Andrew- When I finished residency I came out saying the same thing you post. Over the years though I have found promethazine to be helpful in controlling vomiting associated with acute gastroenteritis in children over age 2 years. Granted- I don't know if it is the antiemetic effect or the mild sedation that allows the child to rest and breaks the "puking cycle" but it seems to help. I am a firm believer in oral hydration and instruct parents or it's importance and only infrequently have needed to admit a child for IV hydration. I have not seen dystonic reactions from phenergan though I do remember seeing one in training from Tigan. -----Original Message----- From: Andrew M. Eisen, MD <> To: Ped Talk <> Date: Wednesday, February 03, 1999 12:22 PM Subject: Re: Alternative routes for meds >"Daniel T. Earl" wrote: > >> We have a local pharmacist who has one of the truly great products of this >> century...topical gel phenergan. It is applied to the forearm and rubbed in >> with great absorption and prompt effect. For those kids who are vomiting or >> have diarrhea and nausea, its wonderful. They mix it up locally, he said >> they got the recipe from a pharmacist in Texas. Anyone else stumbled upon >> this? >> >> Daniel T. Earl, DO >> Johnson City TN > >Transdermal administration of meds has been around for some time, and with >certain drugs, can be very effective. Some meds are absorbed on their own, >like EMLA; some require a carrier such as DMSO to facilitate transport; and >others can be driven iontophoretically. > >My only concern about this particular drug is the ridiculously high risk of >dystonic reactions associated with phenothiazines in kids. I'd hate to rub >promethazine on a kid's arm and then have one of those reacions with no IV >access for diphenhydramine. > >My own 2 cents on kids who are vomiting and nauseated from gastroenteritis >(recognizing that I'm jumping off the thread a bit - as if I never do that): >THe best treatment is rehydration, enteral or parenteral, not meds. > > > >-- >Andrew M. Eisen, MD, FAAP >Assistant Professor of Pediatrics >Associate Director, Pediatric Residency Program >University of Nevada School of Medicine > > > > > >