Drug interactions
Hydromorphone + Promethazine
Severity: Major
Hydromorphone and Promethazine: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Promethazine and hydromorphone both depress the central nervous system, and together can produce profound sedation, respiratory depression and hypotension. Promethazine may also increase opioid-induced sedation while not providing reliable analgesic enhancement.
What this interaction means in plain words
Hydromorphone and Promethazine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Hydromorphone belongs to Musculoskeletal; Promethazine belongs to Respiratory.
Why it happens
Additive CNS and respiratory depression through opioid receptor agonism and H1 antagonism.
What to do
Use the lowest effective doses, reduce the opioid dose initially, and monitor sedation and respiratory rate closely. Avoid in patients with respiratory compromise or when other depressants are used.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Promethazine
- Ibutilide + Promethazine Contraindicated
- Pimozide + Promethazine Contraindicated
- Promethazine + Thioridazine Contraindicated
- Alfentanil + Promethazine Major
- Amiodarone + Promethazine Major
- Amisulpride + Promethazine Major
Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Hydromorphone with Promethazine?
MediHelp rates the interaction as major. Hydromorphone and Promethazine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Promethazine and hydromorphone both depress the central nervous system, and together can produce profound sedation, respiratory depression and hypotension. Promethazine may also increase opioid-induced sedation while not providing reliable analgesic enhancement.
How serious is the interaction between Hydromorphone and Promethazine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the lowest effective doses, reduce the opioid dose initially, and monitor sedation and respiratory rate closely. Avoid in patients with respiratory compromise or when other depressants are used.
What other medicines interact with Promethazine?
MediHelp also lists interactions of Promethazine with, for example, Ibutilide, Pimozide, Thioridazine. The full list is on the Promethazine page.
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