{
 "query": "dextromethorphan / promethazine",
 "ingredient": "dextromethorphan / promethazine",
 "slug": "dextromethorphan-promethazine",
 "rxcui": "214491",
 "brands": [],
 "names": [
  "dextromethorphan / promethazine"
 ],
 "components": [
  {
   "ingredient": "dextromethorphan",
   "slug": "dextromethorphan",
   "grade": "B",
   "total": 83,
   "scores": {
    "safety": "A",
    "evidence": "F",
    "regulatory": "A",
    "conflict": "A",
    "options": "A"
   },
   "boxed": false,
   "controlled": false,
   "first_approval_fmt": "10/08/1982",
   "first_approval": "19821008"
  },
  {
   "ingredient": "promethazine",
   "slug": "promethazine",
   "grade": "C",
   "total": 74,
   "scores": {
    "safety": "C",
    "evidence": "F",
    "regulatory": "A",
    "conflict": "A",
    "options": "A"
   },
   "boxed": true,
   "controlled": false,
   "first_approval_fmt": "03/29/1951",
   "first_approval": "19510329"
  }
 ],
 "classes": [],
 "alternatives": [],
 "label": {},
 "faers": null,
 "faers_base": {
  "total": 20692304,
  "serious_share": 0.5742697381596559,
  "death_share": 0.09102355155810585
 },
 "recalls": [],
 "recall_total": 0,
 "drugsfda": {
  "first_approval": "19510329",
  "first_approval_fmt": "",
  "anda": 3,
  "nda": 0,
  "rems": false,
  "labeling_recent": 0
 },
 "trials": null,
 "pubmed": null,
 "payments": {
  "year": "2024",
  "usd": 0.0,
  "records": 0,
  "by_name": [],
  "names_checked": [
   "dextromethorphan / promethazine"
  ],
  "source": "bulk-index"
 },
 "partd": {
  "year": "2024",
  "claims": 13336,
  "beneficiaries": 9957,
  "spend": 130222.47,
  "by_brand": [
   {
    "brand": "Promethazine-DM",
    "claims": 13336,
    "per_claim": 9.7647323035,
    "is_generic": false
   }
  ],
  "per_claim": 9.764732303539292
 },
 "mdl": [],
 "dsc": [],
 "settlements": [],
 "prescrire": null,
 "eml": null,
 "exposure": null,
 "scores": {
  "safety": {
   "score": 66,
   "letter": "C",
   "why": [
    "Graded by its riskiest ingredient, promethazine (66)",
    "Carries an FDA boxed warning, the strongest warning the FDA issues (-30)",
    "Prescrire lists one form only (injectable promethazine) as a drug to avoid; shown for context, no score effect",
    "4,271 FDA reports naming it as the suspect drug per million Medicare fills, 1.5x the median drug on this site (-4)",
    "Death share in reports is near or below the FAERS average (1.1x)",
    "A boxed warning caps the overall grade at C (score 75 shown as 74)"
   ],
   "weight": 0.35
  },
  "evidence": {
   "score": 46,
   "letter": "F",
   "why": [
    "Graded by its riskiest ingredient, dextromethorphan (46)",
    "157 randomized trials and 10 systematic reviews/meta-analyses indexed in PubMed",
    "No Cochrane review found (-5)",
    "Only 39% of completed registered trials posted results (-8)",
    "'Drug ineffective' is the single most-reported item about this drug in FAERS (-5)"
   ],
   "weight": 0.25
  },
  "regulatory": {
   "score": 100,
   "letter": "A",
   "why": [
    "Graded by its riskiest ingredient, dextromethorphan (100)",
    "No recalls on record since 2016"
   ],
   "weight": 0.15
  },
  "conflict": {
   "score": 100,
   "letter": "A",
   "why": [
    "Graded by its riskiest ingredient, dextromethorphan (100)",
    "Pharma paid doctors $0 tied to this drug last year: negligible",
    "Not named in any pending federal MDL"
   ],
   "weight": 0.15
  },
  "options": {
   "score": 100,
   "letter": "A",
   "why": [
    "Graded by its riskiest ingredient, dextromethorphan (100)",
    "Generic versions approved (3 applications)",
    "6 same-class alternatives exist"
   ],
   "weight": 0.1
  }
 },
 "total": 74,
 "grade": "C",
 "questions": [
  "This is a fixed combination of dextromethorphan and promethazine. Why both together, instead of only the one I need?",
  "The most-reported problems in FDA's adverse event data are toxicity to various agents, drug abuse, diarrhoea. How would we recognize and handle those?",
  "Why this one over codeine, ethylmorphine, hydrocodone? What would make you pick one of those instead?",
  "What result are we expecting, by when, and what is the plan if it does not happen?",
  "If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)",
  "An independent reviewer (Prescrire) lists this as a drug to avoid because the harms outweigh the benefits versus alternatives. What is your view on that?",
  "This drug carries a boxed warning. Which specific risk does it cover, and does it apply to me?",
  "The most-reported problems in FDA's adverse event data are intentional overdose, nausea, intentional self-injury, fatigue. How would we recognize and handle those?",
  "Why this one over bamipine, chloropyramine, chlorphenoxamine? What would make you pick one of those instead?"
 ]
}