Promethazine, often sold under names like Phenergan and Promethegan, is known for its effectiveness against allergies and motion sickness, but it also comes with a dark side, including risks of dependency and severe side effects.
While it has legitimate medical uses, Promethazine has also been co-opted into the party scene, frequently mixed with codeine to make lean or sizzurp. This concoction has not only caught on among lean users but also resonates with opioid and Oxycodone users, highlighting a worrisome trend toward risky recreational use.
What Are K3, Phenergan, and Promethazine Tablets?
Promethazine, the active ingredient in medications like Phenergan, is an antihistamine that targets bothersome allergy symptoms like runny noses, sneezing, and hives. Unlike opioids, promethazine modifies brain chemistry and counteracts the effects of histamine in the body. Beyond relieving allergies, it’s recognized for inducing drowsiness and helping individuals get much-needed rest, making it a popular choice for those in need of a sleep aid.
Promethazine is available on its own or in combination with other ingredients including dextromethorphan, paracetamol and/or codeine.It comes in tablet, capsule, liquid, and suppository forms. The common brand names are Phenergan, K3, and Promethazine hydrochloride. The typical dosage for allergy relief in adults is 25 mg before bedtime. For nausea and vomiting, the typical dosage is 12.5 to 25 mg, with a maximum of four doses in 24 hours.
Is Promethazine a narcotic?
Promethazine alone is not a narcotic and is not classified under any DEA schedule when used independently. However, when promethazine is combined with codeine, a Schedule II narcotic, the combination becomes a controlled substance under DEA Schedule V.
Potential Side Effects and Addiction Risks of Promethazine
Promethazine, while not classified as a narcotic by the DEA, has significant sedative effects that mirror those of narcotics, heightening its potential for misuse and addiction.
Sedation and Impaired Functioning
Promethazine can cause drowsiness, dizziness, tiredness, dry mouth, and constipation. It impairs the ability to drive or perform dangerous activities, with sedation lasting several hours. Higher doses enhance these effects, causing confusion, hallucinations, fainting, fast heartbeat, blurred vision, and jaundice.
Promethazine Addiction and Dependence
Although promethazine itself typically does not lead to addiction, its pronounced sedative effects can foster dependence, particularly when users seek out the drug to enhance the euphoric effects of narcotics or as a means of self-medication for insomnia or anxiety. The risk of developing a dependency is notably higher when promethazine is used in conjunction with opioids.
Research by the National Institute on Drug Abuse indicates that promethazine-codeine cough syrup is especially prone to abuse among teens and young adults, leading to cases of addiction and physical dependence in individuals who consume the medication regularly or at high doses.
Promethazine and Opioids: Lethal Combination
Promethazine has gained popularity as a drug of choice due to its potent sedative effects and ability to enhance the euphoric high when combined with opioids like Codeine, Methadone, or Oxycodone.
This combination is particularly common among methadone maintenance patients, injection drug users, and teenagers.
Promethazine is believed to amplify the effects of opioids, leading to its frequent misuse.
The National Institutes of Health study has found widespread nonmedical use of promethazine among opioid-prescribed chronic pain patients.
Promethazine and Codeine in “Lean”
According to data from a study involving 1,423 adults who reported past-year lean use on Reddit, 31.7% of participants used promethazine in their lean/sizzurp mixture, and 13.5% used a combination of codeine and promethazine.
The concoction known as “lean,” containing codeine and promethazine, holds a prominent cultural presence and is often referenced in mass media platforms, such as music and social media.
National Institutes of Health data indicates that in the late 1990s, teenagers in Texas began drinking cough syrup with codeine and promethazine to get high.
Lean is popular with young users because it is easy to find and easy to make, contributing to its growing prevalence.The combination of promethazine and codeine produces a euphoric, sedative effect that can be highly addictive, especially for those with a history of opioid addiction.
Promethazine and Heroin: Substitution When Heroin Is Unavailable
Promethazine is often used by heroin users to “augment an inadequate heroin dose or when heroin was not available.” The combination of Promethazine and opioids like heroin can produce a more intense euphoric “high.
Promethazine and Oxy: Intensifying Effects
Consuming large quantities of Promethazine and Oxycodone together “prolongs and intensifies each drug’s sedative effects”, creating a more euphoric high that users may seek.
Promethazine, whether used alone or in combination with opioids, can lead to significant health risks such as respiratory depression, hematologic issues, injection site reactions, jaundice, and neuroleptic malignant syndrome. Additionally, Promethazine has the potential to enhance the sedative effects of opioids such as Oxy.
Promethazine and Methadone: Risk of Abuse
In opioid addiction treatment, like methadone maintenance, there’s evidence that promethazine is used to enhance the ‘high’ from methadone, perpetuating the cycle of opioid abuse.
People undergoing Medication-Assisted Treatment (MAT) for opioid use disorders may sometimes abuse promethazine. This misuse can occur in outpatient settings, where the opportunities for diverting or misusing promethazine increase. Often, individuals may use promethazine to enhance the effects of opioids or to alleviate some of the side effects associated with opioid withdrawal, such as nausea.
Prolonged QT interval, linked to heart rhythm abnormalities, is a concern with promethazine and methadone use.
In one study, it was reported that one-quarter of methadone maintenance patients had promethazine in their urine samples
Promethazine has also been reported to be present in a significant proportion of overdose deaths involving depressants, with key informants noting that it is often used by those on methadone to potentiate the “high.”
According to the research on Science Direct, “Promethazine has also been reported to be present in fatal opioid overdoses. Promethazine was identified by postmortem toxicological analysis in 14.2% of methadone fatalities in Kentucky from 2000–2004 and 8.7% of fatal overdose cases that involved depressants in Seattle in 2003.
Risks of Mixing Promethazine with Opioids
Respiratory Depression and Overdose Risks
Combining high doses of promethazine with opioids can lead to severe respiratory depression, unconsciousness, and irregular heart rhythms. These effects significantly increase the risk of a potentially fatal overdose.
Withdrawal Symptoms
Prolonged use of promethazine and opioids can lead to physical dependence. Abrupt cessation of these substances may trigger intense withdrawal symptoms, including tremors, vomiting, and an accelerated heart rate, which can be distressing and challenging to manage.
Addiction and Abuse Potential
The mixture of promethazine and opioids, commonly known as “lean” or “purple drank,” poses a considerable risk of abuse. This concoction is particularly popular among teenagers and young adults, who may not fully understand the health risks associated with its use.
Increased Sedation and Impairment
The combination of promethazine and opioids produces a sedative, euphoric effect that heightens sensory pleasure but also increases impairment. This effect can be highly addictive, especially in individuals with a history of opioid addiction, leading to a dangerous cycle of continuous use and increased tolerance.
Delirium and Neuroleptic Malignant Syndrome
Promethazine and opioid combinations can exacerbate sedation and impairment, raising the likelihood of severe adverse events such as delirium and neuroleptic malignant syndrome (NMS). Delirium may manifest as severe confusion, agitation, and disorientation, typically triggered by an overdose of promethazine. NMS is a life-threatening reaction characterized by muscle rigidity, fever, and autonomic instability, which requires immediate medical attention.
It is crucial to recognize the dangers of mixing opioids and promethazine and seek professional help if you or someone you know is struggling with addiction.
Promethazine Overdose Symptoms
When promethazine is taken in excessive amounts or mixed with opioids, it can lead to the following overdose symptoms:
Central Nervous System Effects:
- Drowsiness or coma
- Agitation, nervousness, confusion, and hallucinations
- Seizures and tremors
Cardiovascular Complications:
- Rapid heartbeat
- Weakness due to low blood pressure
Other Symptoms:
- Urinary hesitancy or inability to urinate
- Dry mouth and flushed skin
- Muscle stiffness and spasms
- Widened or constricted pupils
- Hallucinations
- Confusion
- Overwhelming or unmanageable fear or emotion
- Uncontrollable eye movements
- Tongue sticking out
- Abnormal neck position
- Inability to respond to people around you
- Yellowing of the skin or eyes
Can You Die From Promethazine Overdose?
While promethazine overdose can result in severe symptoms, the search results indicate that few people actually die from this condition. The risk of a serious outcome is highest for individuals who experience heart rhythm irregularities and seizures.
People who survive the first 24 hours after a promethazine overdose are likely to recover. However, immediate medical attention is crucial in the event of an overdose to manage symptoms and prevent potentially life-threatening complications.
Do not mix Promethazine allergy with overdose
Call 911 now if the following symptoms are present:
- Your lips, mouth, throat, or tongue suddenly become swollen.
- You’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air).
- Your throat feels tight or you’re struggling to swallow.
- Your skin, tongue, or lips turn blue, grey, or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet).
- You suddenly become very confused, drowsy, or dizzy.
- Someone faints and cannot be woken up.
- A child is limp, floppy, or not responding like they normally do (their head may fall to the side, backward or forwards, or they may find it difficult to lift their head or focus on your face).
These symptoms can be signs of a serious allergic reaction (anaphylaxis) to Promethazine and require immediate emergency medical treatment.
Why was Phenergan discontinued?
Phenergan (promethazine HCl) tablets, 12.5 mg and 50 mg, were discontinued from sale for reasons other than safety or effectiveness. This decision was made by Wyeth in 2004, and it was not due to safety or effectiveness concerns. Additionally, the brand name Promethazine VC has been discontinued in the U.S., but generic versions of this product may be available if approved by the FDA.
Promethazine with codeine syrup was also discontinued due to the popularity of its recreational use. Pharmaceutical company Actavis made this decision, as the product was increasingly used outside its intended purpose. Promethazine with codeine syrup is indicated to temporarily relieve coughs and upper respiratory tract symptoms related to allergies or the common cold. Source
Opioid Addiction Treatment Program in Boca Raton, Florida
If you suspect that you or someone you know is struggling with addiction to lean or misusing promethazine in combination with opioids like oxycodone, we are here to help. At Still Detox, Florida’s top alcohol and drug detox treatment center, our experienced professionals are dedicated to providing you with personalized care and support to help you overcome opioid addiction and regain control of your lives.
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