Promethazine Abuse

Estimated reading time: 33 minute(s)

While many people are unaware, promethazine syrup abuse has recently become a serious problem across the United States. Often combined with an opioid called codeine, these syrups can be quite addictive and easily make a person habitual of abusing them. The addiction potential of these promethazine syrups is certainly not comparable to that of more potent opioids, like fentanyl, Percocet, or oxycodone. Still, the threat continues to increase with time because this drug often remains under the radar.

Due to the rising addiction and overdose cases related to promethazine abuse, it is imperative to learn what the medicine is, how it works, the mechanism of its abuse and addiction, and the signs and symptoms of catching it. The right level of information and awareness can someday save a life.

How Promethazine Works and its Potential Side Effects

Promethazine hydrochloride is part of a drug class known as phenothiazines. Unlike narcotics, these drugs do not affect neurotransmitters to manage anxiety or pain but target histamines. Histamines are naturally-existing molecules in the body involved in different types of cell signaling. These molecules are best known for triggering and regulating allergic reactions by modulating the immune system. Promethazine and other drugs in this class control the release of these molecules; hence, they are known as antihistamines. In addition to these anti-histamine properties, this drug can control nausea, vomiting, and motion sickness.

While the mechanism of action of promethazine seems pretty harmless, the drug carries many dangers, especially because of how it interacts with other medicines. It can intensify and prolong the effects of many central nervous system depressants, such as opioids, alcohol, barbiturates, tranquilizers, and antidepressants. Moreover, promethazine also interacts negatively with certain medications, such as anticholinergics and vasopressors. Some common side effects of this drug, alone or in combination with the drugs mentioned above, include the following:

  • Labored breathing
  • Extreme sleepiness
  • Dry mouth
  • Dermatitis
  • Euphoria
  • Involuntary muscle movements
  • Confusion
  • Increased risk of seizures
  • Low white cell count
  • Apnea
  • Nausea and vomiting

Promethazine Abuse: How it Takes Place

Promethazine was first discovered in France in the 1940s. The medication sought approval for use in the United States a few years later, in 1951. Soon after its arrival in the U.S., many pharmaceutical companies introduced it in combined formulations, for example, where promethazine was mixed with a known opioid called codeine. Since these combined formulations were introduced, promethazine and codeine abuse slowly began to surface and became an increasingly widespread problem during the 1990s. Many rap artists started using lean, a substance that combines promethazine, codeine, and alcohol.

What made these combination formulations particularly dangerous was the codeine element. Despite being a weaker opioid compared to others, codeine does carry a significant potential for abuse and addiction. Together with promethazine, its effects on the brain become quicker and stronger. Later, the pharmaceutical company released promethazine DM syrup, combining the medication with dextromethorphan. Abusing this specific drug became popular very soon through a practice called robotripping, where teenagers used it in higher doses to experience hallucinations and dissociations.

Today, promethazine abuse continues to increase with full intensity. Present in different forms, this abuse and addiction can be extremely damaging and potentially trigger irreversible damage to the body.

The Dangers Associated with Promethazine Abuse

Despite not being a controlled substance, promethazine carries a potential abuse, especially when it is combined with codeine. Some people routinely use the substance with alcohol which also heightens the risk. Promethazine abuse has been highly associated with many adverse outcomes, such as the following:

  • Impaired Coordination: As a depressant of the central nervous system, promethazine can slow down cognitive functioning and response times when abused. Chronic abuse may even lead to permanent impairment of the coordination
  • Extreme Vomiting and Nausea: Ironically, abusing promethazine, a drug that controls nausea and vomiting in normal doses, can trigger gastrointestinal complications, including excessive vomiting and nausea.
  • Hallucinations: Promethazine in very high doses may trigger visual or auditory hallucinations. Some people may even experience paranoia or panic attacks due to these hallucinations.
  • Memory Loss: Abusing promethazine, especially with codeine, may cause temporary memory loss or blackouts. If the abuse continues, long-term memory issues may surface.
  • Abnormal Blood Pressure & Heart Rate: Promethazine can quickly enter the bloodstream to target and negatively affect the cardiovascular system. The medication can alter the blood pressure and make the heartbeat irregular.
  • Seizures: Seizures are likely to occur in people who take too much cough syrup with codeine and promethazine. These seizures can sometimes indicate an underlying promethazine withdrawal.

Perhaps the most pressing issue related to long-term promethazine abuse is addiction. Especially in the case of combined formulations, many people are at risk of acquiring promethazine addiction and opioid use disorder simultaneously. As a chronic, relapsing brain disorder, addiction can quickly take over the entire body and negatively affect other aspects of life, such as employment, school, everyday responsibilities, relationships, and overall life quality.

Signs of Promethazine Addiction

Being an over-the-counter medication, promethazine is easy to obtain and abuse. Many continue to abuse it for years before realizing their underlying addiction because of a lack of awareness about what it looks like. The same holds true for promethazine-codeine combined formulations, which may be harder to obtain but carry an even higher abuse potential.

Following are some common signs indicating an underlying promethazine addiction case:

  • Taking the drug in higher doses than needed or instructed
  • Sharing the promethazine-codeine prescription with somebody, even if they have the same issues
  • Using someone else’s promethazine medication Combining the drug with other substances, such as opioids, benzodiazepines, and alcohol to increase its sedative effects
  • Using the promethazine-codeine drug without a prescription
  • Taking promethazine at a different time or in different ways than prescribed
  • Taking the medication improperly, such as crushing pills and mixing it with water to inject into the veins or snorting the crushed pill powder

Sometimes, abuse may occur accidentally and continue because the abuser wishes to enjoy the euphoric effects of promethazine. However, remember that abusing codeine does not always confirm the presence of an underlying addiction. However, the abuse does increase the chances of acquiring addiction sooner or later.

Can You Overdose on Promethazine: Evaluating the Risk and Management

While promethazine may not be as addictive as opioids, it can lead to fatal overdoses. Most of the symptoms related to promethazine overdose involve the central nervous system and may include the following:

  • Disturbed gait
  • Increased reflexes
  • Dips in blood pressure
  • Respiratory depression
  • hallucinations
  • Unconsciousness
  • Abnormal muscle contractions
  • Agitation
  • disorientation
  • Confusion
  • Nervousness
  • Drowsiness

Apart from the rare side effects mentioned above, the more common ones include dry mouth, flushing, dilated pupils, and digestive problems. If you suspect that you or someone you know has accidentally or intentionally overdosed on promethazine, it is imperative to let the emergency poison control services know about it. Do not leave the victim; try protecting their airways if you are trained. Seek professional help by taking them to the nearest emergency room as soon as possible. At the emergency department, medical health professionals may treat promethazine overdose by:

  • Administrating laxatives to eliminate promethazine from the body rapidly
  • Provide breathing support
  • Medically manage other symptoms, like agitation
  • Administer fluids through the veins to maintain BP
  • Administer activated charcoal to stop the body from absorbing too much of the drug

Overcoming Promethazine Addiction and Abuse: Recovery is Possible

No matter how crippling and destructive promethazine addiction may seem, recovery is achievable with the right support and guidance. Plenty of rehabilitation centers offer addiction recovery programs for people fighting promethazine abuse, with or without an underlying opioid addiction. These programs are available at various levels of care to suit clients’ varying needs and help them at an appropriate rate and pace.

Most treatment programs begin with a quick detoxification process that usually does not extend beyond two weeks. This detox aims to help people overcome physical addiction while keeping themselves safe from dangerous withdrawal symptoms. Sometimes, medications may make the withdrawal less painful and minimize promethazine cravings. Following the detox process, rehabilitation begins, which involves identifying and overcoming destructive drug use patterns. As a part of this rehabilitation, patients may make use of the following therapies under expert supervision:

  • Individual counseling
  • Family therapy
  • Group therapy
  • Daily meetings
  • Psychotherapy: trauma-based therapy, cognitive behavioral therapy, acceptance, commitment therapy, etc.
  • Holistic therapies, such as yoga, art therapy, mindfulness meditation, music therapy, dance, and more
  • 12-step immersion program

Through medically-supervised and highly-personalized treatment programs, beating promethazine abuse and addiction can eventually become possible.


What is the medical indication for using promethazine?

Promethazine is a synthetic medication belonging to a drug family called phenothiazines. Promethazine has many medical uses as a medication, such as managing motion sickness and allergies. Due to its strong sedative effect, some people prescribe it before or after surgery to manage nausea and vomiting.

Does promethazine get you high?

Promethazine is a first-generation anti-histamine drug that targets the brain and downregulates its activity. This downregulation produces sedation or a “high” many people enjoy and wish to experience repeatedly. As they keep using the drug, their bodies become more accustomed to its presence, and tolerance develops, eventually leading to addiction.

Why do people abuse promethazine?

Promethazine itself possesses the ability to cause sedation which some people enjoy. Moreover, many of its formulations available in the market include a combination of the drug with codeine, an opioid. As a part of this combination, promethazine strengthens the codeine-related high, leading to strong euphoria that forces people to indulge in promethazine abuse.

Are promethazine DM side effects reversible?

Whether or not you can reverse the side effects of promethazine abuse depends on how you consume it. Promethazine can be consumed through four main routes: oral tablets, oral liquids, rectal suppositories, and intravenous injections. When taken intravenously, the substance can easily cross the surrounding blood vessels and enter the surrounding tissue. This process, called extravasation, can lead to serious side effects with potentially irreversible damage. Administration through the intramuscular injection usually does not lead to this irreversible tissue damage. The FDA has warned the public regarding the risk of extravasation and the consequent side effects in the form of a boxed warning.

Will I ever be able to recover from promethazine addiction?

As difficult as it may seem, recovering from promethazine addiction with the right help and support is possible. Many rehab centers are working nationwide to support people who want to give up their addictive habits and adopt a sober lifestyle. These rehabs slowly guide them to give up their addictive habits through medically-supervised detoxification and other evidence-based rehabilitative therapies, such as cognitive behavioral therapy, dialectical behavioral therapy, motivational interviewing, and more. Aftercare services are also available to ensure that no one goes back to abusing promethazine again.

Can I take promethazine without developing an addiction to it?

It is possible to use promethazine without developing an addiction to it as long as you use it as prescribed and only until you truly need it. 

Get in Touch for Help