Promethazine was developed in the mid-1940s when a team of scientists from the French chemical manufacturing company Rhône-Poulenc combined phenothiazine and a diamine side chain of diphenhydramine to create a new drug. Their creation, promethazine, is a synthetic medication that belongs to a pharmaceutical family known as phenothiazines.
As a medication, promethazine has several uses, including treating allergies, motion sickness, and more. It is also a strong sedative that is sometimes prescribed during labor, before and after surgery, and at other times.
Medical Uses for Promethazine
Promethazine is a first generation antihistamine that is only available by prescription. It effectively treats several conditions, such as:
- Motion sickness
As an antihistamine, promethazine competes with histamine for binding at some of its receptor sites (H1-receptors), thereby blocking histamine from binding to many. This, in turn, prevents or reduces the typical effects of histamine activating those receptors, including hives, constriction of the airways, nausea, increased wakefulness, nasal congestion, sneezing, and a runny nose.
Even though promethazine is a useful medicine, it is not without risks. Common side effects of promethazine include:
- Blurred vision
Rare but serious side effects of promethazine include:
- Respiratory depression
- Changes in heart rate
- Yellow skin and/or eyes
- Rigid muscles
How Use Leads to Abuse
- Although it is not a controlled substance, promethazine does have the potential to be abused. The risk of abuse heightens when it’s combined with codeine, which is a combination used as a prescription medication for cough and upper respiratory symptoms accompanying allergies or a cold. Codeine is an opioid that can alleviate coughing.
- For someone looking for a way to get high, promethazine and codeine combinations may be easier to access than other opioids that are more carefully controlled. Opioids such as oxycodone and hydrocodone are Schedule II drugs, whereas the combination of promethazine and codeine is a Schedule V drug. Although this lower scheduling means that the medication is thought to have a lower abuse potential, it could make it easier to obtain.
- Dangers of Promethazine Abuse
Promethazine abuse can lead to side effects that range from inconvenient to incredibly dangerous. Promethazine overdose can be even more dangerous. Overdosing on promethazine may cause symptoms such as:
- Trouble breathing
- Decreased or stopped breathing
- Increased heart rate
- Tense muscles
- Dilated pupils
- Excessive agitation or excitement
- Lost of consciousness
If an overdose occurs, it is very important that someone call the poison control helpline (1-800-222-1222). If the person has had a seizure, has difficulty breathing, has collapsed, or cannot be woken up, immediately call 911.
- Treatment for Promethazine Addiction
Although it is clear that promethazine abuse can be dangerous, there is not much research that offers a clear picture of its addictive potential. However, a 2013 study found that 26 percent of methadone maintenance patients sampled had their urine test positive for promethazine, while only 15 percent of those promethazine-positive patients had a current prescription for promethazine. Additionally, 17 percent of injection heroin users reported using promethazine in the past month, and 24 percent of injection drug users who reported enrollment in methadone treatment reported promethazine use in the past month. They concluded there was “compelling evidence of significant nonmedical use of promethazine in this patient population” and recommended that there be further research on the nonmedical use of promethazine.
Furthermore, there is evidence that codeine, which is combined with promethazine in some medications, is addictive. Codeine on its own is a Schedule II substance. This means that it has a high potential for abuse, although it is still medically useful in certain cases. Medications consisting of both codeine and promethazine are Schedule V, meaning they have a lower potential for abuse, but there is still abuse potential and so they are controlled substances.
People who frequently use codeine (with or without promethazine) may develop a dependence on opioids. If they stop using it or drastically decrease their use, they may experience withdrawal. Withdrawal can last several days, and symptoms may include:
- Dilated pupils
- Runny nose
- Trouble sleeping
- Increased heart rate
- Increased breathing rate
- Stomach cramps
- Muscle aches
If you, or a loved one, are struggling with an addiction to cough syrup or cold medicine, or if promethazine abuse has become part of your or your loved one’s life, it is important to get treatment as soon as possible. In treatment, clients have the opportunity to safely detox from any drugs they are dependent on and to receive treatment for their addiction with therapy and sometimes medication as well. With a strong support network and a commitment to working on recovery, clients can discover a brighter, healthier future – one that is much better than anything addiction to promethazine or codeine could offer.