The Institute for Safe Medication Practices and the American Society of Health-System Pharmacists have advocated for removing all injectable promethazine from inpatient and outpatient settings; however, this drug is still being used despite the risk for tissue necrosis, gangrene, and possible amputation when it inadvertently is given by the subcutaneous or intra-arterial route. This article describes alternative injectable medications that can be selected based on patient comorbidities, indications, and clinician experience.

At the University of Toledo in Toledo Ohio Andrew Overholser is an assistant professor in the PA program and practices in the Department of Family Medicine Megan Sizemore is an assistant professor and clinical pharmacist in the Department of Family Medicine and Eric Czech is an assistant professor in the PA program and practices in the Department of Family Medicine The authors have disclosed no potential conflicts of interest financial or otherwise

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