When discussing addiction, most people tend to conjure up thoughts of drugs like cocaine, opioids, or heroin. However, many other drugs could potentially be drugs of abuse…including the common allergy medication promethazine.
At PCP, we are dedicated to providing information on the risks of promethazine addiction and provide a look at the recovery process.
What Is Promethazine? Uses for Motion Sickness
Promethazine is a commonly used medication that belongs to a class of drugs called antihistamines. The medication goes by several popular brand names like Phenergan, Avomine, and Sominex, and can be found in tablets, capsules, and syrups.
Promethazine is used to treat several medical conditions like allergies, nausea and vomiting, insomnia, motion sickness, and symptoms of the common cold. Unfortunately, one of the most prominent side effects of promethazine is drowsiness and sedation, making it a popular drug of abuse.
Risks and Complications of Promethazine Use
Promethazine use can lead to several risks and complications, especially when taken in excess or combined with other substances. Some of the potential risks and complications include:
Respiratory Depression: One of the most severe risks of promethazine is respiratory depression. This condition can slow down your breathing to dangerously low levels, mainly when promethazine is mixed with other central nervous system depressants like opioids or alcohol. In extreme cases, this can lead to coma or even death.
Motion Sickness: While promethazine is often used to treat motion sickness, it can also cause dizziness and drowsiness. These side effects can increase the risk of accidents and injuries, especially when driving or operating heavy machinery.
Runny Nose and Other Allergic Reactions: Promethazine can cause allergic reactions, including a runny nose, itching, and hives. In rare cases, it can lead to more severe reactions like anaphylaxis, which is life-threatening and requires immediate medical attention.
Promethazine Misuse: The potential for promethazine misuse is significant, particularly when it is combined with other substances. Misuse can lead to addiction and a host of other health problems, including physical and psychological dependence.
Narcotic Analgesics: Promethazine can interact with narcotic analgesics such as codeine, increasing the risk of respiratory depression and other severe complications. This combination is particularly dangerous and should be avoided.
Chronic Pain Patients: While promethazine can be used to manage chronic pain, it also carries the risk of dependence and addiction. Chronic pain patients should use this medication under strict medical supervision to avoid these risks.
Cold Medicines: Promethazine is often found in cold medicines, which can increase the risk of misuse and addiction. It’s essential to use these medications only as directed by a healthcare professional.
Central Nervous System: Promethazine affects the central nervous system, leading to side effects like dizziness, drowsiness, and impaired motor skills. These effects can be exacerbated when combined with other CNS depressants.
Nausea and Vomiting: Although promethazine is used to treat nausea and vomiting, taking it in excess can ironically cause these symptoms, along with other gastrointestinal issues like diarrhea and constipation.
Methadone Maintenance Patients: Promethazine can interact with methadone, increasing the risk of respiratory depression and other complications. Methadone maintenance patients should consult their healthcare provider before using promethazine.
Prescription Opioids: Combining promethazine with prescription opioids can significantly increase the risk of respiratory depression and other severe side effects. This combination should be avoided unless specifically prescribed by a healthcare professional.
Prescription Cough Medicines: Promethazine is often included in prescription cough medicines, which can lead to misuse and addiction. It’s crucial to follow the prescribed dosage and consult a healthcare professional if you have any concerns.
Other CNS Depressants: Promethazine can interact with other CNS depressants, such as sedatives and tranquilizers, increasing the risk of severe side effects like respiratory depression and impaired motor skills.
Other Medicines: Promethazine can interact with various other medicines, including herbal remedies and supplements. Always consult a healthcare professional before combining promethazine with other treatments.
Recreational Drugs: Using promethazine recreationally can lead to addiction and other severe health problems. It’s essential to use this medication only as prescribed and under the guidance of a healthcare professional.
Healthcare Professional: It is crucial to consult a healthcare professional before taking promethazine, especially if you have a history of addiction or other health problems. They can provide guidance on safe usage and monitor for potential complications.
Promethazine Effects and Side Effects
Promethazine can cause several effects and side effects, which vary in severity. Understanding these can help you use the medication safely and recognize when to seek medical attention.
Drowsiness and Dizziness: One of the most common side effects of promethazine is drowsiness, which can impair your ability to perform tasks that require alertness, such as driving. Dizziness is also a frequent side effect, which can increase the risk of falls and injuries.
Dry Mouth and Dry Nose: Promethazine can cause dryness in the mouth and nose, leading to discomfort and potential issues with oral health.
Headache and Fatigue: Some users may experience headaches and a general sense of fatigue, which can affect daily activities and overall well-being.
Nausea and Vomiting: While promethazine is used to treat nausea and vomiting, it can also cause these symptoms, particularly if taken in high doses or for extended periods.
Diarrhea and Constipation: Gastrointestinal issues like diarrhea and constipation are possible side effects, which can be uncomfortable and disruptive.
Skin Rash and Itching: Some individuals may develop a skin rash or experience itching as a reaction to promethazine.
Allergic Reactions, Including Anaphylaxis: Promethazine can cause allergic reactions, ranging from mild symptoms like a runny nose and itching to severe reactions like anaphylaxis, which is a medical emergency.
Respiratory Depression: A severe side effect of promethazine is respiratory depression, especially when combined with other CNS depressants. This condition can be life-threatening and requires immediate medical attention.
Motion Sickness: While promethazine is effective in treating motion sickness, it can also cause symptoms like dizziness and drowsiness, which can be problematic in certain situations.
Promethazine Misuse and Addiction: Misuse of promethazine can lead to addiction, characterized by physical and psychological dependence. Recognizing the signs of misuse is crucial for early intervention.
Interactions with Other Medicines and Substances: Promethazine can interact with various other medicines and substances, leading to increased side effects and complications. Always consult a healthcare professional before combining promethazine with other treatments.
Is the Promethazine Addictive?

Yes, promethazine has the potential for addiction and is a popular drug of abuse for several reasons.
The calming and euphoric properties of the drug at higher doses make it an attractive choice. Furthermore, promethazine is often combined – both legally and illicitly – with other potentially addictive drugs, especially cough medications like codeine and dextromethorphan. Promethazine mixed with medications such as paracetamol, dextromethorphan, or codeine can increase the risk of misuse and addiction, particularly when combined with sedatives and opioids.
A common example is the popular street drug called “drank” or “lean”. This is made by combining promethazine and a range of other drugs like opioids, alcohol, or other antihistamines.
Also, promethazine has the potential to cause both physical and psychological dependence.
Physical dependence occurs when the body becomes reliant on a drug due to repeated use. Eventually, long-term abusers will notice they require the drug to function normally and may develop withdrawal symptoms – e.g., nausea, tremors, sweating – if the drug is stopped suddenly.
Psychological dependence, on the other hand, involves an emotional or mental need for the drug. The user feels they cannot cope or function without it, craving the drug to relieve stress, anxiety, or other psychological discomforts. This can lead to compulsive drug-seeking behaviour.
Is Promethazine a Controlled Substance?
No, promethazine is not considered a controlled substance in the UK or most European countries. Many promethazine medications can be purchased over-the-counter (OTC) without a prescription.
However, pharmacists and doctors in the UK are aware of potential misuse and may choose to limit access or monitor promethazine use by patients in certain situations.
How Addictive Is Promethazine?
Alone the addictive potential of antihistamines like promethazine is generally considered to be low, especially if taken correctly. However, promethazine’s addictive potential is higher if taken at exceedingly high doses or for longer than prescribed.
Also, combining promethazine with other sedatives like alcohol or codeine can increase the risk of dependence by creating a stronger feeling of euphoria and calm, as well as even triggering hallucinations.
Factors That May Contribute to Promethazine Misuse and Addiction
Mental health disorders. Individuals with psychological conditions such as PTSD, anxiety, or depression are at a higher risk of abusing medications like promethazine. These conditions often drive people to self-medicate in an attempt to alleviate distressing symptoms.
History of substance use disorder (SUD) or polydrug use. Those with prior substance abuse issues may view promethazine as a safer alternative or a way to enhance the effects of other drugs.
Societal pressures. The glamorization of drug use in certain music genres and pop culture, combined with peer pressure, has led to the normalization of promethazine abuse, particularly among young people.
Chronic pain or discomfort. Some individuals turn to promethazine as a way to manage chronic pain or discomfort. Over time, the body’s tolerance to the drug increases, leading to greater use and, eventually, addiction.
Lack of awareness and education. Many people perceive promethazine as a “safer” drug because it is commonly prescribed for mild conditions. However, the sedative and euphoric effects can lead to dependency if used improperly.
Genetic predisposition. Those with a family history of substance use disorders may have a higher likelihood of developing an addiction to promethazine due to inherited risk factors that influence behaviour and response to drugs.
Low cost and availability. As a relatively inexpensive medication that can be purchased without a prescription, it is often easy to access, which makes it more susceptible to abuse.
Mixing Promethazine with Other Substances
Mixing promethazine with other substances can significantly increase the risk of complications and health problems. It’s essential to be aware of these risks and avoid dangerous combinations.
Narcotic Analgesics, Such as Codeine: Combining promethazine with narcotic analgesics like codeine can enhance the sedative effects and increase the risk of respiratory depression, which can be life-threatening.
Prescription Opioids: Mixing promethazine with prescription opioids can lead to severe respiratory depression and other serious side effects. This combination should only be used under strict medical supervision.
Methadone: Promethazine can interact with methadone, increasing the risk of respiratory depression and other complications. Methadone maintenance patients should consult their healthcare provider before using promethazine.
Other CNS Depressants, Such as Sedatives and Tranquilizers: Combining promethazine with other CNS depressants can amplify the sedative effects, leading to severe drowsiness, impaired motor skills, and respiratory depression.
Recreational Drugs: Using promethazine with recreational drugs can lead to unpredictable and dangerous effects, including increased risk of addiction and severe health problems.
Herbal Remedies and Supplements: Promethazine can interact with herbal remedies and supplements, potentially increasing the risk of side effects and complications. Always consult a healthcare professional before combining these treatments.
Other Medicines, Including Cold Medicines and Prescription Cough Medicines: Promethazine is often found in cold and prescription cough medicines, which can increase the risk of misuse and addiction. It’s crucial to follow the prescribed dosage and consult a healthcare professional if you have any concerns.
Consequences of Promethazine Addiction

Promethazine abuse can lead to addiction and many health and non-health consequences like:
Health Consequences: Respiratory Depression
Respiratory depression. Promethazine can cause severe respiratory depression, especially when combined with other central nervous system depressants like opioids or alcohol. This can slow breathing to dangerous levels, potentially leading to coma or death.
Cognitive impairment. Chronic promethazine misuse can lead to confusion, memory loss, difficulty concentrating, impaired thinking, and mood swings, including depression or anxiety.
Withdrawal symptoms. Repeated misuse may cause physical dependence and withdrawal symptoms like nausea, sweating, insomnia, and irritability.
Cardiovascular problems. Promethazine can affect your heart rate and blood pressure, especially when taken at higher doses. This can lead to an irregular heartbeat, low blood pressure, and other cardiovascular complications.
Liver damage. Like many drugs, long-term misuse of promethazine may lead to liver damage, especially when taken in high doses or in combination with other substances that affect the liver like alcohol.
Severe drowsiness. The sedation caused by the antihistamine can impair motor skills, leading to accidents or injuries, particularly while driving or operating heavy machinery.
Hallucinations and psychosis. In some cases, misuse of promethazine can cause hallucinations, paranoia, and symptoms of psychosis, particularly at high doses.
Overdose. Taking high doses or combining promethazine with other drugs increases the risk of overdose, which can result in respiratory depression, seizures, loss of consciousness, or death.
Allergic reaction. Promethazine can cause severe allergic reactions, including anaphylaxis, which is a life-threatening condition. Symptoms may include difficulty breathing, swelling, and hives. Immediate medical attention is crucial if an allergic reaction is suspected.
Social Consequences
Social isolation and strained relationships. Addiction can cause people to withdraw from family and friends, tarnish their personal reputation, and strain relationships due to dishonesty, neglect, or erratic behaviour associated with drug misuse.
Unemployment and financial problems. Chronic promethazine use may affect job performance, leading to absenteeism, lower productivity, workplace injuries, or even job loss. Financial difficulties can also arise from spending excessive amounts on drugs, legal issues, or medical bills due to health problems related to misuse.
Legal issues. Misusing or acquiring promethazine illegally can result in criminal charges leading to arrests, fines, or incarceration. This includes prescription fraud, causing harm to a person or property due to drug use, or driving under the influence.
Academic decline. For students, promethazine misuse can lead to poor academic performance due to impaired concentration, missed classes, or reduced motivation.
Emotional distress. The stress of hiding an addiction, coupled with feelings of guilt, shame, or hopelessness, can take a significant emotional toll. This may lead to anxiety, depression, or even suicidal thoughts.
How To Recognise a Promethazine Addiction
Here are some signs to look out for:
Using larger amounts or taking the drug for a longer duration than originally intended.
Having persistent cravings for promethazine.
Making repeated unsuccessful attempts to cut down or control drug use.
Spending a significant amount of time on obtaining, using, or recovering from the effects of promethazine.
Drug use negatively affects your performance at work, school, home, or social obligations.
Avoiding important social, occupational, or recreational activities because of drug use.
Using promethazine in dangerous situations or drug use leads to dangerous situations.
Continuing to use the drug despite persistent or recurrent physical or psychological problems caused or worsened by the substances.
Continuing to use drugs despite persistent or recurrent social or interpersonal problems caused or worsened by the drug.
Requiring increased amounts of drugs to achieve the same level of intoxication or desired effect.
Experiencing discomforting symptoms when drug use stops, which may lead to substance abuse to relieve or avoid these symptoms
How To Treat a Promethazine Addiction
Treating a promethazine addiction requires a comprehensive approach that addresses both the physical and psychological aspects of dependence. Here are the key steps involved:
Medical Detoxification: The first step in treating promethazine addiction is medical detoxification. This process involves gradually reducing the dose of promethazine to minimize withdrawal symptoms. A medically supervised detox program can provide intensive monitoring and support, ensuring a safer and more comfortable withdrawal process.
Counselling and Therapy: Counseling and therapy are crucial components of addiction treatment. These sessions can help individuals understand the underlying causes of their addiction and develop coping strategies to manage cravings and prevent relapse. Therapies such as cognitive-behavioural therapy (CBT) are particularly effective in addressing the psychological aspects of addiction.
Support Groups: Joining a support group, such as Narcotics Anonymous, can provide individuals with a sense of community and accountability. These groups offer a supportive environment where individuals can share their experiences and receive encouragement from others who are also on the path to recovery.
Medications: In some cases, medications such as methadone or buprenorphine may be prescribed to help manage withdrawal symptoms and cravings. These medications can be an essential part of a comprehensive treatment plan, particularly for individuals with severe dependence.
Behavioural Therapy: Behavioral therapy can help individuals identify and change negative thought patterns and behaviours that contribute to their addiction. This type of therapy is often used in conjunction with other treatment modalities to provide a holistic approach to recovery.
Relapse Prevention: Developing strategies to prevent relapse is a critical component of addiction treatment. This involves identifying triggers, creating a plan to avoid them, and staying connected with support groups and healthcare professionals. Ongoing therapy and aftercare support are essential for maintaining long-term sobriety.
It is essential to consult a healthcare professional before attempting to treat a promethazine addiction. They can provide guidance and support throughout the recovery process, ensuring that individuals receive the appropriate care and resources needed for successful recovery.
Detoxification
During this period the drugs are allowed to wash out from the body. The complex nature of a drug addiction may require a medically supervised detox program to provide intensive monitoring and support.
During a medically supervised detox addiction recovery specialists offer medications and treatments to reduce the severity of withdrawal symptoms. Supervised detox programs are much safer, especially for individuals with complex addictions such as severe dependence, polydrug use, or co-existing medical conditions.
Rehabilitation
The next step is a structured rehabilitation program that offers treatments that are tailored to the peculiarities of the individual.
Most treatment centres offer both inpatient and outpatient services. Inpatient services are better suited for individuals with complicated addictions. These services can offer 24-hour monitoring, medical support, and close supervision by trained personnel.
Outpatient services can be performed at home and involve regular check-ins with your rehabilitation program, as well as therapy and medications.
Rehab programs offer a range of counselling and psychotherapy treatments. These include therapies such as cognitive behavioural therapy (CBT), 12-step programmes, and group therapy. Patients are also offered medications to help ease the discomfort of withdrawal.
Aftercare
Aftercare involves ongoing counselling, social support services, and medical treatment after the initial rehabilitation.
The ultimate goal of aftercare is to empower individuals with the tools and support they need to maintain sobriety during everyday life, prevent relapse, and fully integrate them back into society.
Aftercare services include:
Ongoing therapy and mental health services
Support groups like Alcoholics Anonymous or Narcotics Anonymous
Medical therapy
Providing a sober living environment
Helping them obtain financial independence and employment
Providing them with legal assistance
Teaching former drug users relapse prevention techniques
Improving family and community relationships
Monitoring individual progress via regular check-ins and promoting accountability
Seek Help Today From PCP
Understanding the dangers of promethazine addiction is life-saving. Recognizing the signs of addiction, seeking professional help, and adopting effective treatment strategies are vital steps toward recovery. With the right support and commitment, those struggling with promethazine misuse can regain control of their lives, rebuild their health, and prevent future relapse, ensuring a safer, healthier path forward.
Reach out to PCP today if you or someone you care about is struggling with promethazine addiction.
Author
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Dr Otulana is PCP’s longest-serving doctor. He is an experienced Physician with Specialist Interest in Substance Misuse Management and he has a wide range of experience in the assessment and management (including detoxification) of clients with various drug and substance addiction problems. Dr Otulana started practising as a doctor in 2000 and with over 10 years as an Addiction Physician. He is an Advanced Addiction Practitioner Member of Addiction Professionals and also holds the Certificate in Clinical Psychopharmacology (Part 1) of the British Association for Psychopharmacology. He is additionally a strong healthcare services professional with a Master of Business Administration (M.B.A.) degree from Cambridge University Judge Business School.
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