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Promethazine topical gel

Supportive Care

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What is promethazine?

Promethazine (also called ­­­Phenergan®) is a medicine called an antiemetic. It is used to treat nausea and vomiting. Promethazine topical gel is a way of giving your child this nausea medicine. When the gel is put on your child's skin, a small amount of the medicine is absorbed through the skin.

The best thing about giving medicine this way is your child will receive this medicine without having to swallow it, have an intramuscular (IM) injection, or have an intravenous (IV) line.

This gel is not available commercially, but the St. Jude Pharmacy will compound (custom-make) your child’s correct dosage. Your child will have the dosage of ________. You will need to reapply the gel every 4–6 hours as needed or as directed by your child’s doctor.

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How to apply promethazine gel

  1. Open the package of promethazine topical gel.
  2. The gel should be applied on your child’s wrist. Even though the gel is being used to treat nausea and vomiting, do not apply the gel to the abdomen.
  3. Inspect the skin. Only put the gel on an area of normal skin. Do not put the gel on skin that is red, swollen, or sore. Do not put on skin that has been treated with radiation.
  4. Use only water if you need to clean the skin before you apply the gel. Soaps or lotions may irritate the skin. The skin should be allowed to dry completely before applying the gel.
  5. You can wear disposable gloves to reduce your exposure to the gel, or you can use a cotton swab to apply the gel.
  6. When you are ready to apply the gel, pick up the syringe and remove the cap.
  7. Gently squeeze ______ml on the underside of your child’s wrist and massage it into the skin. Allow the gel to dry completely.
  8. Recap the syringe for future doses. Store at room temperature. Throw away the syringe in the trash if it is empty.
  9. You should repeat this process every 4 to 6 hours as needed or as directed by your child’s doctor.
  10. If you get some of the gel on your skin, wash your skin with running water. Do not use soap or alcohol to remove the gel. That might make it easier for your skin to absorb the medicine. If you have concerns about the medicine getting on your skin, call 901-595-3300 and ask to speak to the pharmacist, or your primary clinic doctor or nurse.

Do not swallow promethazine topical gel.

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Possible side effects of promethazine gel

All medicines have side effects. Some mild side effects of promethazine gel include:

  • Feeling drowsy
  • Feeling excited
  • Sensitive skin where the gel is placed
  • Dry mouth
  • Blurred vision

Side effects that need to be reported quickly to the doctor include:

  • Hallucinations (seeing things that are not there)
  • Feeling dizzy, especially if standing up or sitting up quickly
  • Constipation (ask the doctor about a stool softener)

Some side effects need emergency medical care right away:

  • Breathing problems
    • Quick shallow breaths
    • Trouble breathing
    • A slow breathing rate (less than ____/min)
  • A change from being alert; becoming drowsy or being hard to wake up

If your child has any of these side effects, call 911.

Not all patients who take promethazine topical gel will experience these side effects. Common side effects are listed, but there may be others. Please report all suspected side effects to your doctor or pharmacist.

Find more information on side effects.

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Special precautions for promethazine gel

Be sure to discuss all questions and instructions with your doctor or pharmacist. 

  • Being exposed to promethazine by accident can lead to harm or even death. Young children are at greatest risk because they are mobile and curious. Be sure to follow these guidelines to protect everyone from the dangers:
  • Keep opened and unopened syringes of promethazine topical gel out of the reach of children.
  • If anyone is exposed to the gel, have them wash their skin right away with running water.
  • If anyone ingests the gel, seek medical help right away.
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Special instructions for promethazine gel

  • Because skin absorbs promethazine slowly, your child's nausea and vomiting might not be relieved right after applying the gel.
  • Do not use a heating pad over the skin where the gel has been applied.
  • Promethazine may impair your child’s ability to drive or operate heavy machinery. Your child should not do either if feeling even slightly sleepy, drowsy, or not alert.
  • This medicine can increase the risk of falls.
  • Do not refrigerate the promethazine gel. Do not store the gel in hot places such as a car in the summer.
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Always check the medication label. Many medicines look the same. Do not take any new medicine, including over-the counter medicines or supplements, without checking with your doctor or pharmacist. Talk to your doctor or pharmacist about what to do in the case of a missed dose, allergic reaction, or medical emergency. 

This information is not intended to be a complete guide and is not a substitute for talking with your provider. Medicine names, appearance, formulas, or availability may vary by clinic location. Always follow the instructions given by your care team.

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