Several hospitals have told us about nausea and vomiting prevention protocols they use to reduce the use of IV promethazine. For example, one pharmacist reported that patients receive ranitidine and dexamethasone preoperatively, and dolasetron 30 minutes before the end of surgery. Promethazine IV is used only as a last resort. As such, healthcare providers need to review their current practices associated with the administration of IV promethazine and establish safeguards to prevent inadvertent arterial injection and IV extravasation.
For 27 years, I have used IV promethazine 2 to 3 times every shift I work. I have personally never seen serious tissue damage or other major problems with this medication, aside from rare instances of local phlebitis that have resolved without incident. In my opinion, the benefits far outweigh the risks with IV promethazine…I have seen many good drugs go out of favor because of reported problems, which have almost always been disproportionate to their benefits. Most of these have been related to improper use or administration.
Thanks to all who completed the survey and those who sent messages to us about this complex issue. We hope that our recent article and survey have brought sufficient attention to this longstanding problem to drive needed changes in practice around the administration of IV promethazine. From the nearly 1, survey responses and many additional unsolicited comments we received, two things were abundantly clear: Promethazine extravasations that result in serious tissue damage are not rare; indeed, one in five respondents reported awareness of such an occurrence in their facility within the past 5 years While healthcare providers are frustrated with this longstanding problem for which there is no easy solution, many have been inspired to revisit the issue and take new measures to reduce the risk of patient injury from IV promethazine.
Create alerts. Build an alert to appear on computer-generated medication administration records MARs , electronic MARs, and on automated dispensing cabinet screens for nurses to view each time they access and administer a dose of promethazine, reminding them that the drug is a vesicant and should be diluted and administered slowly through a running IV. The manufacturer notes there is no proven successful management of unintentional intra-arterial injection or perivascular extravasation.
However, sympathetic block and heparinization have been employed during acute management of promethazine extravasations. Use alternatives. Consider safer alternatives that can be used for the various conditions treated with IV promethazine. For example, 5-hydroxytryptamine type 3 5-HT3 receptor antagonists may be used for both prophylaxis and as a rescue antiemetic.
Zofran goes off patent in late , so generic alternatives should be available by Also ensure that appropriate surgical patients are receiving a 5-HT3 for prophylaxis and are well hydrated to reduce the risk of post-operative nausea and vomiting and, thus, the need for a rescue antiemetic. Remove from formulary.
Some hospitals that have continued to experience adverse outcomes despite safety measures have removed promethazine from their formulary or banned its IV use.
Figure 1. Safe Practice Recommendations Along with the manufacturer recommendations, the following strategies should be considered to prevent or minimize tissue damage when giving IV promethazine.
Administer slowly. Consider administering IV promethazine over minutes. In general, antiemetics are not recommended for treatment of uncomplicated vomiting in children. Extrapyramidal symptoms that may occur in children receiving promethazine may be confused with signs of undiagnosed primary disease; thus the drug should be avoided in children whose signs or symptoms suggest the possibility of Reye's syndrome, hepatic encephalopathy or other hepatic disease.
In pediatric patients who are acutely ill associated with dehydration, there is an increased susceptibility to dystonic reactions with the use of promethazine. Promethazine is classified under FDA pregnancy risk category C.
Because there are no adequate studies in pregnant women, promethazine should be considered during pregnancy only when the benefits of therapy outweigh the risks to the fetus. Guidance regarding the use of promethazine during labor and obstetric delivery is varied. According to its manufacturers, promethazine may be used alone or as an adjunct to narcotic analgesics during labor.
Limited data suggest that its use is not associated with any appreciable effect on the duration of labor or delivery and does not increase the risk or need for intervention in the newborn; the effect on later growth and development of the newborn is unknown.
The effects of promethazine on respiration in the exposed neonate are unclear. Although respiratory depression was observed in a study including a small group of patients, data from three large studies demonstrated no such effect. Promethazine administered to a pregnant woman within 2 weeks of delivery may inhibit platelet aggregation in the newborn. Although the clinical significance of this is unknown, neonatal impairment is comparable to disorders associated with a definite bleeding state. Finally, diagnostic pregnancy tests based on immunological reactions between HCG and anti-HCG may result in false-negative or false-positive interpretations.
According to the manufacturer, it is not known whether promethazine is excreted in human milk, and accounting for its potential to cause harm to a nursing infant, a decision should be made whether to discontinue nursing or the drug. Like other phenothiazine derivatives, promethazine is expected to have low excretion into breast milk, and occasional short-term use is probably compatible with posing little risk to a nursing infant. However, if multiple doses are to be used, the infant should be monitored for excess sedation or paradoxical CNS stimulation.
Theoretically, promethazine can lower basal prolactin secretion and may interfere with the establishment of lactation. An antiemetic without a potent histamine blocking action, such as prochlorperazine, may be considered as an alternative.
Potential side effects include sedation in the infant. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.
If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA. Promethazine should be avoided, if possible, in patients with open-angle or closed-angle glaucoma and an H1-antagonist with less anticholinergic effects should be substituted. An increase in intraocular pressure may occur from the anticholinergic actions of the drug, precipitating an acute attack of glaucoma. Elderly patients are more susceptible to the anticholinergic effects of promethazine, including possible precipitation of undiagnosed glaucoma.
Other ocular effects resulting from the anticholinergic effects of promethazine include dry eyes or blurred vision. This may be of significance in the elderly and wearers of contact lenses. Promethazine has substantial anticholinergic effects and a worsening of symptoms may be seen in patients with bladder obstruction, GI obstruction or ileus, benign prostatic hypertrophy, or urinary retention. These precautions are most significant when using antihistamines from the ethanolamine or phenothiazine group.
In general, the elderly tend to be more susceptible to the anticholinergic effects of drugs since there is a decline in endogenous cholinergic activity that occurs with age. Use promethazine with caution in patients with cardiac disease or other conditions that may increase the risk of QT prolongation including cardiac arrhythmias, congenital long QT syndrome, heart failure, bradycardia, myocardial infarction, hypertension, coronary artery disease, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances.
Females, elderly patients, patients with diabetes, thyroid disease, malnutrition, alcoholism, or hepatic dysfunction may also be at increased risk for QT prolongation. Phenothiazines can lower the seizure threshold. Because of a potential increased risk of seizures, phenothiazines should not be used during intrathecal radiographic contrast administration.
Phenothiazines should be discontinued 48 hours before the myelography and should not be resumed until at least 24 hours after the procedure. Promethazine should not be used for the control of nausea and vomiting associated with these procedures.
Promethazine can cause drowsiness and CNS depression. Patients receiving promethazine should be advised to avoid driving or operating machinery or other hazardous tasks until the effects of the drug are known. If such use cannot be avoided, a dose reduction in one or both agents may be required. Patients should avoid ethanol intoxication if taking promethazine. Phenothiazines have been reported to increase blood sugar. Since promethazine is a phenothiazine antihistamine, patients with diabetes mellitus should routinely monitor their blood glucose during concomitant phenothiazine therapy.
Reported clinical experience with promethazine has not identified differences in response between older and younger adult patients. Howeveer, the elderly are more sensitive to anticholinergic side effects of sedating antihistamines such as promethazine. Use of other anticholinergic medications may increase the risk of these effects in any patient, particularly the elderly.
According to the Beers Criteria, first-generation antihistamines are considered potentially inappropriate medications PIMs in geriatric patients and should be avoided because they are highly anticholinergic, there is reduced clearance in advanced age, tolerance develops when used as hypnotics, and there is a greater risk of anticholinergic effects e.
The federal Omnibus Budget Reconciliation Act OBRA regulates medication use in residents of long-term care facilities; cough, cold, and allergy medications should be used only for a limited duration less than 14 days unless there is documented evidence of enduring symptoms that cannot otherwise be alleviated, as first-generation antihistamines have strong anticholinergic properties and are not medications of choice in older individuals.
If administered, use the smallest possible dose. Anticholinergics may cause excessive sedation, confusion, cognitive impairment, distress, dry mouth, constipation, and urinary retention. Many of these effects may lead to other adverse consequences, such as falls.
Also according to OBRA, phenothiazine-related antiemetics such as promethazine should be used cautiously. Potential adverse consequences of phenothiazine-related antiemetics include sedation, dizziness, drowsiness, postural hypotension, neuroleptic malignant syndrome, lowering of the seizure threshold, anticholinergic effects e. Abarelix: Minor Abarelix can cause QT prolongation. In a single, active-controlled, clinical study comparing abarelix to LHRH agonist plus nonsteroidal antiandrogen, periodic electrocardiograms were performed.
The effect of abarelix on the QT interval may be due to androgen deprivation or other variables, as similar effects were seen in men that received a gonadotropin-releasing hormone GnRH agonist with a nonsteroidal antiandrogen. Patients with a baseline QTc value greater than milliseconds may not be appropriate candidates for abarelix receipt. Prescribers need to weigh the potential benefits and risks of abarelix use in patients with prolonged QT syndrome or in patients taking other drugs that may prolong the QT interval.
Agents with a possible risk for QT prolongation and TdP include phenothiazines. Acarbose: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations.
Patients who are taking antidiabetic agents should monitor for worsening glycemic control when a phenothiazine is instituted. Acetaminophen; Butalbital: Moderate Phenothiazines are CNS depressant drugs that may have cumulative effects when administered concurrently and they should be used cautiously with anxiolytic, sedative, and hypnotic type drugs, such as the barbiturates.
Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. Phenothiazines can also lower the seizure threshold, which may be important in patients taking a barbiturate for the treatment of seizures. Additionally, sleep-related behaviors, such as sleep-driving, are more likely to occur during concurrent use of other CNS depressants than with the use of sedatives alone. Monitor for additive effects, unusual moods or behaviors, and warn about the potential effects to driving and other activities.
Acetaminophen; Butalbital; Caffeine: Moderate Phenothiazines are CNS depressant drugs that may have cumulative effects when administered concurrently and they should be used cautiously with anxiolytic, sedative, and hypnotic type drugs, such as the barbiturates. Acetaminophen; Butalbital; Caffeine; Codeine: Major Concomitant use of opioid agonists with promethazine may cause excessive sedation and somnolence. Avoid prescribing opioid cough medications in patients taking promethazine.
Limit the use of opioid pain medications with promethazine to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce the opioid dose by one-quarter to one-half; use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect.
Educate patients about the risks and symptoms of excessive CNS depression. Moderate Phenothiazines are CNS depressant drugs that may have cumulative effects when administered concurrently and they should be used cautiously with anxiolytic, sedative, and hypnotic type drugs, such as the barbiturates. Acetaminophen; Caffeine; Dihydrocodeine: Major Concomitant use of opioid agonists with promethazine may cause excessive sedation and somnolence.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate Additive anticholinergic and sedative effects may be seen when promethazine is used with first generation antihistamines, such as chlorpheniramine.
Patients should be informed to read non-prescription cough and cold product labels carefully for additional interacting antihistamines. Moderate Other non-cardiovascular drugs with alpha-blocking activity such as phenothiazines, directly counteract the effects of phenylephrine and can counter the desired pharmacologic effect.
They also can be used to treat excessive phenylephrine-induced hypertension. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate Additive anticholinergic and sedative effects may be seen when promethazine is used with first generation antihistamines, such as chlorpheniramine.
Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate Additive anticholinergic and sedative effects may be seen when promethazine is used with first generation antihistamines, such as chlorpheniramine. Acetaminophen; Codeine: Major Concomitant use of opioid agonists with promethazine may cause excessive sedation and somnolence. Acetaminophen; Dextromethorphan; Doxylamine: Moderate Additive anticholinergic and sedative effects may be seen when promethazine is used with first generation antihistamines, such as doxylamine.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate Other non-cardiovascular drugs with alpha-blocking activity such as phenothiazines, directly counteract the effects of phenylephrine and can counter the desired pharmacologic effect. Acetaminophen; Dextromethorphan; Phenylephrine: Moderate Additive anticholinergic and sedative effects may be seen when promethazine is used with first generation antihistamines, such as chlorpheniramine.
Acetaminophen; Dichloralphenazone; Isometheptene: Moderate Phenothiazines can potentiate the CNS-depressant action of other drugs such as dichloralphenazone. Acetaminophen; Diphenhydramine: Moderate Additive anticholinergic and sedative effects may be seen when Promethazine is used with first generation antihistamines, such as diphenhydramine.
Patients should be informed to read non-prescription allergy, sleep, and cough and cold product labels carefully for additional interacting antihistamines. Acetaminophen; Guaifenesin; Phenylephrine: Moderate Other non-cardiovascular drugs with alpha-blocking activity such as phenothiazines, directly counteract the effects of phenylephrine and can counter the desired pharmacologic effect. Acetaminophen; Hydrocodone: Major Concomitant use of opioid agonists with promethazine may cause excessive sedation and somnolence.
Hypotension, profound sedation, coma, respiratory depression, or death may occur. Prior to use of oxycodone in patients taking a CNS depressant, assess the level of tolerance to CNS depression that has developed, the duration of use, and the patient's overall response to treatment. Consider the patient's use of alcohol or illicit drugs.
Monitor for sedation and respiratory depression. Furthermore, oxycodone is metabolized in part by 2D6 to oxymorphone, which represents Acetaminophen; Pentazocine: Moderate Concomitant use of pentazocine with other CNS depressants, such as phenothiazines, can potentiate respiratory depression, CNS depression, and sedation.
Pentazocine should be used cautiously with phenothiazines. Acetaminophen; Propoxyphene: Moderate Phenothiazines can potentiate the CNS depressant action of other drugs such as opiate agonists. A dose reduction of one or both drugs may be needed. Acetaminophen; Tramadol: Moderate Caution is advisable during concurrent use of tramadol and promethazine. Seizures have been reported in patients receiving monotherapy with both tramadol and promethazine at recommended doses.
Concomitant use of tramadol and promethazine may increase the risk of seizures. In addition, due to the primary CNS effects of promethazine, caution is advisable during use of other centrally acting medications such as tramadol. Impairment of metabolism of tramadol by CYP2D6 inhibitors, such as promethazine, may increase the risk of serotonin syndrome. Serotonin syndrome is characterized by rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes e.
The analgesic activity of tramadol is due to the activity of both the parent drug and the O-desmethyltramadol metabolite M1 , and M1 formation is dependent on CYP2D6. Therefore, use of tramadol with a CYP2D6 inhibitor may decrease tramadol analgesic efficacy. Acetohexamide: Moderate Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Hyperglycemia and glycosuria have been reported. Also, concomitant use may increase the risk for phototoxicity.
Patients should take care and use proper techniques to limit sunlight and UV exposure. Alfentanil: Moderate Concomitant use of alfentanil with other CNS depressants, including the phenothiazines, can potentiate the effects of alfentanil on respiration, alertness, and blood pressure. A dose reduction of one or both drugs may be warranted. Alfuzosin: Moderate Use caution when administering alfuzosin with promethazine due to the potential for QT prolongation.
Alfuzosin may prolong the QT interval in a dose-dependent manner. Promethazine, a phenothiazine, is also associated with a possible risk for QT prolongation. In the absence of electrolyte imbalances, these agents can be used together safely with appropriate monitoring; clinicians should monitor for evidence of electrolyte disturbances or cardiac-related patient complaints. Thiazide diuretics may potentiate the orthostatic hypotension that can be seen with the use of the phenothiazine antipsychotics.
Alogliptin: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Alogliptin; Metformin: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. When such drugs are administered to a patient receiving metformin, observe the patient closely for loss of blood glucose control.
When such drugs are withdrawn from a patient receiving metformin, observe the patient closely for hypoglycemia. Alogliptin; Pioglitazone: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Alpha-glucosidase Inhibitors: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Alprazolam: Moderate Phenothiazines are CNS depressant drugs that may have cumulative effects when administered concurrently and they should be used cautiously with anxiolytic, sedative, and hypnotic type drugs, such as the benzodiazepines.
Additionally, sleep-related behaviors, such as sleep-driving, are more likely to occur during concurrent use of other CNS depressants than with sedatives alone. Amantadine: Moderate Although the mechanism of amantadine is not clear, it appears it potentiates the actions of dopamine. Since phenothiazines are dopamine antagonists, these drugs should be avoided when possible in patients with Parkinson's disease who require amantadine therapy.
Also, the anticholinergic actions of phenothiazines can be additive to those of amantadine, and may increase the risk of antimuscarinic-related side effects. Clinicians should note that antimuscarinic effects might be seen not only on GI smooth muscle, but also on bladder function, the eye, neurologic function, and temperature regulation. Amifampridine: Major Carefully consider the need for concomitant treatment with phenothiazines and amifampridine, as coadministration may increase the risk of seizures.
Consider an alternative to the phenothiazine. If coadministration occurs, closely monitor patients for seizure activity. Seizures have been observed in patients without a history of seizures taking amifampridine at recommended doses.
Phenothiazines may lower seizure threshold and should be used with caution with concomitant medications which may also affect seizure threshold. Amikacin: Minor Antiemetics, like promethazine, should be used carefully with aminoglycosides because they can mask symptoms of ototoxicity e.
These agents block the histamine or acetylcholine response that causes nausea due to vestibular inner ear emetic stimuli such as motion. Aminoglycosides: Minor Antiemetics, like promethazine, should be used carefully with aminoglycosides because they can mask symptoms of ototoxicity e. Aminolevulinic Acid: Moderate Phenothiazines may increase the photosensitizing effects of photosensitizing agents used in photodynamic therapy.
Patients should limit ultra-violet exposure. Amiodarone: Major The concomitant use of amiodarone and other drugs known to prolong the QT interval should only be done after careful assessment of risks versus benefits, especially when the coadministered agent might decrease the metabolism of amiodarone. If possible, avoid coadministration of amiodarone and drugs known to prolong the QT interval. Due to the extremely long half-life of amiodarone, a drug interaction is possible for days to weeks after discontinuation of amiodarone.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with amiodarone include promethazine. Promethazine carries a possible risk of QT prolongation. Monitor for side effects like sedation and changes in heart rate or rhythm.
Amitriptyline: Moderate Promethazine carries a risk of QT prolongation and should be used cautiously with drugs that may prolong the QT interval and have additive anticholinergic properties such as the tricyclic antidepressants.
Additive drowsiness and anticholinergic effects may also occur. Anticholinergic effects may be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation.
Amitriptyline; Chlordiazepoxide: Moderate Phenothiazines are CNS depressant drugs that may have cumulative effects when administered concurrently and they should be used cautiously with anxiolytic, sedative, and hypnotic type drugs, such as the benzodiazepines.
Moderate Promethazine carries a risk of QT prolongation and should be used cautiously with drugs that may prolong the QT interval and have additive anticholinergic properties such as the tricyclic antidepressants. Amobarbital: Moderate Phenothiazines are CNS depressant drugs that may have cumulative effects when administered concurrently and they should be used cautiously with anxiolytic, sedative, and hypnotic type drugs, such as the barbiturates.
Amoxapine: Moderate Additive anticholinergic effects are possible during coadministration of promethazine and amoxapine. Additive drowsiness and sedation are also possible.
Amoxicillin; Clarithromycin; Lansoprazole: Major Clarithromycin is associated with an established risk for QT prolongation and torsades de pointes TdP. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with clarithromycin include promethazine. Anagrelide: Major Torsades de pointes TdP and ventricular tachycardia have been reported with anagrelide. In addition, dose-related increases in mean QTc and heart rate were observed in healthy subjects.
A cardiovascular examination, including an ECG, should be obtained in all patients prior to initiating anagrelide therapy.
Monitor patients during anagrelide therapy for cardiovascular effects and evaluate as necessary. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with anagrelide include promethazine.
Anticholinergics: Moderate Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including promethazine. Clinicians should note that antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation.
Additive drowsiness or other additive CNS effects may also occur. Anxiolytics; Sedatives; and Hypnotics: Moderate Phenothiazines are CNS depressant drugs that may have cumulative effects when administered with other CNS depressant drugs and they should be used cautiously with anxiolytic, sedative, and hypnotics. Additionally, sleep-related behaviors, such as sleep-driving, are more likely to occur during concurrent use of hypnotics and other CNS depressants than with use of a hypnotic alone.
Apomorphine: Major Exercise caution when administering apomorphine concomitantly with promethazine as concurrent use may increase the risk of QT prolongation, decrease the efficacy of apomorphine, and increase CNS depression. Phenothiazines may block the dopamine agonist properties of apomorphine, thereby compromising apomorphine effectiveness.
Apomorphine causes considerable somnolence, and concomitant administration of apomorphine and CNS depressants like phenothiazines could result in additive CNS effects. In addition, limited data indicate that QT prolongation is possible with apomorphine or phenothiazine administration. The change in QTc interval associated with apomorphine is not significant in most patients receiving dosages within the manufacturer's guidelines.
Apraclonidine: Minor No specific drug interactions were identified with systemic agents and apraclonidine during clinical trials.
Theoretically, apraclonidine might potentiate the effects of CNS depressant drugs such as phenothiazines. Aripiprazole: Moderate Both promethazine and aripiprazole are associated with a possible risk for QT prolongation; therefore, caution is advisable during coadministration. In addition, because aripiprazole is partially metabolized by CYP2D6, patients should be monitored for aripiprazole-related adverse reactions during concurrent use of a CYP2D6 inhibitor such as promethazine.
Coadministration of phenothiazines such as promethazine and antipsychotics may also increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures.
Arsenic Trioxide: Major If possible, drugs that are known to prolong the QT interval should be discontinued prior to initiating arsenic trioxide therapy. QT prolongation should be expected with the administration of arsenic trioxide.
Torsade de pointes TdP and complete atrioventricular block have been reported. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with arsenic trioxide include promethazine. ECGs should be monitored at initiation, weekly and more frequently in clinically unstable patients , during arsenic trioxide therapy. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert.
Promethazine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. If you can, avoid people with infections. Check with your doctor immediately if you or your child think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
Check with your doctor right away if you or your child are having convulsions, difficulty in breathing, fast heartbeat, high fever, high or low blood pressure, increased sweating, loss of bladder control, severe muscle stiffness, unusually pale skin, or tiredness. These could be symptoms of a serious condition called neuroleptic malignant syndrome NMS. Check with your doctor right away if you or your child have pain or tenderness in the upper stomach; pale stools; dark urine; loss of appetite; nausea; unusual tiredness or weakness; or yellow eyes or skin.
These could be symptoms of a liver problem. Before you have any medical tests, tell the medical doctor in charge that you or your child are receiving this medicine. The results of some tests may be affected by this medicine. This medicine may cause dryness of the mouth. For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist.
Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections. This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription over-the-counter [OTC] medicines and herbal or vitamin supplements. Along with its needed effects, a medicine may cause some unwanted effects.
Although not all of these side effects may occur, if they do occur they may need medical attention. Some side effects may occur that usually do not need medical attention.
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