THE THE OFF-LABEL USE OF PROMETHAZINE IN THE MANAGEMENT OF ANXIETY

Abstract

Anxiety is an emotional state that arises in response to the anticipation of a real or potential threat, leading to an increased state of alertness. It is a normal response in human experience; however, when persistent, it can become pathological, interfering with individuals’ quality of life and triggering excessive worry, tension, fear, and physical symptoms. Traditional treatment includes Cognitive Behavioral Therapy (CBT) and medications such as benzodiazepines and antidepressants. However, the search for alternatives led to the investigation of promethazine, an antihistamine medication derived from phenothiazine, which exhibits antiemetic, antiallergic, and sedative actions. This study aimed to analyze the efficacy and impacts of promethazine when used off-label in the management of anxiety. To achieve the proposed goal, a bibliographic review was conducted using the National Library of Medicine (PUBMED) database, with DeCS/MeSH descriptors “Anxiety” and “Promethazine,” intercalated with the boolean operator “AND,” published between 2008 and 2025, in Portuguese, English, and Spanish, with full-text material freely available, in addition to the use of the Treatise on Psychiatry by the Brazilian Association of Psychiatry (2021). After analysis, six articles were selected. It was concluded that promethazine can be effective in cases requiring mild sedation or in emergency situations such as aggression and psychosis. However, its off-label use should be cautious, and further research is essential to evaluate its risks and benefits, allowing for a safer and more effective therapeutic approach to anxiety treatment.