Promethazine Addiction: Signs, Risks, Prevention, and Recovery

Promethazine addiction refers to the compulsive use of a first-generation antihistamine used to treat conditions like allergies, nausea, and motion sickness. According to a study by Chiappini et al. titled Beyond the ‘Purple Drank’: Study of Promethazine Abuse According to the European Medicines Agency Adverse Drug Reaction Reports, published in the Journal of Psychopharmacology (2021), promethazine addiction arises from misuse of sedative or euphoric effects, leading to dependency and withdrawal symptoms.

Signs of promethazine addiction include drowsiness, confusion, impaired coordination, and compulsive drug-seeking behavior. As stated in a study by Burns and Boyer titled Promethazine: Toxicity and Abuse, published in Clinical Toxicology (2013), prolonged misuse can cause respiratory depression and psychological dependence.

Treatment options for phenergan addiction include medically supervised detoxification, behavioral therapies like Cognitive Behavioral Therapy (CBT), and outpatient programs. According to a study by Deepa Shiwcharan titled Purple or Pink: Time to Rethink the Availability of Promethazine with Codeine, published in the Hofstra Law Review (2023), structured care such as Partial Hospitalization Programs (PHPs) is effective for severe cases.

Prevention of promethazine addiction includes educating individuals on risks, monitoring prescriptions, and limiting access to medications. As highlighted by the National Institute on Drug Abuse (2020), proper counseling on prescription use reduces the likelihood of misuse and addiction.

What Is Promethazine Addiction?

Promethazine addiction is a condition where individuals misuse promethazine, an antihistamine primarily used for allergies, motion sickness, and nausea, to achieve sedative or euphoric effects. 

According to a study by Chiappini et al. titled Beyond the ‘Purple Drank’: Study of Promethazine Abuse According to the European Medicines Agency Adverse Drug Reaction Reports, published in the Journal of Psychopharmacology (2021), out of 1,543 adverse drug reaction cases, 557 were related to misuse, with 55.6% resulting in fatalities due to drug abuse or toxicity. 

These numbers demonstrate a significant public health concern tied to promethazine misuse, especially when combined with substances like opioids.

What Is Promethazine?

Promethazine is a first-generation antihistamine classified under the phenothiazine drug class, commonly used to treat allergies, motion sickness, nausea, and insomnia. It is available in various forms, including tablets, syrups, suppositories, and injectable solutions. 

According to the National Institute on Drug Abuse (2020), medications containing promethazine, especially in combination with codeine, are frequently misused for their sedative effects, contributing to rising substance abuse cases. 

Promethazine works by blocking histamine receptors in the brain and central nervous system. It reduces symptoms like nausea and allergic reactions while inducing sedation.

What Is The Relationship Of Promethazine With Codeine?

The relationship of promethazine with codeine is rooted in their combination in cough syrups, which enhances sedative and euphoric effects, making them prone to abuse. 

According to a study by Chiappini et al. titled Beyond the ‘Purple Drank’: Study of Promethazine Abuse According to the European Medicines Agency Adverse Drug Reaction Reports, published in the Journal of Psychopharmacology (2021), 53.8% of promethazine misuse cases involved co-ingestion with opioids like codeine, amplifying the risk of respiratory depression and fatal overdoses. 

This mixture, referred to as “purple drank” or “sizzurp,” is widely abused recreationally, particularly among young adults and adolescents.

What Are The Signs Of Promethazine Addiction?

The signs of promethazine addiction are drowsiness, confusion, impaired coordination, respiratory depression, and compulsive drug-seeking behavior. These symptoms arise from misuse of the drug, especially when combined with substances like alcohol or opioids, increasing its sedative and euphoric effects. 

According to the National Institute on Drug Abuse (2020), misuse of promethazine-containing medications is a growing issue, leading to significant physical and psychological dependence.

The signs of promethazine addiction are listed below:

• Drowsiness: Individuals experience persistent lethargy and sedation beyond the therapeutic purpose of the drug. This excessive sedation interferes with daily activities and responsibilities.
• Confusion: Users report difficulty thinking clearly, with frequent episodes of disorientation and poor memory, a direct result of the drug’s impact on brain function.
• Impaired Coordination: Physical movements become clumsy, and tasks requiring fine motor skills are challenging. This is caused by promethazine’s depressant effect on the central nervous system. A study by Jensen et al., published in Clinical Toxicology (2017), emphasizes that prolonged abuse impacts cognitive function and motor control.
• Respiratory Depression: Breathing slows significantly, especially when promethazine is mixed with codeine or alcohol, posing a life-threatening risk in severe cases.
• Compulsive Drug-Seeking Behavior: Affected individuals exhibit an uncontrollable urge to obtain and consume promethazine, engaging in risky behaviors to access the drug.
• Psychological Dependence: The user develops a reliance on promethazine for relaxation or escaping stress, leading to withdrawal symptoms such as anxiety or agitation when use is stopped.

What Are The Side Effects Of Promethazine Addiction?

The side effects of promethazine addiction are drowsiness, dry mouth, dizziness, hallucinations, and respiratory depression, with severe cases leading to overdose and fatalities. These effects stem from the drug’s sedative and central nervous system depressant properties, which are magnified when combined with alcohol or opioids. 

According to a study by Chiappini et al. in the Journal of Psychopharmacology (2021), over 55% of promethazine misuse cases involve severe outcomes like respiratory failure, coma, or death, highlighting its dangerous misuse potential.

The side effects of promethazine addiction are listed below:

• Drowsiness: A persistent state of sedation that impairs the ability to perform daily activities and increases the risk of accidents. This sedation occurs due to the drug’s depressant effects on the central nervous system.
• Dry Mouth and Dehydration: Promethazine reduces saliva production, leading to a constant feeling of dryness. This makes it difficult to eat, speak, and maintain oral health.
• Dizziness and Confusion: Chronic misuse disrupts cognitive functioning, resulting in disorientation and impaired judgment. This is particularly dangerous when operating vehicles or machinery.
• Respiratory Depression: A critical slowing of breathing caused by the drug’s suppression of respiratory centers in the brain. When combined with other sedatives, this can result in fatal outcomes such as asphyxiation.
• Hallucinations and Delirium: At high doses, promethazine can induce visual or auditory hallucinations and severe agitation, as noted in studies by Jensen et al. published by Clinical Toxicology in 2017.
• Cardiovascular Effects: Misuse leads to irregular heart rhythms or blood pressure instability, which increases the risk of heart attacks or strokes in predisposed individuals.
• Psychological Dependence: Long-term misuse causes emotional reliance on the drug, with withdrawal symptoms such as anxiety, restlessness, and depression when attempting to stop.

Who Is At Risk Of Promethazine Addiction?

Individuals at high risk of promethazine addiction include teenagers and young adults who misuse the drug recreationally for its sedative and euphoric effects in the form of “purple drank.” 

Heroin users and methadone patients are also vulnerable, as promethazine is frequently used to enhance the effects of opioids. According to a study by Chiappini et al. published in the Journal of Psychopharmacology (2021), over 53% of promethazine misuse cases involved opioid users, indicating a strong link between these substances. 

Patients with chronic pain, individuals with access to prescription promethazine, and those with a history of substance abuse are also at significant risk due to the drug’s easy accessibility and calming properties. Additionally, individuals in low-supervision medical settings misuse the drug due to a lack of awareness or monitoring.

Can You Overdose On Promethazine?

Yes, you can overdose on promethazine, which results in severe, life-threatening consequences. This risk increases significantly when promethazine is consumed in large amounts or combined with substances like alcohol, opioids, or sedatives. 

The Centers for Disease Control and Prevention (CDC) noted that in 2018, over 14,000 deaths involved prescription opioids such as codeine, which is often combined with promethazine in cough syrups.

The symptoms of promethazine overdose include:

• Urinary Hesitancy: Difficulty starting or maintaining urine flow due to the drug’s strong anticholinergic effects, leading to bladder dysfunction.
• Rapid Heartbeat: Tachycardia occurs as the cardiovascular system reacts to toxic levels of the drug, which may stress the heart and increase the risk of arrhythmias.
• Low Blood Pressure: Promethazine depresses the autonomic nervous system, causing hypotension that results in fainting or shock in severe cases.
• Drowsiness or Coma: High doses suppress CNS activity, leading to extreme sedation, loss of consciousness, or a coma, making immediate medical intervention crucial.
• Hallucinations: Overdose disrupts brain function, causing vivid visual or auditory hallucinations, leading to distress or panic.
• Depression: Acute psychological effects, including sadness and a sense of hopelessness, accompany physical symptoms.
• Fever: Hyperthermia arises from metabolic disturbances caused by the drug’s toxic impact on body systems.
• Unsteadiness: Overdose affects motor control, leading to severe difficulty walking or maintaining balance and increasing the risk of falls.
• Restlessness: Paradoxical agitation, characterized by irritability or erratic behavior, occurs despite the drug’s sedative properties.
• Seizures: Toxicity disrupts brain activity, leading to involuntary convulsions that cause physical harm and require emergency care.
• Tremor: Neurological distress manifests as uncontrolled shaking of limbs or hands, a clear sign of overdose-induced nervous system strain.

What Are The Withdrawal Symptoms Of Promethazine Addiction?

The withdrawal symptoms of promethazine addiction are restless legs, insomnia, muscle aches, nausea, and intense cravings. These symptoms occur as the body adjusts to the absence of the drug after prolonged misuse, causing both physical and psychological distress. 

According to research by Burns and Boyer in Clinical Toxicology (2013), withdrawal frequently includes vomiting, headaches, depression, and pain, with symptoms varying in intensity depending on the duration and severity of the addiction.

Common withdrawal symptoms of promethazine addiction are given below:

• Restless Legs: Individuals often experience an uncontrollable urge to move their legs, particularly at night, disrupting sleep. This symptom arises due to the neurological imbalances caused by withdrawal from promethazine’s sedative effects.
• Insomnia: Difficulty falling or staying asleep is a common withdrawal symptom as the body struggles to reestablish natural sleep cycles without the drug’s sedative properties. Insomnia is frequently reported during the first stages of withdrawal.
• Muscle Aches: Generalized aches and stiffness occur as the body reacts to the absence of promethazine, which masks physical discomfort by depressing the central nervous system.
• Nausea and Vomiting: Withdrawal disrupts gastrointestinal processes, causing persistent nausea that may lead to vomiting. A study by Burns and Boyer titled Promethazine: Toxicity and Abuse, published in Clinical Toxicology (2013), highlights these symptoms as key markers of promethazine withdrawal.
• Depression: Emotional instability, sadness, and feelings of hopelessness are common during withdrawal, as the brain adapts to functioning without the drug’s calming influence.
• Cravings: A psychological and physical drive to consume promethazine again often occurs, making relapse a significant risk factor during the withdrawal phase.
• Headaches: Severe headaches result from changes in brain chemistry as it adjusts to the lack of promethazine’s sedative effects, often lasting for days during initial withdrawal.
• Restlessness and Irritability: A heightened sense of agitation and difficulty remaining calm are common as the body experiences stress during withdrawal.

How Long Does Promethazine Stay In Your System?

Promethazine stays in the system for approximately 7 to 14 hours, meaning it takes this time for half of the drug to be eliminated from the body. 

Burns and Boyer’s study, Promethazine: Toxicity and Abuse, published in Clinical Toxicology (2013), found that promethazine can be detected in the blood for up to 24 hours, in urine for 2 to 3 days, and in saliva for up to 48 hours. Promethazine can be traced in hair samples for up to 90 days, depending on the dose and frequency of use. These detection windows vary based on factors such as metabolism, dosage, and method of administration.

What Are The Treatments For Promethazine Addiction?

The treatments for promethazine addiction are medically supervised detoxification, behavioral therapy, and outpatient programs. Detoxification helps remove the drug from the system under medical supervision, minimizing withdrawal symptoms and ensuring safety. 

According to a study by Burns and Boyer titled Promethazine: Toxicity and Abuse, published in Clinical Toxicology (2013), treatments for promethazine addiction include detoxification under medical supervision to safely manage withdrawal and outpatient programs that combine behavioral therapy with ongoing medical care to prevent relapse and address underlying dependency issues.

Detoxification

Detoxification is the process of removing promethazine from the body under medical supervision to manage withdrawal symptoms safely. During detox, healthcare professionals monitor the individual to ensure they remain stable, and medications may be prescribed to alleviate withdrawal symptoms. 

This treatment is critical for individuals with severe addiction or those experiencing intense withdrawal effects. Recovery time varies depending on the individual but lasts 7 to 10 days. The advantage of detoxification is that it offers a controlled environment for the patient, ensuring physical stability. 

However, a disadvantage is that it does not address the psychological aspect of addiction, requiring follow-up care. According to a study by Burns and Boyer, detoxification is a necessary first step in treating promethazine addiction as it helps the body stabilize before other treatments begin.

Partial Hospitalization Program (PHP)

A Partial Hospitalization Program (PHP) is a structured treatment program where patients receive intensive therapy during the day and return home at night. It includes group and individual counseling, medical care, and behavioral therapy to treat both the physical and psychological aspects of addiction. 

The recovery time for PHP varies, but it lasts 3 to 6 weeks, depending on the severity of the addiction. The primary advantage of PHP is that it offers intensive care without full hospitalization, allowing individuals to maintain some daily activities. 

However, a disadvantage is that it is not suitable for individuals with unstable home environments. According to the National Institute on Drug Abuse (2020), PHPs have shown significant success in treating individuals with severe substance use disorders by providing structured care.

Outpatient Program (OP)

An Outpatient Program (OP) allows individuals to attend treatment sessions while continuing their daily lives. It typically involves fewer hours of treatment than PHP and can include therapy, support groups, and medical management. 

OP is suitable for those with less severe addiction or those who have completed a more intensive program like detoxification or PHP. Recovery time ranges from a few months to a year, depending on the individual’s progress. 

The advantages of OP include flexibility and the ability to maintain regular life activities, but a disadvantage is that it offers less supervision, which leads to a higher risk of relapse. Chiappini et al. emphasized the role of outpatient programs in maintaining long-term recovery when paired with other treatment methods.

Behavioral therapy aims to help individuals identify and change unhealthy patterns of behavior related to addiction. Cognitive Behavioral Therapy (CBT) is commonly used to treat promethazine addiction, helping patients understand the thoughts and feelings behind their drug use and develop healthier coping mechanisms. 

This treatment is essential for addressing the psychological aspects of addiction. Recovery time depends on the individual, but therapy often lasts for 6 to 12 months with ongoing support. The advantage of behavioral therapy is that it helps individuals address the root causes of addiction and develop lifelong skills for managing triggers. 

A disadvantage is that it requires a high level of commitment and may be emotionally taxing. According to Burns and Boyer, CBT has been shown to reduce relapse rates in individuals with substance use disorders, including those addicted to promethazine.

How To Prevent Promethazine Addiction?

To prevent promethazine addiction, a combination of education, careful prescription management, and early intervention is needed. Educating the public and healthcare providers about the dangers of promethazine misuse is critical, as many individuals are not aware of its addictive potential. 

Proper prescription monitoring ensures that promethazine is only prescribed when medically necessary and prevents overprescription or misuse. As recommended by the National Institute on Drug Abuse (2020), individuals at risk for substance use disorders should be closely monitored, and healthcare providers should be trained to recognize early signs of misuse. 

Encouraging non-pharmacological treatments, such as lifestyle changes or alternative therapies for conditions like insomnia or motion sickness, reduces dependency on promethazine. Additionally, support networks like counseling and peer support groups play an important role in preventing relapse and maintaining long-term recovery. 

The key to prevention is a multi-faceted approach that includes education, monitoring, and appropriate interventions before the development of addiction.

What Substances Are Commonly Abused With Promethazine?

Substances commonly abused with promethazine are opioids, alcohol, and benzodiazepines. The drug’s sedative properties are amplified when promethazine is mixed with opioids like codeine or heroin, leading to enhanced euphoria and a higher risk of respiratory depression. 

According to a report by the National Institute on Drug Abuse titled Prescription and Over-the-Counter Medications: Misuse and Addiction, published in 2020, promethazine is abused with substances like opioids, benzodiazepines, and alcohol, which amplify its sedative effects and increase the likelihood of severe respiratory depression and overdose.

Alcohol also intensifies the CNS depressant effects of promethazine, leading to extreme sedation, cognitive impairment, and dangerous respiratory suppression. 

Similarly, combining promethazine with benzodiazepines like diazepam or alprazolam causes profound drowsiness, confusion, and impaired coordination, raising the risk of accidents or overdose. 

These combinations, often referred to as “polysubstance abuse,” are a major concern in the treatment and prevention of promethazine addiction.

Is Promethazine Addiction Common Among Opioid Addiction Patients?

Yes, promethazine addiction is common among opioid addiction patients. Promethazine is frequently abused alongside opioids such as codeine or heroin to intensify the euphoric effects, and it is used to alleviate opioid withdrawal symptoms. 

According to the National Institute on Drug Abuse (2020), individuals with opioid use disorder are at an increased risk of misusing promethazine, especially when it is combined with opioids. 

This combination, referred to as “purple drank,” enhances the effects of both drugs but significantly increases the risk of overdose and respiratory depression, a leading cause of death among those who misuse opioids and promethazine together.

Can You Take Promethazine After Drinking Alcohol?

No, taking promethazine after drinking alcohol is highly risky. Both promethazine and alcohol are central nervous system depressants, meaning they slow down brain function and respiratory activity, which increases the risk of severe sedation, respiratory failure, and even death. According to the National Institute on Drug Abuse (2020), combining alcohol with promethazine can lead to dangerous side effects, including excessive drowsiness, difficulty breathing, and loss of coordination. 

This combination significantly amplifies the depressant effects of both substances, increasing the likelihood of overdose and fatal respiratory depression. Individuals must avoid mixing these substances to prevent life-threatening consequences.

Is It Dangerous To Take Promethazine With Recreational Drugs?

Yes, it is dangerous to take promethazine with recreational drugs. Combining promethazine with substances like cocaine, heroin, or other stimulants or depressants results in unpredictable and harmful effects. 

According to the National Institute on Drug Abuse (2020), the sedative properties of promethazine are amplified when used with recreational drugs, leading to a heightened risk of overdose, respiratory depression, and even death. 

The interaction between promethazine and substances like cocaine also causes severe cardiovascular stress, while combining it with opioids drastically increases the chances of fatal respiratory failure. Recreational addictions like heroin addiction,  mixed with the abuse of promethazine, significantly increases the risk of long-term health complications and death.

Is Promethazine Safe In Pregnancy?

No, promethazine is not considered entirely safe during pregnancy, particularly in higher doses. Although it is commonly used to treat nausea and vomiting during pregnancy, such as in cases of morning sickness, it should be used cautiously and only under the supervision of a healthcare provider. 

According to the U.S. Food and Drug Administration (FDA), promethazine is classified as a Category C drug, meaning that animal reproduction studies have shown adverse effects on the fetus, but there are no well-controlled studies in humans. 

Therefore, it should only be used if the potential benefits justify the potential risks to the fetus. Studies, including those from the National Institutes of Health (2020), advise that promethazine should be avoided unless necessary during pregnancy due to potential risks, such as developmental issues or sedation that affect both the mother and the unborn child.

Is Promethazine A Controlled Substance?

No, promethazine is not classified as a controlled substance in the United States, including in New Hampshire. It is available by prescription for medical purposes, such as treating allergies, motion sickness, and nausea. 

According to the Drug Enforcement Administration (DEA) (2020), promethazine is not listed under any of the controlled substance schedules, meaning it is not considered to have a high potential for abuse or addiction on its own. 

However, when combined with other substances, such as opioids like codeine, it may be misused, leading to concerns about abuse. Despite not being a controlled substance, promethazine is closely regulated due to its potential for misuse, particularly when used in combination with other drugs to enhance sedative effects.