From the Guidelines
Promethazine is not the preferred choice for someone with Ehlers-Danlos Syndrome (EDS) due to its potential to exacerbate symptoms. While promethazine is commonly used for allergies, nausea, and as a sedative, it should be used with caution in EDS patients due to several concerns. The medication has anticholinergic properties that can worsen autonomic symptoms often present in EDS, such as tachycardia, blood pressure fluctuations, and gastrointestinal issues 1. Additionally, promethazine may increase joint hypermobility issues through muscle relaxation effects, potentially exacerbating EDS symptoms. Many EDS patients also have Mast Cell Activation Syndrome (MCAS) or Postural Orthostatic Tachycardia Syndrome (POTS), which could be negatively affected by promethazine's side effects.
Some key points to consider when evaluating the use of promethazine in EDS patients include:
- The potential for increased risk of adverse effects due to the anticholinergic properties of promethazine 1
- The possibility of worsening autonomic symptoms, such as tachycardia and blood pressure fluctuations 1
- The potential for increased joint hypermobility issues due to muscle relaxation effects 1
- The presence of comorbidities, such as MCAS or POTS, which could be negatively affected by promethazine's side effects 1
If medication for nausea or allergies is needed, alternatives like ondansetron (Zofran) for nausea or non-sedating antihistamines might be better tolerated 1. Any medication decisions should be made in consultation with healthcare providers familiar with EDS and its comorbidities, as individual responses can vary significantly among EDS patients.
From the Research
Ehlers-Danlos Syndrome (EDS) and Promethazine
There are no research papers to assist in answering whether promethazine is suitable for someone with Ehlers-Danlos Syndrome (EDS).
Key Points About EDS
- EDS is a group of heritable disorders of connective tissue, comprising mutations in the genes involved in the structure and/or biosynthesis of collagen 2
- Thirteen EDS subtypes are recognized, with a wide degree of symptom overlap among subtypes and with other connective tissue disorders 2
- The clinical hallmarks of EDS are tissue fragility, joint hypermobility, and skin hyperextensibility 2
- Arterial complications are more characteristically a feature of vascular EDS, although individual cases of arterial events in classical EDS have been reported 3
- Management of EDS consists of a care team responsible for surveillance of major and organ-specific complications, integrated physical medicine and rehabilitation 4
Considerations for Treatment
- No specific medical or genetic therapies are available for any type of EDS 4
- A novel therapeutic strategy for EDS based on nutritional supplements has been proposed, but its effectiveness is unknown 5
- The diagnosis of EDS should be considered in patients under the age of 45 years who present with arterial tearing or dissection, colonic perforation, or visceral rupture 6