From the Guidelines
Promethazine should be used with caution in patients with heart failure, as it may worsen heart failure symptoms due to its anticholinergic properties and potential for causing QT interval prolongation. The European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure do not specifically mention promethazine, but they do emphasize the importance of careful monitoring and management of patients with heart failure, particularly when it comes to medications that may affect cardiac function 1.
Key Considerations
- The potential benefits of promethazine must be weighed against the potential risks, considering the severity of heart failure and other medications the patient is taking that might interact with promethazine or independently affect cardiac function.
- Patients with heart failure taking promethazine should be monitored for worsening symptoms such as increased shortness of breath, edema, or irregular heartbeat.
- Alternative medications with fewer cardiovascular effects might be preferable for heart failure patients, especially those with severe or unstable disease.
- The decision to use promethazine in heart failure patients should involve careful consideration of the potential benefits and risks, and consultation with a healthcare provider is recommended before starting or continuing promethazine if you have heart failure.
Monitoring and Management
- Regular monitoring of symptoms, urine output, renal function, and electrolytes is recommended during use of i.v. diuretics in patients with heart failure 1.
- Inotropic agents are not recommended unless the patient is symptomatically hypotensive or hypoperfused because of safety concerns 1.
- Vasodilators and vasopressors should be used with caution and under close monitoring in patients with heart failure 1.
Conclusion is not allowed, so the answer will be ended here.
From the FDA Drug Label
Promethazine hydrochloride injection should be used cautiously in persons with cardiovascular disease or impairment of liver function The patient with heart failure should use promethazine (Phenergan) with caution, as the drug label recommends cautious use in patients with cardiovascular disease 2.
From the Research
Safety of Promethazine in Heart Failure Patients
- There is limited direct evidence on the safety of promethazine (Phenergan) in patients with heart failure from the provided studies.
- However, a study 3 suggests that promethazine may be a safer alternative to ondansetron in certain situations, as an institutional ban on intravenous promethazine led to increased use of ondansetron, which was associated with a higher risk of adverse reactions, including heart block.
- Another study 4 compared the risk of sudden cardiac death between ondansetron and antiemetics with lesser QT-prolonging potential, including promethazine, in patients receiving hemodialysis. The results showed that initiation of ondansetron was associated with a higher risk of sudden cardiac death compared to promethazine and other antiemetics.
- The other studies 5, 6, 7 do not provide direct evidence on the safety of promethazine in heart failure patients, but rather focus on exercise prescription, digoxin use, and adherence to exercise in heart failure patients.