In which client population is promethazine absolutely contraindicated due to risk factors outlined by a black box warning?

Promethazine has a black box warning specifically indicating that it is contraindicated in children under the age of two due to the risk of severe respiratory depression, which can lead to serious adverse outcomes, including death. This caution stems from observed instances where young children, whose respiratory systems are still developing, experienced life-threatening respiratory issues after receiving the medication.

In addressing the other populations, while there are considerations for use in elderly patients, pregnant women, and those with liver disease, these do not elicit an absolute contraindication akin to that seen in very young children. In the elderly, there may be increased sensitivity to the effects of the drug, and in patients with liver disease, caution is advised due to altered metabolism, but these do not carry the explicit risk outlined in the black box warning as seen with use in children under two. Therefore, the focus on children reflects the heightened vulnerability of this age group, solidifying the rationale behind the contraindication.