What Is Promethazine, and How Can It Be Abused?

WHAT ARE THE RISKS OF LEGITIMATE MEDICAL USE?

When promethazine is used as intended, the medication can induce extreme drowsiness. It can also cause various side effects to present. Some promethazine side effects are common and mild, others less common and more severe.

HOW IS PROMETHAZINE ABUSED?

Promethazine was developed in the 1940s in France. In 1951, the medication was approved for use in the United States.

A year after coming to market in the U.S., pharmaceutical companies introduced combination products containing promethazine and codeine – a prescription opioid narcotic – for the treatment of coughs and colds.

Promethazine with codeine abuse became an increasingly widespread problem in the 1990s. Rap artists began mythologizing lean, an illicit substance made by combining codeine, promethazine, and occasionally alcohol. Lean is also known as:

• Drank

• Purple drank

• Sizzurp

The most dangerous effects of promethazine codeine abuse occur due to its codeine content. Although codeine is among the weaker opioids, it nevertheless has the potential for abuse and addiction. Lean addiction can develop quite quickly as opioids hijack the reward circuitry in your brain.

Promethazine DM syrup abuse is a specific form of promethazine drug abuse involving cough syrup containing dextromethorphan. Taken in large doses – this form of promethazine codeine abuse is called robotripping – dextromethorphan can induce hallucinations and a dissociative experience.

All forms of promethazine with codeine abuse can be damaging.

WHAT ARE THE RATES OF PROMETHAZINE ABUSE?

This decade-long study found that exposure to promethazine was highest among those aged 10 to 19.

Researchers also discovered that promethazine is infrequently abused in isolation. More commonly, the substance is abused in combination with products containing codeine. Cough syrups containing promethazine and codeine are also commonly abused.

Why is promethazine abuse inadvisable, then?

WHAT ARE THE DANGERS ASSOCIATED WITH PROMETHAZINE ABUSE?

Promethazine is not a controlled substance, but it does have the potential for abuse.

This risk is heightened when promethazine is combined with codeine. This is the primary form of polysubstance abuse involving promethazine. The substance is also routinely abused in combination with alcohol.

Promethazine abuse is associated with many adverse outcomes, including:

• Impaired coordination: Promethazine is a CNS (central nervous system) depressant. As such, it slows response times and cognitive functioning significantly when abused. Chronic promethazine abuse can lead to permanently impaired coordination.

• Extreme nausea or vomiting: If you abuse promethazine in especially high doses, you are likely to experience digestive and gastrointestinal complications.

• Hallucinations: Very high doses of promethazine can bring about hallucinations, both auditory and visual. These hallucinations can trigger panic attacks and paranoia.

• Memory loss: The abuse of promethazine/codeine cough syrup causes blackouts (temporary memory loss). The sustained abuse of lean and similar products can impact memory long-term.

• Changes to heart rate and blood pressure: Promethazine enters your bloodstream and impacts your cardiovascular system. The ongoing abuse of this medication can cause your heart rate and blood pressure levels to change.

• Seizures: Seizures commonly occur if high doses of cough syrup containing codeine and promethazine are taken. Seizures are also indicative of promethazine withdrawal.

• Fatal overdose: Abusing products like lean that contain promethazine and codeine is associated with respiratory depression, a potentially fatal condition.

Fatal overdose: Abusing products like lean that contain promethazine and codeine is associated with respiratory depression, a potentially fatal condition.

The most pressing concern with long-term abuse of promethazine and codeine is addiction in the form of opioid use disorder. Tolerance and physical dependence to opioids forms rapidly. Addiction often follows. Addiction is a chronic and relapsing brain disorder. Opioid use disorder is characterized by the compulsive use of medications like promethazine and codeine cough syrup despite obviously negative outcomes.

While there is no cure for addiction, it responds well to evidence-based treatment. 

 

COMMON SIDE EFFECTS OF PROMETHAZINE

• Drowsiness

• Altered blood pressure levels

• Breathing problems

• Abnormal movements

• Allergic reactions

• Reduced production of white blood cells

• Low platelet count

• Excitability

If the above side effects present in mild form, they will typically subside within a week or two. If symptoms present more severely or do not go away, consult your physician.

SERIOUS SIDE EFFECTS OF PROMETHAZINE

You should call your physician immediately if severe side effects manifest after taking promethazine. Call 911 if your symptoms feel life-threatening. These can include:

• Uncontrollable movements of eyes, neck muscles, or head (extrapyramidal symptoms)

• Hallucinations

• Seizure

• Dizziness

• Palpitations

• Fainting

• Chest pain

• Shortness of breath

• Lightheadedness

• Severe breathing complications

• Decreased platelet count

• Decreased production of white blood cells

• Severe breathing problems

• Angioedema (swelling)

• Jaundice

Can promethazine be abused, then, and why do people abuse promethazine?