
8. Patient exposed to extreme heat or cold or phosphorus insecticides
9. Ceribrovascular disorder
10. Patient on ECT
11. Reaction to Insulin
12. Prostatic hyperplasia
13. Glaucoma
14. Peptic ulcer
15. Slowly withdraw the drug with caution
CHILDREN (below 2 years): Contraindicated
NEONATES: Contraindicated
2. Nausea
3. Sedation
4. Allergy
5. Migraine
6. Vertigo
7. Anticough ingredient
8. Anaesthetic adjuncts
Aluminium salts: Decrease efficacy.
Antacids should be given 1 hour before or 2 hours after promethazine.
Anticholinergics: Decrease efficacy and increase the anticholinergic side-effects of promethazine.
Barbiturates: Decrease efficacy.
Barbiturate anaesthetics: Increase frequency and severity of neuromuscular excitation and hypotension.
Bromocriptine: Efficacy decreased by promethazine.
Charcoal: Prevents absorption of promethazine.
Lithium: Disorientation, unconsciousness and extrapyramidal symptoms.
Meperidine: Excessive sedation and hypotension.
TCAs: Serum concentration increased by promethazine.
Propranolol: Increased plasma levels of both drugs.
MAOIs: Additive orthostatic hypotensive effect.
Lab tests: Pregnancy tests: False positive results.
Plasma bound iodine (PBI): Increase in PBI occurs.
Motion sickness: 50 mg / day in 2 divided dose
Allergy: 25 mg at bed time
Nausea: 12.5 - 25 mg / day
Sedation: 25 - 50 mg at bed time
Children:
Motion sickness: 12.5 - 25 mg / day
Allergy: 6.25 - 12. 5 mg 3 times a day
Sedation: 12.5 - 25 mg at bed time
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