A retrospective study of promethazine and its failure to produce the expected incidence of sedation during space flight.

Since March 1989, intramuscular (IM) promethazine has been successfully used to treat the symptoms of space motion sickness. The incidence of sedation associated with promethazine administration on the ground is large and may result in operational impact. The authors undertook a retrospective study to quantify the incidence of sedation from promethazine use during Space Shuttle flights. Crew medical debriefings from 14 shuttle missions were reviewed for crew members who had been treated with IM promethazine and their corresponding symptoms were identified. Twenty-one crew members received IM promethazine (25-50 mg), and only one experienced any associated sedation with no operational impact. This sedation incidence of less that 5% is in stark contrast to the 60 to 73% incidence of sedation seen in ground-based studies. The incidence of sedation during space flight from IM promethazine is substantially less than that seen on the ground and does not present an operational problem during Space Shuttle flights. Future investigations of environmental stressors and pharmacodynamic changes associated with space flight may explain the huge disparity between the space-flight and ground-based data.