Promethazine (Phenergan, Promethegan) is a prescription antihistamine medication. It is used to help with allergies, treat nausea and vomiting after surgery, and for motion sickness. It also acts as a sedative. It is also used off-label for nausea and vomiting in pregnancy.
Side effects include sedation, confusion, and disorientation. It can also cause excitability, restlessness, or, rarely, seizures. It is taken by mouth as a liquid or tablet, and as a suppository [1].
However, promethazine is also used in a variety of ways recreationally that are very dangerous. Since it is often available in association with opioids, its abuse may be considered a public health issue, with huge implications for clinical practice.
‘Pharming’ involves the non-medical use of prescription (pain relievers, tranquilizers, stimulants, sedatives) and over-the-counter (OTC) drugs, including cough and cold preparations, particularly those containing dextromethorphan and promethazine. This offers easy accessibility, low cost, decreased perception of potential for harm, and growing social acceptance [2].
In this article, I explain what this drug is, how it’s abused, and how to detox from its use.
How Does Promethazine Work?
Promethazine blocks histamine H1 receptors, dopamine receptors, and acetylcholine effects in the brain. Histamines are substances released by the body during an allergic reaction. It helps reduce itching, sneezing, swelling, and other symptoms of allergies. It also affects areas of the brain that control nausea and vomiting. It may affect your coordination, reaction time, or judgment [3].
What Side Effects Are There from Promethazine?
Common side effects may include [3] [4] [5]:
Drowsiness or lack of energy | Confusion or inability to think clearly | Dizziness or coordination problems |
Blurred vision | Nervousness or trouble sleeping | Hallucinations or feelings of intense happiness, pleasure, and well-being |
Dry mouth | Nausea or vomiting | Tremor |
Severe side effects may include:
Severe Allergic Reactions | Slow or shallow breathing | Seizures |
Movement Problems, Severe Tissue Injury | Neuroleptic Malignant Syndrome (NMS) | Jaundice |
How Is Promethazine Abused?
Promethazine is abused particularly as an enhancer (potentiator) when mixed with opioids and other depressants. This polydrug use poses a dangerous and often underestimated risk to health and life. Promethazine is abused in the following ways:
1. Abuse in Combination with Opioids
This is the most well-known and dangerous form of recreational use, especially in hip-hop culture. The beverage, with street names “Lean”, “Purple Drank”, and “Sizzurp”, is a mix of prescription-strength cough syrup containing both promethazine and the opioid codeine with soda and sometimes hard candy.
Promethazine enhances the euphoric, anti-anxiety sedative effects of codeine. This provides the “heavy”, relaxed, dream-like high users look for. Because both substances are central nervous system (CNS) depressants, they can lead to severe respiratory depression. Breathing slows or stops entirely, resulting in coma or death. And the promethazine-codeine cough mixture might lead to addiction [2].
In the US, promethazine abuse/misuse has been described in teenagers and young adults, methadone maintenance patients, heroin users, and opioid-prescribed chronic pain patients
2. Abuse to Enhance Other Depressants
Other CNS depressants may also be mixed with promethazine.
- Alcohol: Promethazine is taken before or while drinking alcohol. It intensifies the feeling of drunkenness and sedation, drastically increasing the risk of alcohol poisoning, memory blackouts, and accidental injury.
- Benzodiazepines such as Xanax and Valium: These are combined, creating a more powerful sedative and anxiety-reducing effect.
- With Other Opioids: While codeine is most well-known, promethazine may be abused with other opioids like hydrocodone, oxycodone, or fentanyl for a similar enhancing effect with the risk of fatalities. This use has declined in the past ten years.
3. Abuse as a Standalone Drug
While combination abuse is the most common, promethazine is misused on its own, particularly by individuals seeking its sedative side effects.
- For Sedation: Especially with those struggling with insomnia, individuals may take much higher than prescribed doses to induce intense drowsiness and sleep.
- For Mild Euphoria or Relaxation: Some users report a feeling of calmness or a detached, dream-like state that they find desirable, when taken in high doses.
- To Self-Medicate: Seeking its tranquilizing properties, some people might misuse it without a prescription to manage anxiety or agitation.
4. Abuse in a Clinical or Institutional Setting
Healthcare workers may inappropriately use promethazine to sedate agitated or difficult patients. This is for staff convenience, not medical reasons, and is a serious ethical and legal violation.
Key Factors that Enable Abuse
- Believing it’s safe: Users may underestimate its dangers, especially when combined with other drugs since it’s “just a prescription antihistamine”.
- Availability: Promethazine is relatively easy to obtain from multiple doctors (“doctor-shopping”), from family medicine cabinets, or on the illicit market.
Withdrawal and Detox from Promethazine in Palm Springs
Promethazine misuse may lead to dependence. When discontinuing the drug, gradual tapering of the dose by 25-50% every 1-4 weeks is recommended. If there are serious adverse effects, faster tapering or immediate stop is advised, monitored by healthcare professionals [6].
Treatment involves medically supervised detox, in which withdrawal typically lasts 7 to 10 days. In the first few days, physical symptoms peak, with psychological symptoms such as cravings and depression lasting longer.
Withdrawal symptoms include [2]:
Restless legs | Insomnia | Muscle aches |
Nausea | Vomiting | Depression |
Headaches | Irritability | Strong cravings |
Residential treatment is recommended to address both physical dependence and psychological aspects following withdrawal. This typically includes:
- Cognitive Behavioral Therapy (CBT): To process underlying issues like insomnia, anxiety, or substance use.
- Counseling: Building coping skills and relapse prevention techniques through individual and group therapy.
- Support Groups: Sharing with others who have similar experiences.
Help Is Available at Hideaway Recovery
At Hideaway Recovery, we proudly serve men from Cathedral City, Palm Springs, Palm Desert, throughout the Coachella Valley, and beyond. Offering substance abuse detox, residential addiction treatment, and dual diagnosis care, our programs are designed to meet the unique needs of every client. Whether you’re seeking addiction recovery services or support for co-occurring disorders, our compassionate team is here to guide you every step of the way.
Sources
[1] Southard BT, Al Khalili Y. 2024. Promethazine. [Updated 2024 Jan 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-
[2] Chiappini, S. et al. (2021). Beyond the ‘purple drank’: Study of promethazine abuse according to the European Medicines Agency adverse drug reaction reports. Journal of psychopharmacology (Oxford, England), 35(6), 681–692.
[3] Chabot S. 2024. Promethazine – Uses, Side Effects, and More. WebMD.com
[4] Mayo Clinic. 2025. Promethazine (oral route). Mayoclinic.org
[5] Cleveland Clinic. 2025. Promethazine Tablets. Clevelandclinic.org
[6] Northern Sydney Local Health District, NSW Therapeutic Advisory Group Inc. 2029. Deprescribing Guide for Sedating Antihistamines.