Promethazine (Phenergan) should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. According to Wyeths letter to all medical providers in the United States dated February 15, 2005, Caution also should be exercised when administering Phenergan tablets and suppositories to pediatric patients 2 years of age and older because of the potential for fatal respiratory depression. Respiratory depression and apnea (lack of breathing), sometimes associated with death, are strongly associated with PROMETHAZINE products. Concomitant administration of Promethazine products with other respiratory depressants has an association with respiratory depression, and sometimes death, in pediatric patients. Asthmatics are too often prescribed Promethazine DM (Dextromethorphan), and I have seen the negative consequences. Parents often ask me as to why their doctors prescribed Promethazine DM to their children, especially asthmatics, given the information available. I simply read a lot, and I pay for my own continued medical education (CME). Many asthmatics are readily prescribed various over-the-counter OTC) drugs that provide no curative value. Youd think OTC drugs work given the manner that companies market them on Television through Doctor Moms. These usually contain an Antihistamine, Decongestant (Pseudoephedrine), Dextromethorphan (anti-tussive; against cough), the expectorant Guaifenesin (of no proven therapeutic value), and may complicate the treatment of bronchial asthma. Promethazine is a phenothiazine that was first used in the 1940s to treat agitation in psychiatric patients. At present, we have other phenothiazines that are more useful in psychiatry. Promethazine can be useful for its anti-emesis (anti-vomiting) properties, and I prescribe it only to adults in the form of a mixture of Promethazine and Diphenhydramine (The active ingredient in Benadryl Allergy). Many patients with anxiety disorders seem to do very well with the mixture of Promethazine and Diphenhydramine I long ago developed. In future writings, I will describe my findings in this area in more detail. Promethazine and Diphenhydramine are not addicting and this combination, with ACETAMINOPHEN (the active ingredient in Tylenol) has helped more successfully treat the nausea associated with migraine headaches as well as the pain (cephalgia). Children with bronchial asthma often vomit the phlegm in an effort to clear their airway passages (a potentially life saving reflex). Some doctors often confuse this vomiting as emanating from the gastrointestinal tract and prescribe Promethazine. Healthy children readily develop ketosis after an over night fast. This ketosis explains why many children arent hungry before breakfast. If a child is sick or has a throat infection (viral or bacterial), his lack of carbohydrate intake and the associated ketosis makes him nauseous and anorexic. Simply checking the urine for ketones or smelling the childs breath can confirm this. The nausea and vomiting associated with fasting or lack of carbohydrate intake can readily be reversed by a small amount of juice. Carbohydrates are stored in the body, i.e., liver, as glycogen. The excess intake of carbohydrates are converted to fat. Fat cannot be converted to glucose (sugar). In the fasting state, amino acid breakdown from muscle protein provides the body with needed glucose. Glucose is the brains preferred source of energy. By providing glucose intravenously to hospitalized patients, we can reduce muscle breakdown by 85 percent. Asthmatics have an intermittent cough that is worse with activity and at night. Most children that present to a doctor with a cough have asthma. Rhinoviruses and other cold viruses usually present with a mild cough. Acute Bronchiolitis may be confused with asthma. Bronchiolitis is usually due to Respiratory Syncitial Virus (RSV), Parainfluenza 3 virus and less often to Adenoviruses and occurs during the first two years of life. Mycoplasma Pneumoniae has been associated with Bronchiolitis and bronchopneumonia. Since Mycoplasma bacteria lack a cell wall, they do not respond to the penicillins or cephalosporins. The treatment consists of a Macrolide like Erythromycin or Azithromycin. I encourage students of medicine to read about Croup (Laryngotracheobronchitis), Tracheitis, Acute Epiglottitis and retropharyngitis before an emergency presents. Wyeth is no longer liable for any deaths associated with Promethazine and related products. It has already informed us, medical providers, of Promethazine dangers. Luis Lomeli MD/Beta