Promethazine For Children Under 2 Years Old

The use of promethazine in children under two years of age isn't approved by the FDA (Food and Drug Administration). It used to be prescribed to infants and children under two years old but was linked to respiratory depression and SIDS (sudden infant death syndrome).^[1]

Current guidelines on the use of promethazine state that use in children under two years old is contraindicated and the prescribing information for the drug contains a black box warning regarding the risk of respiratory depression in this age group.

Per the prescribing information:^[2]

Phenergan [promethazine] should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. Postmarketing cases of respiratory depression, including fatalities, have been reported with the use of Phenergan [promethazine] in pediatric patients less than 2 years of age.

Dosing in children over two years old is weight-based, and depends on what it is being used for.

For the prevention of motion sickness:^[3]

• 0.25 to 0.5 mg/kg/dose given 30 minutes to 2 hours before travel and every six to twelve hours as needed. The maximum amount per dose is 25 mg. Most sources recommend using the lowest dose possible and should be reserved only for severe cases of motion sickness.

For the treatment of postoperative nausea/vomiting:^[4]

• 0.25 to 1 mg/kg/dose every four to six hours as needed, with a maximum dose of 25 mg.

In your question, you inquired about the use of promethazine in a 19-month-old child.

As described above, it is not indicated by the FDA to be used in that age group due to the risk of respiratory depression.

Having said that, everyone's medical situation is different and there certainly could be extenuating circumstances that make prescribing promethazine 'off-label' the most appropriate therapy choice for your child.

Be sure to speak with your doctor about the risks and benefits of this particular therapy.