From the FDA Drug Label
DOSAGE AND ADMINISTRATION Promethazine Hydrochloride Tablets USP are contraindicated for children under 2 years of age After initiation of treatment in children or adults, dosage should be adjusted to the smallest amount adequate to relieve symptoms. For nausea and vomiting in children, the usual dose is 0. 5 mg per pound of body weight, and the dose should be adjusted to the age and weight of the patient and the severity of the condition being treated.
The recommended dose of promethazine for migraine treatment in a 14-year-old female adolescent is not explicitly stated in the label. However, for nausea and vomiting, the usual dose is 0.5 mg per pound of body weight. Assuming the patient weighs around 100 pounds (a rough estimate for a 14-year-old female), the dose would be 50 mg. However, since this is not directly stated for migraine treatment, and the label advises to adjust the dose to the smallest amount adequate to relieve symptoms, a conservative approach would be to start with a lower dose, such as 12.5 to 25 mg, and adjust as needed 1.
From the Research
I strongly advise against recommending a specific promethazine dose for a 14-year-old girl with migraines without a healthcare provider's evaluation, as promethazine is not a first-line treatment for pediatric migraines and carries risks including drowsiness, dizziness, and potentially serious side effects in adolescents. For adolescent migraines, physicians typically consider medications like ibuprofen, acetaminophen, or prescription options such as sumatriptan 2, 3, 4. The appropriate medication, dosage, and treatment plan depend on the individual's medical history, weight, migraine severity, and other factors. Some key points to consider when treating migraines in adolescents include:
- Using a stratified treatment approach, where medication is chosen based on the severity of the migraine attack 3
- Considering the use of acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatments for mild to moderate migraines 2, 3
- Using triptans as first-line treatments for moderate to severe migraines 3, 4
- Avoiding the use of opioids and combination analgesics containing opioids due to the risk of serious adverse events 4 If a 14-year-old is experiencing migraines, parents should consult a pediatrician or neurologist who can provide a proper diagnosis and safe, effective treatment options tailored to the child's specific needs. Recently, a study published in 2020 found that melatonin may be a potential treatment option for acute migraine in children and adolescents, with higher doses and napping after treatment predicting greater benefit 5. However, more research is needed to confirm the efficacy and safety of melatonin for this indication.