Promethazine Side Effects

Why Is This Medication Prescribed?

Promethazine is a medication used to relieve the symptoms of allergic reactions such as allergic rhinitis (watery eyes and runny nose caused by allergy to mold, pollen, or dust), allergic conjunctivitis (red, watery eyes caused by allergies), allergic reactions to blood or plasma products and allergic skin reactions.

According to the National Institute of Health (NIH) [1], promethazine is used with other medications to treat anaphylaxis (severe, sudden allergic reactions) and the common cold symptoms such as cough, sneezing, and runny nose. Promethazine is also prescribed to relax and sedate patients before and after surgery and during labor.

Promethazine may also be used to prevent and control nausea and vomiting after surgery and other medications to help relieve pain after surgery. In addition, it is prescribed to avoid and treat motion sickness. However, it is essential to remember that this medication only helps control symptoms but will not treat the cause of the symptoms or speed recovery. It is available as a solution, tablet, and rectal suppository. In tablet form, it can be crushed or cut and taken with or without food.

Promethazine has been reported to be misused in combination with opioids in several settings. The drug misuse by itself or in combination with opioids may have serious and adverse promethazine side effects. According to the National Center for Biotechnology (NCBI) [2], In contemporary medical practice, the use of promethazine in combination with opioids for pre and post-operative sedation has declined due to adverse promethazine side effects and lack of data supporting the clinical efficacy.

How Promethazine Works?

Promethazine works by blocking a specific natural substance in the body called histamine during an allergic reaction. Histamine is an organic compound released during a local immune response. Promethazine also decreases the number of signals shot off by the brain, which induces vomiting. When in tablet form, it may interact with other drugs.

Promethazine Side Effects & Abuse

Promethazine affects the body’s ability to regulate alertness, inflammation, and pain control. By blocking the release of histamine, it causes deep relaxation and sleepiness. This drug increases the skin’s sensitivity to the sun and increases the risk of sunburn.

According to the Nation Center for Biotechnology Information (NCBI) [4], promethazine has been reported to induce significant agitation, sedation, hallucinations, dystonic reactions, seizures, and possibly apparent life-threatening events or sudden infant death syndrome.

Two of the most serious promethazine side effects are addressed in a boxed warning on the drug’s labeling. These reactions include respiratory depression, which can be lethal (happening primarily in children under the age of 2 years), and, when this drug is given intravenously, severe tissue damage and chemical irritation, including gangrene.

When abused, this over the counter drug creates several negative effects like:

Though dangerous on their own, the Antihistamine such as promethazine can be life-threatening when combined with other illicit drugs. Promethazine side effects and abuse is often seen in people struggling with coexisting substance use disorder and addiction. In a research published by the National Center for Biotechnology Information (NCBI) [5], experts discovered compelling evidence of Promethazine’s non-medical use. One-quarter of the participants in the study who were using Methadone was also taking Promethazine. Out of the sample of Methadone users, only 15% had an active Promethazine prescription.

Due to its antihistamine property, many people believe that this drug is harmless; however, this is far from the truth. Individuals who engage in any form of substance abuse are at risk of dependency and even overdose. Promethazine side effects due to abuse and addiction can be damaging and life-changing in the most dangerous ways possible. The emotional and physical effects of substance abuse and addiction can take a toll on anyone. Promethazine is one of the many dangerous substances that should always be handled with caution.

Promethazine Side Effects in Combination with Opioid Abuse

Promethazine, opioids like codeine, heroin, and morphine, and abuse are highly connected. Methadone use for opioid addiction treatment is associated with Promethazine abuse. The antihistamine property of this drug strengthens the opioid “high.” The enhancing capacity makes promethazine popular among individuals with an addiction disorder. Promethazine abuse is common among people with chronic pain, injection drug users, and at-risk teenagers. Unfortunately, people without prior substance use disorders are becoming addicted to this drug as well.

The medical use of a combination of opioids and promethazine was first reported in 1949 as a “lytic cocktail,” a combination of promethazine, chlorpromazine, and meperidine (and related compounds) that was noted to have an opioid-sparing effect, allowing the use of lower doses of opioids to achieve sedation. This resulted in the decline of its use for pre and post-operative sedation due to its adverse effect [7].

According to reports from NCBI [8], cough medicine containing both promethazine and codeine began to appear in or around 2000, with an epicenter in Texas. Promethazine has also been reported to be present in fatal opioid overdoses in Kentucky and Seattle. There was also documented intravenous promethazine use by new heroin injectors in Vietnam. Cases of promethazine abuse in patients receiving buprenorphine treatment for opioid dependence have been reported in India and China.

Promethazine Side Effects & Withdrawal Symptoms

Individuals who frequently use codeine (with or without promethazine) may develop a dependence on opioids. If they quit using it or drastically decrease their use, they may experience withdrawal. Withdrawal can last several days, and symptoms may include:

What Is Pharming?

Lately, the potential for misuse of medications that are not already controlled has been reported worldwide. Pharming is a phenomenon concerning the non-medical use of prescription drugs (tranquilizers, pain relievers, stimulants, sedatives) and over-the-counter (OTC ), including cold and cough medications, particularly those containing dextromethorphan or DXM ( a cough suppressant and expectorant found in many OTC cold medicines) and promethazine. The abuse of these compounds may be facilitated by their easy accessibility, low cost, decreased perception of the potential for harm, and growing social acceptance.

What Is Purple Drank Or Lean?

Lean or purple drank is the moniker given to the recreational drug that is created by combining large doses of prescription cough syrup (most commonly promethazine-codeine products, which are commonly a deep purple color) with hard candy and carbonated soft drinks. Common side effects of purple drank are nausea, euphoria, dizziness, impaired vision, hallucinations, memory loss, and seizures.

Drinking promethazine-codeine cough syrup combined with soda (a combination called syrup, sizzurp, purple drank, lean, or barre) was referenced often in some popular music beginning in the late ’90s and has become increasingly popular among youth in several areas of the country. A variation of “purple drank” is promethazine-codeine cough syrup mixed with alcohol. Users may also flavor the mixture with the addition of hard candies.

Operating machinery or getting behind the wheel of a car after drinking purple drank increases the risk of accidents. As a depressant, alcohol can cause sedation and even euphoria. Once the buzz from the drink wears off, however, you may feel very sleepy and possibly depressed. For instance, DJ Screw died in 2000 because of codeine-promethazine-alcohol overdose. Big Moe was another DJ who died after falling into a coma related to purple drank misuse.

Treatment For Promethazine Side Effects Due To Addiction

Promethazine may be a legal prescription medication that’s not a concern for drug-enforcement officials. However, that doesn’t mean it doesn’t have the potential to cause harm or be abused. It’s very important to treat all drugs, even the “safe” ones, with caution. Be watchful and ensure that promethazine does not fall into the wrong hands as it could instantly become deadly if combined with another illicit substance [9].