What is Pro?
Pro is a central nervous system stimulant. It works by stimulating the brain. Pro is found naturally in foods and beverages such as coffee, tea, colas, energy and chocolate. Botanical sources of Pro include kola nuts, guarana, and yerba mate. Pro is also available in prescription and non-prescription medications.
Pro is used to restore mental alertness or wakefulness during fatigue or drowsiness. Pro is also found in some headache and migraine medications, in certain dietary supplements used for weight loss, and in many popular energy drinks.
Pro citrate (Pro) is available by prescription only. It is used for short-term treatment of neonatal apnea (breathing problems).
Pro may also be used for other conditions as determined by your health care provider.
Pro indications
Pro and Sodium Benzoate Injection has been used in conjunction with supportive measure to treat respiratory depression associated with overdosage with CNS depressant drugs (e.g., narcotic analgesics, alcohol). However, because of questionable benefit and transient action, most authorities believe Pro and other analeptics should not be used in these conditions and recommend other supportive therapy.
How should I use Pro?
Use Pro as directed by your health care provider. If the medication is OTC, check the label on the bottle for the exact dosing instructions. If you have any questions about the use of an OTC medication, ask your pharmacist.
- Pro may be taken with or without food. If Pro upsets your stomach, take it with food.
- Do not exceed the recommended dose of Pro. Pro can be habit-forming.
- Most OTC medications used for mental alertness contain 200 milligrams of Pro per tablet or capsule. The usual maximum recommended dose of OTC Pro is no more than 200 mg every 3-4 hours, or 1600 mg per day.
- Do not double-up on your Pro dose if you should miss the time for next dose.
- The average cup of coffee contains 150-200 milligrams (mg) of Pro per cup, while a cup of tea will have about 60 mg of Pro. Cola products have about 30-40 mg of Pro, and most energy drinks have about 60-70 mg. Be sure to account for any dietary Pro that is consumed.
Ask your health care provider any questions you may have about how to use Pro.
Uses of Pro in details
Use: Labeled Indications
Pro citrate: Treatment of idiopathic apnea of prematurity
Pro and sodium benzoate: See Off-Label uses.
Pro [OTC labeling]: Restore mental alertness or wakefulness when experiencing fatigue
Off Label Uses
Augmentation of seizure induction during electroconvulsive therapy (Pro and sodium benzoate)
Data from a randomized, double blind study as well as a few unblinded studies support the use of Pro/sodium benzoate in the treatment of augmentation of seizure induction during electroconvulsive therapy (ECT).
Pro description
A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Pro's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of Pro have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [PubChem]
Pro dosage
Usual Adult Dose for Drowsiness:
100 to 200 mg orally not more often than every 3 to 4 hours.
For occasional use only.
Not intended for use as a substitute for sleep.
Limit the use of Pro containing medications, foods, or beverages while taking this product because too much Pro may cause nervousness, irritability, sleeplessness, and occasionally, rapid heartbeat.
Usual Pediatric Dose for Drowsiness:
>= 12 years: 100 to 200 mg not more often than every 3 to 4 hours.
For occasional use only.
Not intended for use as a substitute for sleep.
Limit the use of Pro containing medications, foods, or beverages while taking this product because too much Pro may cause nervousness, irritability, sleeplessness, and occasionally, rapid heartbeat.
Usual Pediatric Dose for Apnea of Prematurity:
For short term treatment of apnea of prematurity in infants between 28 and <33 weeks gestational age.
Prior to initiation of Pro citrate, baseline serum levels of Pro should be measured in infants previously treated with theophylline, since preterm infants metabolize theophylline to Pro. Likewise, baseline serum levels of Pro should be measured in infants born to mothers who consumed Pro prior to delivery, since Pro readily crosses the placenta.
Loading Dose: 20 mg/kg Pro citrate intravenous (over 30 minutes) once
Maintenance Dose: 5 mg/kg Pro citrate intravenous (over 10 minutes) or orally every 24 hours.
Note: The dose of Pro base is one-half the dose when expressed as Pro citrate (e.g., 20 mg of Pro citrate is equivalent to 10 mg of Pro base).
Serum concentrations of Pro may need to be monitored periodically throughout treatment to avoid toxicity. Serious toxicity has been associated with serum levels greater than 50 mg/L.
Apnea of prematurity is a diagnosis of exclusion. Other causes of apnea (e.g., central nervous system disorders, primary lung disease, anemia, sepsis, metabolic disturbances, cardiovascular abnormalities, or obstructive apnea) should be ruled out or properly treated prior to initiation of Pro citrate.
Pro citrate should be used with caution in infants with seizure disorders or cardiovascular disease.
The duration of treatment of apnea of prematurity in the placebo-controlled trial was limited to 10 to 12 days. The safety and efficacy of Pro citrate for longer periods of treatment have not been established.
Pro interactions
See also:
What other drugs will affect Pro?
Acebrophylline: May enhance the stimulatory effect of CNS Stimulants. Avoid combination
Adenosine: Pro and Pro Containing Products may diminish the therapeutic effect of Adenosine. Management: Monitor for decreased effect of adenosine if patient is receiving Pro. Discontinue Pro in advance of scheduled diagnostic use of adenosine whenever possible. Consider therapy modification
Amifampridine: Agents With Seizure Threshold Lowering Potential may enhance the neuroexcitatory and/or seizure-potentiating effect of Amifampridine. Monitor therapy
AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy
Broccoli: May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers). Monitor therapy
Bromperidol: Pro and Pro Containing Products may decrease the absorption of Bromperidol. Monitor therapy
BuPROPion: May enhance the neuroexcitatory and/or seizure-potentiating effect of Agents With Seizure Threshold Lowering Potential. Monitor therapy
Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol. Monitor therapy
Cannabis: May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers). Monitor therapy
CloZAPine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of CloZAPine. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Monitor therapy
Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Consider therapy modification
CYP1A2 Inducers (Moderate): May decrease the serum concentration of Pro and Pro Containing Products. Monitor therapy
CYP1A2 Inhibitors (Moderate): May increase the serum concentration of Pro and Pro Containing Products. Monitor therapy
CYP1A2 Inhibitors (Strong): May increase the serum concentration of Pro and Pro Containing Products. Monitor therapy
Doxofylline: Pro and Pro Containing Products may enhance the adverse/toxic effect of Doxofylline. Avoid combination
Esketamine: May enhance the hypertensive effect of CNS Stimulants. Monitor therapy
Formoterol: Pro and Pro Containing Products may enhance the adverse/toxic effect of Formoterol. Pro and Pro Containing Products may enhance the hypokalemic effect of Formoterol. Monitor therapy
Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Monitor therapy
Indacaterol: Pro and Pro Containing Products may enhance the adverse/toxic effect of Indacaterol. Pro and Pro Containing Products may enhance the hypokalemic effect of Indacaterol. Monitor therapy
Iohexol: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants. Consider therapy modification
Iomeprol: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants. Consider therapy modification
Iopamidol: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants. Consider therapy modification
Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Consider therapy modification
Lithium: Pro and Pro Containing Products may decrease the serum concentration of Lithium. Monitor therapy
Norfloxacin: May increase the serum concentration of Pro and Pro Containing Products. Monitor therapy
Olodaterol: Pro and Pro Containing Products may enhance the adverse/toxic effect of Olodaterol. Pro and Pro Containing Products may enhance the hypokalemic effect of Olodaterol. Monitor therapy
Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Management: Concomitant use of ozanimod with sympathomimetic agents is not recommended. If combined, monitor patients closely for the development of hypertension, including hypertensive crises. Consider therapy modification
Pipemidic Acid: May increase the serum concentration of Pro and Pro Containing Products. Monitor therapy
Regadenoson: Pro and Pro Containing Products may diminish the vasodilatory effect of Regadenoson. Management: Avoiding using Pro or other methylxanthine containing products (e.g., theophylline) for at least 12 hours prior to the administration of regadenoson. Consider therapy modification
Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Monitor therapy
Solriamfetol: CNS Stimulants may enhance the hypertensive effect of Solriamfetol. CNS Stimulants may enhance the tachycardic effect of Solriamfetol. Monitor therapy
Stiripentol: May increase the serum concentration of Pro and Pro Containing Products. Avoid combination
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy
Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Monitor therapy
Theophylline Derivatives: CYP1A2 Inhibitors (Weak) may increase the serum concentration of Theophylline Derivatives. Exceptions: Dyphylline. Monitor therapy
TiZANidine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of TiZANidine. Management: Avoid these combinations when possible. If combined use is necessary, initiate tizanidine at an adult dose of 2 mg and increase in 2 to 4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. Consider therapy modification
Tobacco (Smoked): May decrease the serum concentration of Pro and Pro Containing Products. Monitor therapy
Pro side effects
See also:
What are the possible side effects of Pro?
Cardiovascular
Tachycardia; extrasystoles; palpitations; other cardiac arrhythmias.
CNS
Insomnia; restlessness; excitement; nervousness; tinnitus; scintillating scotoma; muscular tremor; headache; lightheadedness.
Dermatologic
Urticaria; rash, dry skin, skin breakdown (Pro citrate).
EENT
Retinopathy of prematurity (Pro citrate).
GI
Vomiting; nausea; diarrhea; stomach pain; necrotizing enterocolitis, gastritis, GI hemorrhage (Pro citrate).
Genitourinary
Diuresis; kidney failure (Pro citrate).
Hematologic
Disseminated intravascular coagulation (Pro citrate).
Metabolic
Hyperglycemia; acidosis (Pro citrate).
Respiratory
Dyspnea, lung edema (Pro citrate).
Miscellaneous
Hypersensitivity (eg, dermatitis, rhinitis, bronchial asthma); feeding intolerance, sepsis, accidental injury, hemorrhage, cerebral hemorrhage (Pro citrate).
Pro contraindications
See also:
What is the most important information I should know about Pro?
Pro citrate should not be given to a child who has had an allergic reaction to it in the past.
Before using Pro citrate, tell the doctor if your child is allergic to any drugs, or has a seizure disorder, heart disease, kidney disease, liver disease, or high or low blood sugar.
Do not use the medication for longer than 12 days without the advice of your child's doctor.
Each bottle of Pro citrate is for one use only, even if your child does not use the entire bottle for a single dose. Throw away any medication left over in the bottle after measuring your child's dose.
Call your doctor if the child's breathing symptoms do not improve after using Pro citrate.
To be sure Pro citrate is helping your child's condition, the child's blood will need to be tested on a regular basis. Do not miss any scheduled appointments.
Active ingredient matches for Pro:
Caffeine in Malta, Taiwan.
Piroxicam/Proglumide in Taiwan.
Promethazine hydrochloride in United States.
| Unit description / dosage (Manufacturer) | Price, USD |
| Pro / Y.C. 10 mg/1 g x 1 g | |
| Pro / Y.C. 10 mg/1 g x 10 g | |
| Pro / Y.C. 10 mg/1 g x 20 g | |
| Pro / Y.C. 10 mg/1 g x 40 g | |
List of Pro substitutes (brand and generic names): | |
| PRIMOZYN-P (India) | |
| Primozyn-P Promethazine hydrochloride 2.5mg, paracetamol 125 mg/5 mL. SYR / 60ml (Mandar) | $ 0.24 |
| Pro Plus (Malta) | |
| Pro-Plus (United Kingdom, Ireland) | |
| Tablet; Oral; Caffeine 50 mg (Roche consumer) | |
| PROGENE-25 (India) | |
| 25 mg x 100's (Psycorem) | $ 1.45 |
| Progene-25 25mg TAB / 100 (Psycorem) | $ 1.45 |
| PROGENE-25 tab 25 mg x 10's (Psycorem) | $ 0.14 |
| Progene-25 25mg TAB / 100 (Psycorem) | $ 1.45 |
| PROMEDICВ® | |
| Promethazine Hydrochloride | |
| Promethazine Hydrochloride 50 mg/2 mL x 5's | |
| 118 milliliter in 1 bottle | |
| 237 milliliter in 1 bottle | |
| 473 milliliter in 1 bottle | |
| Promethazine Hydrochloride tablet 12.5 mg/1 (Northwind Pharmaceuticals (US)) | |
| Promethazine Hydrochloride tablet 50 mg/1 (Sandoz Inc (US)) | |
| Promethazine Hydrochloride tablet 25 mg/1 (State of Florida DOH Central Pharmacy (US)) | |
| Promethazine Hydrochloride syrup 6.25 mg/5mL (Rebel Distributors Corp (US)) | |
| Promethazine Hydrochloride suppository 25 mg/1 (Renaissance Pharma, Inc. (US)) | |
| Promethazine Hydrochloride injection 25 mg/mL (West Ward Pharmaceutical Corp. (US)) | |
| Promethazine Hydrochloride suppository 12.5 mg/1 (Perrigo New York Inc (US)) | |
| Promethazine Hydrochloride injection 50 mg/mL (Physicians Total Care, Inc. (US)) | |
| Promethazine Hydrochloride injection, solution 25 mg/mL (X Gen Pharmaceuticals, Inc. (US)) | |
| Promethazine Hydrochloride solution 6.25 mg/5mL (Nostrum Laboratories, Inc. (US)) | |
| Promethazine Hydrochloride injection, solution 50 mg/mL (General Injectables & Vaccines, Inc (US)) | |
| Promethazine Hydrochloride tablet 25 mg/301 (Northwind Pharmaceuticals (US)) | |
| Promethazine Hydrochloride suppository 50 mg/1 (Renaissance Pharma, Inc. (US)) | |
| Promethazine Hydrochloride injection, solution 25 mg/1 (REMEDYREPACK INC. (US)) | |
| Promethazine Injection | |
| Promethazine Suppositories | |
| Promethazine Syrup | |
| PROMOZY (India) | |
| PROMOZY syr 5 mg x 60ml (Unikind) | $ 0.33 |
| Propoxyphene Compound-65 | |
| Quick Pep (United States) | |
| Quick-Pep (United States) | |
| Refresh'n | |
| Respia (Japan) | |
| Revive | |
| Revive 150 mg x 10 Blister x 10 Tablet (Allergan) | |
| Sitafein (Turkey) | |
| SK 65 Compound | |
| Snizof Tablet | |
| Snizof Tablet (Clin Medicals Pvt Ltd (Geno Pharmaceuticals Ltd)) | $ 0.02 |
| Sodium Cofein Benzoat Darnitsa (Georgia) | |
| Sodium Coffein Benzoat (Georgia) | |
| Sodium Coffein Benzoat SIC BHFZ (Georgia) | |
See 421 substitutes for Pro | |
References
- DailyMed. "PIROXICAM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DailyMed. "CAFFEINE; ERGOTAMINE TARTRATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- PubChem. "piroxicam". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for Pro are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Pro. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
Consumer reported useful
No survey data has been collected yetConsumer reported price estimates
No survey data has been collected yetConsumer reported time for results
No survey data has been collected yetConsumer reported age
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Information checked by Dr. Sachin Kumar, MD Pharmacology
