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At least 631 records · Page 35Linked to original sources
PubMed2005

Motion-sickness medications for aircrew: impact on psychomotor performance.

INTRODUCTION: Motion sickness remains a significant problem for aircrew both in the flying environment (airsickness) and for aircrew deployed at sea (seasickness). While some anti-motion-sickness medications provide reasonable efficacy, adverse neurocognitive effects limit their use in military personnel engaged in safety-sensitive operational roles such as flying. The purpose of this study was to assess the impact on psychomotor performance of promethazine, meclizine, and dimenhydrinate and to determine if the addition of pseudoephedrine or damphetamine to promethazine would ameliorate its adverse effects. METHODS: There were 21 subjects (11 men, 10 women), aged 22-59, who were assessed for psychomotor performance on 4 tasks as well as with sleepiness and drug side-effects questionnaires. Psychomotor testing was conducted prior to, and for 7 h after, ingestion of a single dose of each of placebo, promethazine 25 mg, meclizine 50 mg, dimenhydrinate 50 mg, promethazine 25 mg plus pseudoephedrine 60 mg, and promethazine 25 mg plus d-amphetamine 10 mg. RESULTS: Relative to placebo, promethazine, meclizine, and promethazine plus pseudoephedrine impaired performance on all four tasks [serial reaction time (SRT), logical reasoning (LRT), serial subraction (SST), and multitask (MT)]. Dimenhydrinate impaired performance on the SRT only. Promethazine plus d-amphetamine did not impair performance on any task nor did it result in increased sleepiness. The times to recovery of normal performance for SRT with promethazine, meclizine, dimenhydrinate, and promethazine plus pseudoephedrine were > 7.25, 7.25, 4.25, and 7.25 h, respectively; for LRT were > 7.25, > 7.25, ns, and 7.25 h; for SST were > 7.25, > 7.25, ns, and 7.25 h; for MT were 7.25, 7.25, ns, and 7.25 h. Recovery times to baseline sleepiness levels for promethazine, meclizine, dimenhydrinate, and promethazine plus pseudoephedrine were 7.25, > 7.25, 6.25, and > 7.25 h. CONCLUSION: Only promethazine plus d-amphetamine was free from impact on psychomotor performance and did not increase sleepiness.

Adult↗
PubMed2005

Interaction of surface-active drugs in rabbits.

The interaction of chlorpromazine and promethazine in vivo has been investigated. The drugs were administered to the rabbit orally as a single dose (100 mg of each drug) as well as simultaneously with an interval of 15 min. The presence of multiple peaks at the separate administration of promethazine and chlorpromazine on the one hand, and increase of number of peaks, symbathic character of kinetic curves of mentioned drugs and its prolonged appearance in the systemic circulation of the blood by simultaneous administration on the other hand, may be explained by the intensive presystem metabolism and surface-activity ability of these drugs, and by the periodic 'lassitude' of liver for their capture and elimination (either presystem or systemic). The micelle formation from these drugs in the gastro-intestinal tract and formation of the mixed micelles on simultaneous administration were also taken into consideration. Chlorpromazine is more strongly captured by the liver at its first pass through it than promethazine, from comparison of pharmacokinetics of these drugs administered separately. Therefore, chlorpromazine on simultaneous administration occupies the sites of the liver which were covered by promethazine at single dose, thereby substituting promethazine and promoting its transferral into the systemic blood circulation. This results in a large increase in promethazine content in blood, additional peaks appear and the presence of promethazine in the blood is prolonged. The influence of chlorpromazine on the kinetics of promethazine is especially obvious when chlorpromazine enters the organism first and more easily occupies those sites in the liver which participate in the capture and elimination of both drugs. Concerning influence of promethazine on the kinetics of chlorpromazine, promethazine reinforces in some way the ability of liver to capture chlorpromazine, thereby intensifying the presystem metabolism of chlorpromazine and inhibiting its own metabolism. The analogous effect was observed in the study of the influence of promethazine on the kinetics of carbamazepine.

Animals↗
PubMed1984

Side effects of antimotion sickness drugs.

The possible influence on operational proficiency of the side effects of the anti-motion sickness drugs was investigated using a computerized pursuit meter as the test device. The medications and doses tested were scopolamine (Hyoscine) 0.25 mg and 0.50 mg oral doses, promethazine (Phenergan) 25 mg oral and 25 mg I.M. doses. Combinations of promethazine 25 mg with 10 mg d-amphetamine (Dexadrine) oral were also used, as was a combination of promethazine 25 mg oral with promethazine 25 mg I.M. and 10 mg of oral d-amphetamine. The proficiency on the pursuit meter task was not significantly altered by 0.25 mg or 0.50 mg doses of scopolamine. The combination of promethazine 25 mg oral with 10 mg d-amphetamine did not produce a significant decrement of performance. When promethazine 25 mg was given as an oral or I.M. dose without amphetamine the decrement of performance was significant and was approximately equivalent to an alcohol blood level of 25-50 mg% (one-two drinks). When a combination of promethazine 25 mg oral plus promethazine 25 mg I.M. with 10 mg d-amphetamine was tested, the error scores were significantly lower than with the oral or I.M. dose of promethazine. This combination also produced an error score significantly higher than placebo level. Promethazine by the I.M. route was slowly absorbed and 6 of the 10 subjects reported drowsiness at 6 h post injection.

Adolescent↗
PubMed1991

The discriminative stimulus effects of histamine H(1)-antagonists in pigeons.

Two groups of pigeons were trained to discriminate a histamine H(1)-antagonist (chlorpheniramine or promethazine) from saline with responding maintained under a fixed-ratio 30 schedule of food delivery. There was no cross-substitution with these two histamine H(1)-antagonists: that is, promethazine failed to substitute reliably for chlorpheniramine in chlorpheniramine-trained pigeons, and chlorpheniramine failed to substitute reliably for promethazine in promethazine-trained pigeons. Among the other histamine H(1)-antagonists tested, tripelennamine consistently produced greater than 80% responding in chlorpheniramine-trained pigeons but not in promethazine-trained pigeons. In contrast, diphenhydramine consistently produced greater than 80% responding in promethazine-trained pigeons but not in chlorpheniramine-trained pigeons. Similarly, chlorcyclizine partially substituted for promethazine and failed to substitute for chlorpheniramine. d-Amphetamine substituted for chlorpheniramine in 2 of 4 pigeons and partially in a third pigeon, whereas d-amphetamine substituted for promethazine in only 1 of 4 pigeons. Pentobarbital failed to produce greater than 80% responding in either chlorpheniramine- or promethazine-trained pigeons. The results of the present study demonstrate that the histamine H(1)-antagonists, chlorpheniramine and promethazine, have differential discriminative stimulus effects in pigeons. These findings suggest that the discriminative stimulus effects of this class of compounds are not based entirely on their ability to act as antagonists at histamine H(1)-receptors.

Journal Article↗
PubMed2006

Reduced interference by phenothiazines in amphetamine drug of abuse immunoassays.

CONTEXT: Emergency department physicians frequently request urine drug screens, but many are unaware of their limitations, including the potential for false-positive results. Promethazine, a phenothiazine derivative, is used for the treatment of allergies, agitation, nausea, and vomiting. Many patients taking promethazine are subject to urine drug screens and any potential interferences are important to recognize. DESIGN: During an 11-month period, all patients presenting to the Massachusetts General Hospital emergency department who had a finding of promethazine in their serum drug screen, and who also had a urine drug screen performed, were selected for inclusion in the study. The urine drug screen results (n = 22 patients/samples) were then studied. OBJECTIVE: To determine if promethazine use can cause false-positive urine amphetamine results in widely used drug of abuse immunoassays. RESULTS: Thirty-six percent of patients taking promethazine had false-positive test results for urine amphetamines using the EMIT II Plus Monoclonal Amphetamine/Methamphetamine Immunoassay. Sixty-four percent of patients showed cross-reactivity greater than 20% higher than the blank calibrator rate. In a separate, related study, no promethazine-induced false-positive results were seen with the EMIT II Plus, Triage, and TesTcard 9 amphetamine assays, or the Triage methamphetamine assay. Reduced chlorpromazine interference was also seen with these other assays. CONCLUSIONS: False-positive urine amphetamine results can be obtained in patients taking promethazine. Promethazine metabolite(s), and not the parent compound, are the likely cause of these urine false-positive results obtained with EMIT II Plus Monoclonal Amphetamine/Methamphetamine Immunoassay. Immunoassays from different manufacturers can have very different "interference" profiles, which the pathologist and laboratory scientist must understand and relay to clinicians.

Amphetamine↗
PubMed1998

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

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

Adult↗