What Is Promethazine, and How Can It Be Abused?

While Promethazine can be an effective medication when used as prescribed by a healthcare professional, there is a potential for Promethazine abuse because of its sedative effects. In some cases, individuals combine the drug with codeine to intensify the sedative effects to create a drug known as “purple drank”. However, this potent combination can be highly dangerous, or even fatal, and is associated with several serious health risks like breathing trouble, stifled brain function, addiction, and overdose. 

If you or a loved one are suffering from Promethazine abuse or addiction, it’s important to reach out for help from an addiction recovery program or licensed counselor. 


Promethazine is a generic first-generation antihistamine used to treat nausea, vomiting, motion sickness, and allergic conditions. Promethazine is only available in generic form. There are no branded versions of promethazine.

Belonging to a class of medications known as phenothiazines, this category of drugs is typically used to treat serious emotional and mental disorders like schizophrenia or other psychotic disorders. Additionally, phenothiazines are used to control nausea and vomiting. Occasionally, phenothiazines are used to treat moderate or severe pain in hospitalized patients.

Promethazine has a mechanism of action that inhibits the release of histamine. Histamine is a substance naturally produced in the body when you are exposed to pollen, mold, dander, or other allergens.

By inhibiting the release of histamine, promethazine induces sleepiness and helps with pain relief. Histamine usually regulates wakefulness and keeps you alert. Promethazine also works on the part of the brain that signals vomiting.


There are four different forms of the generic medication promethazine:

  • Oral tablet

  • Liquid

  • Injectable solution

  • Rectal suppository

The oral tablet is administered to treat the following conditions:

  • Allergies

  • Nausea

  • Vomiting

  • Motion sickness

  • Pre-surgery anxiety

  • Post-surgery pain

woman looking away representing symptoms of meth 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.


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.


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?


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. 



  • 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.


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?

A woman in the car looking troubled, representing vicodin abuse


There are four main routes of delivery with promethazine:

  1. Orally in tablet form.

  2. Orally in liquid form.

  3. Via the rectum as a suppository.

  4. By intravenous injection.

When promethazine is administered by intravenous injection, the substance can move beyond the blood vessels and into the surrounding tissue. This process is known as extravasation and can involve potentially irreversible damage. If gangrene develops, this can be fatal.

Administering promethazine via intramuscular injection can prevent tissue damage and other irreversible damage associated with abusing promethazine.

The FDA issued a boxed warning concerning promethazine and the risk of extravasation. Boxed warnings are the FDA’s most serious warnings pertaining to drugs.

Severe or life-threatening side effects and irreversible damage are rare among those who use promethazine. That said, overdose remains a concern if you abuse promethazine.


If you are taking promethazine and you feel that you are experiencing life-threatening symptoms, call 911 immediately.

You can also call 1-800-222-1222 to speak with staff at Poison Control. Provide them with details including the type of drug, the dosage, and the personal details of the affected person for further instructions.

It is imperative to protect the airways of the person suffering a promethazine overdose until you can take them to ER for treatment. Medical health professionals may:

  • Administer laxatives (to help eliminate promethazine from the system).

  • Administer activated charcoal (to prevent promethazine from being absorbed by the body.

  • Provide breathing support.

  • Administer fluids by IV (intravenous) drip.

  • Medically manage symptoms.

Treatment for Promethazine Abuse and Addiction at Gratitude Lodge



Is promethazine a narcotic?

While promethazine is not a narcotic, it is a prescription drug regulated by the DEA. It contains an opioid and is strictly only safe to use when prescribed and under the supervision of a licensed physician. 

Can you OD on Promethazine?

Yes, promethazine can cause overdose when too much is taken. Recovery is likely if the person survives the first 24 hours after overdose, except in cases where heart problems and seizures occur. 

 Does promethazine have codeine in it?

Yes, promethazine does have codeine (an opioid agonist) in its ingredients list.

image of gratitude lodge's promethazine syrup rehab treatment

Promethazine Rehab at Gratitude Lodge

We have luxury rehab centers offering both inpatient and outpatient opioid addiction treatment located in:

To initiate your recovery from addiction to opioids, take advantage of a supervised clinical detox at one of our licensed medical detox centers. Your treatment team can administer FDA-approved medications to make opioid withdrawal less intense and to minimize cravings for promethazine or codeine.

All opioid use disorders respond favorably to MAT (medication-assisted treatment) not only during detox, but also throughout ongoing recovery. You can also access these services at Gratitude Lodge drug rehabs:

At our licensed and accredited facilities, you can detox from Demerol with MAT (medication-assisted treatment) if required. MAT can also be effective throughout ongoing treatment, minimizing cravings and promoting abstinence.

At Gratitude Lodge, a team of dedicated experts are here to help you from detox to discharge and beyond. Call 800-994-2184 to move beyond promethazine abuse