Katie wrote:
>There is a use for phenergan  as a short term (1 week) pattern breaker
>for sleep disturbance or for long haul flights etc. It , of course will
>only work alongside parental behaviour changes, but it is a valuable
>adjunct.
>It also works for urticaria and travel sickness.
>I would be have thought most GP parents would have considered using it
>at one time or another!


My choice of Phenergan as an example followed directly on from Ahmads
concepts of "experience, precedent and peers" and my suggestion of "evidence
based medicine and decision analysis."

In terms of experience and precedent - Hell we were probably given the stuff
as kids (along with junior aspirin) - it's a well known, long established
drug with a good safety record. (Even I can sell it!).
In terms of peers, well David (and probably many others) agree with you. So
by Ahmads criteria you are on safe ground.

On the other hand, promethazine isn't licensed for use in children under 2,
and the dose in the BNF for those under 2 is one of "not recommended". The
bottle it's manufactured in goes further..there's a red rectangle on it
within which is writ large "NOT INDICATED FOR ANY CONDITION IN CHILDREN LESS
THAN 2 YEARS OF AGE"

Why is this? Let's look at some evidence. Promethazine has been implicated
in sudden infant death syndrome.
ref.:
 1. Kahn A, Blum D. Possible role of phenothiazines in sudden
    infant death. Lancet 1979; ii: 364-5.
    2. Kahn A, Blum D. Phenothiazines and sudden infant death
    syndrome. Pediatrics 1982; 70: 75-8.
    3. Kahn A, et al. Phenothiazine-induced sleep apneas in
    normal infants. Pediatrics 1985; 75: 844-7.
    4. Cockfield. Phenergan, Theralene, Algotropyl-drugs
    responsible for the death of new-born babies. Off J EC 1986;
    29: C130/25-6.
    5. Stanton AN. Sudden infant death syndrome and
    phenothiazines. Pediatrics 1983; 71: 986-7.

More recently long haul flights have also been implicated in SID, yet you
wish to  prescribe promethazine for babies on long haul flights?

That it works in cases of urticaria and sleep disorders I have no doubt, but
why promethazine when there are alternatives which are licensed and are not
implicated in SID. e.g. brompheniramine.

In terms of decision analysis, are the parents even informed that
promethazine has been implicated in SID?



Regards

Jeff Green

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