UnifiedACB

Medication evidence profile

Promethazine

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Clinical overview

Antiemetic / dopamine-antagonist medication

Promethazine has public medication-list entries in JARS 2025, Yamada-ABS 2023, BAAS 2019, Swe-ABS 2023, GABS 2018, and CALS 2022 Table 4. These are 6 separate source versions, each with its own evidence and definitions.

Source-specific scores

SourceScore
JARS3
Yamada-ABS3
BAAS3
Swe-ABS3
GABS1
KABSNot listed
CALS3

How to read this: 0 means the source explicitly assigned zero. “Not listed” means the source did not provide a score for this medication. Scores from different scales are not averaged.

How to interpret the evidence

6 of 7 public source versions contain an explicit medication-list entry for promethazine.

The recorded values differ across the source rows for promethazine. Scale methods, definitions, source eras, evidence types and identity handling can differ; the numbers alone do not establish the reason for this medication’s disagreement.

None of the public rows in this profile is an explicit zero. An unlisted source still supplies no value.

Source labels and provenance · 6 observations
  1. Japanese Anticholinergic Risk Scale (JARS) 2025 English translation

    Source label: Promethazine. Published value: 3.
    Source version: JARS-2025
    Source location: RC4 source recovery; recovery_scope=primary_table_complete; ATC=D04AA10
    Observation: JARS_2025_R0136; rating state: published_rating.

  2. Yamada Pharmacological Anticholinergic Burden Scale 2023

    Source label: Promethazine. Published value: 3.
    Source version: YAMADA-ABS-2023
    Source location: RC4 source recovery; recovery_scope=primary_nonzero_complete
    Observation: YAMADA_ABS_2023_R0072; rating state: published_rating.

  3. Brazilian Anticholinergic Activity Scale 2019

    Source label: Promethazine. Published value: 3.
    Source version: BAAS-2019
    Source location: RC4 source recovery; recovery_scope=primary_table_complete
    Observation: BAAS_2019_R0037; rating state: published_rating.

  4. Swedish Anticholinergic Burden Scale 2023

    Source label: Promethazine. Published value: 3.
    Source version: SWE-ABS-2023
    Source location: RC4 source recovery; recovery_scope=primary_final_nonzero_complete
    Observation: SWE_ABS_2023_R0101; rating state: published_rating.

  5. German Anticholinergic Burden Score 2018

    Source label: Promethazine. Published value: 1.
    Source version: GABS-2018
    Source location: RC4 source recovery; recovery_scope=primary_nonzero_complete
    Observation: GABS_2018_R0084; rating state: published_rating.

  6. CALS 2022 - primary final Table 4

    Source label: Promethazine. Published value: 3.
    Source version: CALS-2022-primary-table4
    Source location: Table 4; literal capture row 91; displayed table row 13; displayed column 7
    Observation: CALS2022_T4_0091; rating state: published_final_table_rating.

Class context — antiemetic/dopamine-antagonist medications

For this group, strong-anticholinergic classification, first-generation antihistamine criteria, and disease-specific dopamine-antagonist concerns address different questions. A medication can appear in more than one criterion, each with its own clinical scope.

AGS Beers 2023 Table 2; AGS Beers 2023 Table 3; AGS Beers 2023 Table 7

Promethazine: medication-specific notes

Multiple criterion pathways

Promethazine appears in the strong-anticholinergic reference list and the first-generation antihistamine criterion. It also appears in the Parkinson disease criterion as a dopamine-receptor antagonist. These are separate source-backed criteria.

AGS Beers 2023 Tables 2, 3, and 7

Older-adult medication context

AGS Beers context: classification and criteria

AGS Beers 2023 · Strong anticholinergicBeers: Avoid / generally avoid in older adults
  • Table 7: Strong-anticholinergic reference listing.
  • Table 2: General older-adult medication criterion.

Source-scale observations and geriatric criteria answer different questions. The Beers material does not alter any score above.

Adults 65 years and older; intended for ambulatory, acute, and institutional care except hospice/end-of-life settings.

Condition-specific and medication-combination contexts

Table 3: clinical conditions

Condition-specific contexts: delirium or high delirium risk, dementia or cognitive impairment, and history of falls or fractures. Applicability depends on the condition and the relevant source criterion.

Table 5: cumulative anticholinergic exposure

Concurrent use of more than one anticholinergic medication should be minimized because cumulative exposure increases geriatric safety concerns.

American Geriatrics Society 2023 updated AGS Beers Criteria — Tables 2, 3, 5 and 7; selected criterion context.

Potentially inappropriate does not mean absolutely contraindicated. Apply the criterion in clinical context and use shared decision-making.

What this page does not establish

  • No medication-list entry is available here from KABS 2020 open validation supplement. These gaps remain “Not listed”; no score is inferred from another source or from class membership.
  • No route inference unless present in the source label.
  • These source records do not estimate an individual’s probability of harm or establish whether to start, stop or change a medication. Ordinal source scores are not averaged into a UnifiedACB score.
Why is this medication clinically relevant to anticholinergic burden?Is this medication identified in the 2023 AGS Beers Criteria?What geriatric concerns are most relevant for this medication?
Which separate AGS Beers criteria include promethazine?

References

  1. Mizokami F, Mizuno T, Taguchi R, et al. Development of the Japanese Anticholinergic Risk Scale: English translation of the Japanese article. Geriatr Gerontol Int. 2025;25(1):5-13. doi:10.1111/ggi.15001. Open source
  2. Yamada S, Mochizuki M, Chimoto J, Futokoro R, Kagota S, Shinozuka K. Development of a pharmacological evidence-based anticholinergic burden scale for medications commonly used in older adults. Geriatr Gerontol Int. 2023;23(7):558-564. doi:10.1111/ggi.14619. Open source
  3. Nery RT, Reis AMM. Development of a Brazilian anticholinergic activity drug scale. Einstein (Sao Paulo). 2019;17(2):eAO4435. doi:10.31744/einstein_journal/2019AO4435. Open source
  4. Rube T, Ecorcheville A, Londos E, Modig S, Johansson P. Development of the Swedish anticholinergic burden scale (Swe-ABS). BMC Geriatr. 2023;23(1):518. doi:10.1186/s12877-023-04225-1. Open source
  5. Kiesel EK, Hopf YM, Drey M. An anticholinergic burden score for German prescribers: score development. BMC Geriatr. 2018;18(1):239. doi:10.1186/s12877-018-0929-6. Open source
  6. Ramos H, Moreno L, Pérez-Tur J, Cháfer-Pericás C, García-Lluch G, Pardo J. CRIDECO Anticholinergic Load Scale: an updated anticholinergic burden scale. Comparison with the ACB Scale in Spanish individuals with subjective memory complaints. J Pers Med. 2022;12(2):207. doi:10.3390/jpm12020207. Open source

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Medication context: Promethazine

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