Updated: January 19, 2026

Phenergan Shortage: What Providers and Prescribers Need to Know in 2026

Author

Peter Daggett

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Shortage Summary: Affected Formulations (2026)
Therapeutic Alternatives by Clinical Indication
Nausea and Vomiting (General / Post-Operative / Chemotherapy)
Motion Sickness / Vestibular Nausea
Allergic Conditions
Pregnancy-Related Nausea (Hyperemesis Gravidarum)
Key Safety Reminders During Shortage Management
Communicating the Shortage to Patients
System-Level Recommendations
Resources for Providers

The 2026 promethazine shortage demands proactive prescriber strategies. Here is a clinical overview of affected formulations, alternatives, and patient management.

Promethazine (Phenergan) — the workhorse first-generation antihistamine and phenothiazine antiemetic — is experiencing supply disruptions across multiple dosage forms in 2026. From emergency departments managing post-operative nausea to outpatient clinics treating morning sickness, prescribers across specialties are navigating an increasingly constrained supply. This guide provides a clinical summary of the shortage, evidence-based therapeutic alternatives, and practical patient management strategies.

Shortage Summary: Affected Formulations (2026)

The following formulations are currently affected:

Promethazine HCl Injection (25 mg/mL, 50 mg/mL): Active ASHP-listed shortage. Hikma has multiple presentations on back order, with some on allocation. Estimated resolution for certain products: early January 2027. This most acutely affects inpatient and emergency settings.

Oral tablets (12.5 mg, 25 mg, 50 mg) and oral solution (6.25 mg/5 mL): Flagged as supply concern since October 2025. Available in some markets; severely limited or unavailable in others.

Rectal suppositories (12.5 mg, 25 mg): Supply concern since October 2025. May offer an alternative route when oral forms are unavailable.

Combination products (promethazine VC with codeine): Permanently discontinued by sole US supplier in January 2024. No commercial alternative available.

Therapeutic Alternatives by Clinical Indication

Nausea and Vomiting (General / Post-Operative / Chemotherapy)

Ondansetron (Zofran): 4–8 mg PO/IV/ODT q8h. First-line 5-HT3 antagonist. RCT evidence shows non-inferiority to promethazine for undifferentiated ED nausea, with less sedation. Preferred for CINV and post-operative nausea. Caution: QT prolongation at higher IV doses.

Metoclopramide (Reglan): 10 mg PO/IV q6h. Dopamine antagonist with prokinetic activity. Particularly useful when gastroparesis contributes to nausea. Boxed warning: tardive dyskinesia with use >12 weeks. Use diphenhydramine prophylactically when giving IV to reduce extrapyramidal risk.

Prochlorperazine (Compazine): 5–10 mg PO/IM q6–8h or 25 mg PR q12h. Same phenothiazine class; less sedating than promethazine. Note: Also experiencing independent supply disruptions in 2026 — verify availability before substituting.

Haloperidol: 0.5–2 mg IV/IM. Emerging evidence supports use as antiemetic in ED and palliative care settings. Monitor QTc. Use with caution in Parkinson's disease.

Motion Sickness / Vestibular Nausea

Meclizine: 25–50 mg PO 1 hour before travel. OTC available. Antihistamine; less sedating than promethazine. Well-tolerated. Best choice for patients using promethazine solely for motion sickness prevention.

Scopolamine (Transderm Scop): Transdermal patch 1.5 mg/72 hours. Apply behind ear at least 4 hours before travel. Excellent for extended trips. Anticholinergic side effects (dry mouth, blurred vision). Prescription required.

Allergic Conditions

Cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra): Second-generation antihistamines. OTC available. Far less sedating than promethazine. Preferred for most allergic rhinitis cases where sedation is undesirable.

Diphenhydramine (Benadryl): 25–50 mg PO/IV q6h. First-generation antihistamine; more sedating; OTC and IV forms widely available. Appropriate when sedation is desired or for acute allergic reactions.

Promethazine has historically been used for hyperemesis gravidarum (HG) and is the preferred first-line agent in the UK. For US patients, coordinate with OB-GYN regarding alternatives:

Doxylamine + pyridoxine (Bonjesta, Diclegis) — FDA-approved first-line for nausea of pregnancy

Pyridoxine (vitamin B6) 50–200 mg/day — safe and effective for mild-moderate nausea

Ondansetron — effective but use with caution in first trimester (consult prescribing guidelines)

Key Safety Reminders During Shortage Management

IV promethazine: Even when available, IV administration of promethazine is not recommended due to severe risk of tissue necrosis, gangrene, and potential amputation from extravasation or intra-arterial injection. The boxed warning explicitly states this. IM or oral/rectal routes are preferred.

Pediatric use: Promethazine is contraindicated in children under 2 years of age due to risk of fatal respiratory depression. Caution also warranted in children 2 years and older.

CNS depressant interactions: When transitioning patients to alternative antiemetics, review CNS depressant interactions, particularly with opioids, benzodiazepines, and alcohol.

Communicating the Shortage to Patients

Patients encountering a shortage are understandably frustrated. Recommended communication approach:

Validate the frustration and explain this is a national supply issue, not a problem specific to their pharmacy

Proactively provide a written alternative prescription at the point of prescribing, before a failed fill attempt

Consider providing patients with written information about checking multiple pharmacies

Direct patients to medfinder for Providers to help identify retail pharmacies near them with promethazine in stock

System-Level Recommendations

Implement therapeutic interchange policies permitting pharmacist-driven substitution for promethazine with pre-approved alternatives

Review formulary substitution guidelines and update antiemetic standing orders to reflect shortage conditions

Monitor local outpatient pharmacy availability through ASHP Drug Shortage Database and direct pharmacy partnerships

Consider formulation switching — suppositories may be available when tablets are not, and vice versa

Resources for Providers

For real-time pharmacy stock data to help your patients, visit medfinder for Providers. For a step-by-step guide on helping your patients navigate the shortage, see our companion article: How to Help Your Patients Find Phenergan in Stock: A Provider's Guide

Frequently Asked Questions

Ondansetron 4 mg IV is the most common first-line substitute for post-operative and undifferentiated nausea. Metoclopramide 10 mg IV (with diphenhydramine 25 mg IV to reduce extrapyramidal risk) is an evidence-based alternative, particularly useful when gastroparesis contributes. Haloperidol 0.5–2 mg IV is increasingly used in ED and palliative settings — monitor QTc.

In most states, pharmacists cannot automatically substitute a different drug class without prescriber authorization. Therapeutic interchange policies — established at the hospital or health system level — can pre-authorize pharmacist-driven substitution. Without such a policy, a new prescription or verbal order from the prescriber is typically required.

IV promethazine carries a boxed warning due to severe risk of tissue injury — including gangrene and potential amputation — from extravasation or intra-arterial injection. Even when available, the IM, oral, or rectal routes are strongly preferred. If IV administration is absolutely necessary, it should be given slowly via a large-bore vein with close monitoring.

Consult with OB-GYN for guidance. First-line options for pregnancy nausea include doxylamine/pyridoxine (Bonjesta, Diclegis), which is FDA-approved for this indication. Pyridoxine (vitamin B6) 50–200 mg/day is safe and effective for mild-moderate symptoms. Ondansetron may be used with caution — review current prescribing guidelines and teratogenicity data, particularly for first-trimester use.

The ASHP Drug Shortage Database (ashp.org/drug-shortages) is updated regularly by manufacturers and provides the most reliable clinical information. The FDA's Drug Shortage database also lists current shortages. For outpatient pharmacy availability in your area, medfinder for Providers can identify which local pharmacies have stock for your patients.

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