Comparative Pharmacology
Head-to-head clinical analysis: DIPHENHYDRAMINE versus PROMETHAZINE HYDROCHLORIDE AND DEXTROMETHORPHAN HYDROBROMIDE.
Peer-Reviewed Evidence
Head-to-head clinical analysis: DIPHENHYDRAMINE versus PROMETHAZINE HYDROCHLORIDE AND DEXTROMETHORPHAN HYDROBROMIDE.
Diphenhydramine vs PROMETHAZINE HYDROCHLORIDE AND DEXTROMETHORPHAN HYDROBROMIDE
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Inverse agonist at histamine H1 receptors, blocking histamine-mediated effects in blood vessels, respiratory smooth muscle, and GI tract; also anticholinergic by blocking muscarinic receptors and sedative via central H1 receptor antagonism.
Promethazine is a phenothiazine derivative that acts as a histamine H1 receptor antagonist, antiemetic, and sedative. Dextromethorphan is a cough suppressant that acts as an NMDA receptor antagonist and sigma-1 receptor agonist.
25-50 mg orally or intramuscularly every 4-6 hours; maximum 300 mg/day. Intravenous administration: 10-50 mg slow IV push (max 25 mg/min).
For cough and upper respiratory symptoms: 5 mL (containing promethazine hydrochloride 6.25 mg and dextromethorphan hydrobromide 15 mg) orally every 4 to 6 hours, not to exceed 30 mL in 24 hours.
None Documented
None Documented
Clinical Note
moderateDiphenhydramine + Deferasirox
"The serum concentration of Deferasirox can be increased when it is combined with Diphenhydramine."
Clinical Note
moderateDiphenhydramine + Fluticasone propionate
"The risk or severity of adverse effects can be increased when Diphenhydramine is combined with Fluticasone propionate."
Clinical Note
moderateDiphenhydramine + Tenofovir disoproxil
"The metabolism of Tenofovir disoproxil can be decreased when combined with Diphenhydramine."
Clinical Note
moderateTerminal elimination half-life 4-8 hours in adults; prolonged in hepatic impairment (up to 20 hours) and elderly.
Promethazine: 10-19 hours (mean 12 hours). Dextromethorphan: extensive metabolizers (CYP2D6) 3-5 hours; poor metabolizers 20-30 hours. Clinical context: accumulation with repeated dosing, especially in poor metabolizers.
Primarily renal (90-95% as metabolites, <5% unchanged). Minor biliary/fecal elimination (<5%).
Promethazine: primarily hepatic metabolism, renal excretion of metabolites (~70%, <1% unchanged); fecal excretion (20-30%). Dextromethorphan: hepatic metabolism, renal excretion of metabolites and <1% unchanged drug.
Category C
Category A/B
Antihistamine
Antihistamine / Antiemetic
Diphenhydramine + Sulfisoxazole
"The metabolism of Sulfisoxazole can be decreased when combined with Diphenhydramine."