promazine hydrochloride

CLINICAL USE

Antipsychotic for agitation and restlessness

DOSE IN NORMAL RENAL FUNCTION

Psychomotor agitation: 100–200 mg 4 times a dayAgitation and restlessness in elderly: 25–50 mg 4 times a day

PHARMACOKINETICS

As for chlorpromazine

Molecular weight :320.9

%Protein binding :95–98

%Excreted unchanged in urine : <1

Volume of distribution (L/kg) :7–20

half-life – normal/ESRD (hrs) :23–37/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Start with low doses and titrate slowly

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in GFR <10 mL/min

HD :Unlikely to be dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: increased risk of convulsions with tramadol; enhanced hypotensive and sedative effects with opioids

Anti-arrhythmics: increased risk of ventricular arrhythmias with anti-arrhythmics that prolong the QT interval – avoid concomitant use with amiodarone

Antibacterials: increased risk of ventricular arrhythmias with moxifloxacin – avoid concomitant use

Antidepressants: increased level of tricyclics (possibly increased risk of ventricular arrhythmias and antimuscarinic side effects)Anticonvulsant: antagonises anticonvulsant effect

Antimalarials: avoid concomitant use with artemether/lumefantrine

Antipsychotics: increased risk of ventricular arrhythmias with pimozide – avoid concomitant use

Antivirals: concentration possibly increased with ritonavirAnxiolytics and hypnotics: increased sedative effects

Atomoxetine: increased risk of ventricular arrhythmias

Beta-blockers: enhanced hypotensive effect; increased risk of ventricular arrhythmias with sotalol

Diuretics: enhanced hypotensive effect

Lithium: increased risk of extrapyramidal side effects and possibly neurotoxicity

Pentamidine: increased risk of ventricular arrhythmias

Sibutramine: increased risk of CNS toxicity – avoid concomitant use with drugs that prolong the QT interval

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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