Promethazine (brand name: Phenergan) is a medication that belongs to the family of drugs known as phenothiazines. It is a synthetic medication that acts as an antihistamine, and it is available with a prescription.
Promethazine is primarily used to treat allergies and motion sickness; it is also included in cough medications. The drug produces sedation, and it may be used as a preanesthetic.
While promethazine is not a controlled substance, it is often included in cough syrups with the controlled substance codeine. As a result, many of the products that contain the substance are listed as controlled substances.
Recreational promethazine use is not safe. It comes with the risk of many negative effects.
Effects of Using Promethazine
The medicinal effects of using promethazine include:
- Relieving symptoms that are associated with allergies, such as watery eyes, runny nose, congestion, and similar symptoms
- Reducing sneezing and coughing
- Lessening nausea
- Producing mild sedation
Common side effects include:
- Sedation, drowsiness, or lethargy
- Dizziness, blurred vision, or fever
- Decreased heart rate or breathing rate
Rarer and more severe side effects include fever, hallucinations, a yellow tint to the skin or eyes (jaundice), rigid muscles, or seizures.
The use of the drug is not considered to be safe for very young children. A black box warning from the U.S. Food and Drug Administration (FDA) warns that promethazine should not be given to children under age 2 because the drug may cause very severe breathing issues. These breathing issues are related to the drug producing respiratory suppression as part of its overall effects.
Abuse of Promethazine
The Substance Abuse and Mental Health Services Administration (SAMHSA) does not report figures or estimates for promethazine use; however, it does report estimates of codeine use in the United States.
In 2017, it was estimated that at least 26 million individuals reported using codeine products, and about 2.8 million of these individuals reported misusing substances containing codeine at least once. A good number of people reporting the misuse of codeine products most likely misused the substance in a cough syrup formula, and many of these formulas contain promethazine.
The misuse and abuse of a drug both involve taking the drug for reasons other than its medical uses.
Combinations of promethazine and codeine may be relatively easy to obtain by younger individuals who typically guzzle these products to achieve their psychoactive effects.
Although codeine products are typically considered to be less dangerous than many of the other opioid drugs, such as hydrocodone and oxycodone, taking the combination of codeine and promethazine in large quantities can result in potentially dangerous effects.
Individuals will often abuse these products in conjunction with other drugs of abuse, particularly alcohol. Combining alcohol with an opiate drug enhances the effects of both drugs. The potential for serious effects, such as significantly decreased breathing rates, drastically decreased heart rate, confusion, and, unconsciousness, is increased.
Potential for Overdose
Dangerous symptoms of an overdose include:
- A significant decrease or even stoppage in breathing rate
- Dilated pupils
- A loss of muscle coordination
- Significant slurring of words
- Substantial confusion
- Problems with emotional control
- Loss of consciousness or coma
If someone has overdosed on promethazine or another drug, immediately call 911.
Prescription drugs like promethazine should only be taken exactly as directed by a physician. They should never be misused in a manner that is inconsistent with their medical uses.
Codeine and Promethazine
The National Institute on Drug Abuse (NIDA) reports that one of the most common misuses of promethazine substances is to mix products containing codeine and promethazine with different types of soda. This concoction is referred to as Lean, Purple Drank, Syrup, or Sizzurp.
Although these prescription cough medications are designed for short-term use, the use of these substances in high amounts or over the long term can be potentially dangerous.
There also are a few references in the literature to cases of promethazine abuse alone. For instance, a case study reported in 2013 in the Journal of Substance Usedocumented a possible case of promethazine abuse leading to physical dependence, with the withdrawal symptoms being more psychological or emotional in nature. The authors of the article suggested that more attention be paid to potential cases of promethazine abuse.
A retrospective review reported in the Journal of Addiction Medicine in 2015 looked at the abuse of promethazine cases that were documented by the National Poison Data System during an 11-year period (2002–2012). The data distinguished between abuse of promethazine alone and promethazine with combinations of other drugs, such as codeine.
Over the period studied, there was a significant increase in the exposure rate to promethazine. The age group accounting for most of the exposure was 10 to 19 years old and young adults in their early 20s, consistent with previous findings.
Findings indicated that the following were the most common effects associated with toxic exposure to promethazine alone, in order of prevalence:
- Agitation or confusion
- Slurred speech
- Rapid heartbeat, dizziness, or hallucinations
- High blood pressure
The majority of cases demonstrated no significant long-term effects despite whether the exposure case was due to promethazine alone or promethazine in combination with some other substance.
Nonetheless, the symptom profile associated with toxic exposure to promethazine indicates that the symptoms are potentially dangerous if the person does not receive formal treatment.
Individuals who experience drowsiness or confusion can be at risk for numerous mishaps if they are left on their own recognizance. Studies suggest that overdose effects may also be potentially dangerous.
Is There a Safe Way to Use Promethazine Recreationally?
Promethazine is a medication that has significant medical uses. Even though it is not a controlled substance, it is often included in medications that include a controlled substance like codeine.
Medications should only be taken for their intended purpose. Only one’s physician should endorse any other use, whether it is available over the counter or only via a prescription.
Thus, there is no safe way to recreationally use promethazine (to attempt to use the drug to get a high or buzz or combine it with other drugs for this purpose). The potential for serious effects when the medication is used in a manner that is not consistent with its intended purpose is very real.
Individuals should restrict their use of any medication to the purpose for which it is meant to be used. Any person who misuses drugs should seek treatment.