Promethazine and codeine are two medications that are often used together in prescription cough syrups and cold medications. Promethazine is an antihistamine that helps reduce allergy and cold symptoms like sneezing, runny nose, watery eyes, and cough. Codeine is an opiate narcotic that acts as a cough suppressant by depressing the cough reflex. When combined in a cough syrup or cold medication, promethazine and codeine work together to relieve multiple cold and allergy symptoms.
What is promethazine?
Promethazine is a first-generation antihistamine medication that was developed in the 1940s. It is available by prescription only, either as a standalone medication or as an ingredient in combination prescription medications. Here are some key facts about promethazine:
- Promethazine belongs to a class of medications called phenothiazines. It works by blocking the effects of histamine in the body, which reduces allergy symptoms.
- In addition to treating allergies and cold symptoms, promethazine can also be used to prevent motion sickness, help induce sleep, and control nausea and vomiting.
- Promethazine comes in tablet, rectal suppository, liquid syrup, and injectable forms. Oral tablets or syrup are typically used for allergies, motion sickness, and improving sleep.
- Some common brand name versions of promethazine include Phenergan, Promethegan, Promacot, and Phenadoz.
- Possible side effects of promethazine include drowsiness, dizziness, dry mouth, blurred vision, constipation, and headache.
Overall, promethazine is a widely-used antihistamine medication that can provide relief from allergy symptoms, motion sickness, nausea, or insomnia. It works by blocking the effects of histamine in the body, which reduces symptoms like sneezing, watery eyes, and runny nose.
What is codeine?
Codeine is a narcotic opiate medication used to treat mild to moderate pain. It also has cough suppressant effects. Here are the key facts about codeine:
- Codeine belongs to the drug class of opiate narcotic analgesics, along with drugs like morphine and oxycodone.
- It works by depressing activity in the cough center of the brain, reducing the urge to cough.
- Codeine can be prescribed alone or combined with other medications like acetaminophen or aspirin for pain relief.
- Common brand name versions include Tylenol-Codeine, Empirin-Codeine, and codeine phosphate.
- Potential side effects include drowsiness, nausea, constipation, headaches, and difficulty urinating.
- Codeine has a risk of dependence and addiction with long-term use.
In summary, codeine is an opiate narcotic medication primarily used for its cough suppressing and mild analgesic effects. It works by depressing the cough reflex in the brain and altering how the body perceives pain.
Are promethazine and codeine used together?
Yes, promethazine and codeine are very often combined together in prescription cough syrups and cold medications. Here is some background on promethazine-codeine combinations:
- Promethazine and codeine work synergistically together, meaning their effects complement one another.
- Promethazine reduces allergy, cold, and cough symptoms while codeine suppresses coughing.
- Common brand name combination products include Phenergan with Codeine, Promethazine VC with Codeine, Cheratussin-D, and Siltussin-D.
- These medications require a doctor’s prescription and are not available over-the-counter.
- The most common use is short-term relief of severe coughing associated with the flu, colds, or allergies.
- Potential side effects may include drowsiness, nausea, headache, dizziness, and constipation.
Promethazine-codeine cough syrups provide more robust relief from coughs and upper respiratory symptoms compared to either medication alone. The promethazine handles allergy, sneezing, runny nose, and watery eyes, while the codeine suppresses the cough reflex. However, these combination products also carry risks if used long-term or in excess.
Is promethazine available without codeine?
Yes, promethazine is available both as a standalone medication and in combination products without codeine. Some options for promethazine without codeine include:
- Promethazine hydrochloride tablets
- Phenergan plain promethazine syrup
- Promethazine suppositories
- Promethazine injections
- Promethazine VC syrup (combining promethazine with phenylephrine, a nasal decongestant)
- Diclegis (promethazine and pyridoxine for morning sickness)
- Promethazine DM syrup (combining promethazine with dextromethorphan, a cough suppressant)
The majority of promethazine-only products are available by prescription only. However, some versions like Phenergan plain syrup or promethazine suppositories may rarely be found over-the-counter. In general, promethazine-only products will treat allergy and cold symptoms but will not provide the cough-suppressing effects of promethazine-codeine combinations.
What strengths does promethazine with codeine come in?
Promethazine with codeine cough syrup comes in several different concentrations of each active ingredient. Common strengths include:
- Promethazine 6.25mg + codeine 10mg per 5mL
- Promethazine 12.5mg + codeine 10mg per 5mL
- Promethazine 25mg + codeine 10mg per 5mL
- Promethazine 50mg + codeine 50mg per 5mL (more concentrated high-dose formulations)
The typical dosing range is 5-10mL taken every 4 to 6 hours as needed. Maximum daily doses should not exceed 120mg of codeine and 150mg of promethazine. Be sure to always follow the doctor’s instructions for your particular promethazine-codeine medication’s strength and dosage.
Why is promethazine combined with codeine?
There are a few key reasons why promethazine and codeine are often formulated together in cough and cold medicines:
- Synergistic effects: The combination works better than either drug alone, with promethazine reducing upper respiratory symptoms and codeine suppressing the cough reflex.
- Enhanced cough relief: Codeine quiets coughs while promethazine handles sneezing, runny nose, and congestion.
- Lower abuse potential: Combining promethazine and codeine may deter abuse, as promethazine adds unpleasant side effects.
- Added convenience: Patients get relief from multiple symptoms with a single medication.
Overall, formulating promethazine and codeine together leverages the complementary effects of both drugs. Patients get improved relief from coughs, congestion, runny nose, sneezing, and watery eyes with combination therapy compared to either medication on its own.
What are the side effects of promethazine with codeine?
The following side effects may occur with promethazine-codeine cough syrup:
- Drowsiness or dizziness
- Lightheadedness
- Dry mouth
- Nausea or vomiting
- Constipation
- Headache
- Difficulty urinating
- Nightmares or hallucinations
- Severe itching
- Irregular heartbeat
- Seizures (rare)
Children may experience excitement, nervousness, restlessness, trouble sleeping, and irritability from promethazine-codeine. Caution is needed when driving or operating machinery while using this medication duo. Seek medical help if severe or concerning reactions develop.
Risk of dependence and addiction
Codeine carries a risk of dependence and addiction, especially with prolonged use. Consult with a doctor about the shortest acceptable duration for promethazine-codeine treatment.
Respiratory depression
Excessive doses can slow or stop breathing in rare cases. Use the lowest effective dose only as directed by a doctor.
Drug interactions
Promethazine and codeine may interact with several other drugs like antidepressants, anxiety medications, and sleeping pills. Always discuss other medications with the prescribing provider.
What conditions are promethazine with codeine used to treat?
Promethazine-codeine cough syrup is primarily used to relieve coughing from the flu, colds, bronchitis, pneumonia, or allergies. Specific conditions it may treat include:
- Cough due to pertussis (whooping cough)
- Cough and congestion from respiratory infections
- Allergic rhinitis (hay fever) cough and congestion
- Cough variant asthma
- Cough from emphysema or COPD
- Severe cough following surgery
- Cough due to lung cancer
- Cough related to ACE inhibitor blood pressure medications
Promethazine-codeine should not be used long-term. Follow the doctor’s instructions for the shortest recommended duration of use, typically 3-5 days.
Contraindications
Promethazine-codeine is contraindicated in certain patients:
- Children under age 18 (in some cases age 12)
- Adults over age 65
- Pregnant or breastfeeding women
- People with respiratory problems like COPD, sleep apnea, or asthma
- Patients taking antidepressants called MAOIs
- People with a known codeine allergy or intolerance
Is promethazine with codeine the same as lean?
Lean is a street term referring to an illicit recreational drug concoction involving prescription cough syrups like promethazine-codeine. Here is some background on the relationship between promethazine-codeine and lean:
- Lean first became popular in rap/hip hop culture in the 1990s in Houston, earning street names like “purple drank” or “sizzurp.”
- Purple refers to the color of promethazine-codeine cough syrup.
- Lean is typically made by mixing prescription cough syrup containing promethazine and codeine with soft drinks like Sprite or Mountain Dew. Some versions contain alcohol like vodka or extra narcotics.
- Drinking lean produces euphoria plus a perception of slowed time due to codeine intoxication.
- Consuming lean long term can lead to addiction along with risks like respiratory depression, seizures, coma, and death, especially when taken in excess.
- Because of recreational lean abuse, some states and regions have tightened restrictions around promethazine-codeine prescriptions.
In summary, promethazine with codeine cough syrup is one of the key ingredients used illicitly to make the recreational drug lean. While promethazine-codeine has legitimate medical uses, taken recreationally in excessive doses as lean carries high risks of overdose, addiction, and death.
What should I know about the “Sprite and Jolly Rancher” version of lean?
One popular basic recipe for homemade lean involves mixing promethazine-codeine cough syrup with Sprite soda and Jolly Rancher candy. Here are some key facts about this specific “purple drank” concoction:
- Uses grape-flavored Sprite soda which matches the purple color of the cough syrup.
- Adding Jolly Ranchers sweetens the taste but also helps dissolve the thick cough syrup.
- May include extras like alcohol (vodka, gin) or marijuana for added intoxication.
- Drinking even this simple homemade lean is extremely dangerous due to the codeine overdose risk.
- Consuming only 2-3 ounces can potentially cause critical respiratory depression or even death in some users.
- Long-term use often leads to physical and psychological dependence on both codeine and promethazine.
The “Sprite and Jolly Rancher” lean recipe tries to mask the negative taste of cough syrup but does not reduce the life-threatening overdose potentials. All illegal recreational use of prescription cough syrup should be strictly avoided.
What steps can reduce the dangers of lean/purple drank?
There is no “safe” way to engage in recreational lean or purple drank abuse given the intrinsic dangers. However, certain harm reduction steps may help slightly reduce risks in those determined to use it. Potential damage reduction approaches include:
- Avoiding combinating with other substances like alcohol, marijuana, opioids, or benzodiazepines.
- Measuring doses carefully using a calibrated oral syringe instead of drinking straight from the bottle.
- Taking only 1-2 ounces maximum at a time, with >4 ounces considered a potentially lethal dose.
- Allowing at least 4-6 hours between doses to assess effects.
- Never using alone – have someone present to monitor for overdose.
- Maintaining hydration and avoiding becoming overheated while intoxicated.
However, the only way to eliminate dangers is to avoid non-medical promethazine-codeine abuse entirely. Recreational use always carries substantial risks up to and including death. Consider seeking professional addiction treatment help if substance use has become unhealthy and out of control.
Conclusion
Promethazine and codeine are two medications often combined together in prescription cough syrups and cold remedies. Promethazine is an antihistamine that treats allergy symptoms and codeine is a narcotic cough suppressant. Taken together, promethazine-codeine preparations provide more robust relief from coughing, congestion, runny nose, sneezing, watery eyes, and more compared to either drug alone. However, these products also carry risks like sedation, nausea, constipation and most seriously, potentially fatal respiratory depression and addiction if abused. While promethazine-codeine combinations have legitimate medical uses, their recreational abuse as the street drug “lean” can have life-threatening consequences. Understanding the relationship between prescribed cough syrups and illicit lean abuse is critical.
