Injectable promethazine formulary removal

Aligns with best practice guidelines

The Pharmacy and Therapeutics Committee voted to remove injectable promethazine (IM, IV push, and IVPB) from Salem Health formulary at their February meeting. Injectable promethazine was also removed from the Salem Health Medical Ground outpatient clinic formulary at the end of 2025.

This decision was made at the request of the Medication Safety Committee and aligns with the Institute of Safe Medication Practice (ISMP) best practice guidelines (1). Injectable promethazine is a vesicant and inadvertent arterial injection or IV extravasation that can cause serious tissue injury, potentially requiring amputation.

The timeline below highlights significant promethazine safety events that have occurred at the national level (2). While Salem Health has not experienced any significant safety events related to injectable promethazine, the risk of future safety events remains.

Formulary alternatives

Promethazine oral tablets and rectal suppository will remain on formulary. The following antiemetic alternatives are also available:

• Routine use: Ondansetron, prochlorperazine, metoclopramide, haloperidol, droperidol and olanzapine.
• Situation-specific use: Aprepitant, fosaprepitant, scopolamine and palonosetron.
  

What to expect

Starting April 14, injectable promethazine will no longer be available to order at Salem and West Valley hospitals, including inpatient, procedural areas, emergency department and infusion centers. Supply will be removed from all Omnicell automated dispensing cabinets.

References

1. ISMP Targeted Medication Safety Best Practices for Hospitals. (2026-2027). Accessed: March 11, 2026 https://online.ecri.org/hubfs/ISMP/Resources/ISMP_TargetedMedicationSafetyBestPractices_Hospitals.pdf
2. Le CK, Stevens CA, Park JH, Clark RF. Promethazine: A Review of Therapeutic Uses and Toxicity. J Emerg Med. 2025;70:127-133. doi:10.1016/j.jemermed.2024.09.013