Drug and Alcohol

Promethazine: Why This Ingredient Makes Lean Use Dangerous

What is Promethazine?

Promethazine is a strong and effective antihistamine that can make allergies a lot easier to live with. But when abused, it can be dangerous.

Written by

brian-mooreBrian Moore

Content Writer

Reviewed by

jeremy-arztJeremy Arzt

Chief Clinical Officer

Drug and Alcohol

November 14, 2023

Promethazine, a versatile medication that has been providing relief for various medical conditions for decades, holds a prominent place in medicine. It has become a cornerstone in medical treatment, catering to many conditions and offering much-needed comfort.

It’s not a drug that’s addictive or even gets you high. So, why is a drug rehab blog talking about it?


Lean is a nickname for cough syrup containing codeine. Popular in some subcultures, it’s also known as purple drank, sizzurp, and more. As a prescription cough syrup, it can make coughing less painful. As a party drug? It’s a gateway to opioid abuse due to codeine.

But codeine isn’t the only dangerous part of lean abuse. Taken in high quality, promethazine is dangerous on its own.

What Is Promethazine?

Primarily known for its antihistamine properties, promethazine (commonly known by its brand name Phenergan) has been widely utilized to alleviate a range of medical symptoms and conditions. A first-generation antihistamine, promethazine has found its place in medical practice due to its ability to block histamine receptors, which helps relieve symptoms associated with allergies, motion sickness, and other related conditions.

This medication is available in various forms, catering to the diverse needs of patients.

Medical Uses and Benefits of Promethazine

Promethazine, a multifunctional medication with various applications, is commonly prescribed to address various conditions and symptoms. They include:

Allergic Reactions and Itching

Promethazine has shown efficacy in managing allergic reactions, including skin rashes, hives, and itching. By blocking the action of histamine, a chemical released during allergic responses, Promethazine helps alleviate these symptoms. It acts as an antihistamine, reducing the itchiness and discomfort of allergic reactions.

Motion Sickness and Nausea

Individuals prone to motion sickness or experiencing nausea due to travel or other causes can find relief with promethazine. By targeting the brain's vomiting center, promethazine acts as an antiemetic, effectively reducing feelings of nausea and preventing vomiting. It also has sedating properties that can help individuals relax during travel and mitigate motion sickness symptoms.


Promethazine's soothing properties make it helpful in treating insomnia and promoting sleep. It acts as a central nervous system depressant, helping to induce drowsiness and facilitate a restful night's sleep. Promethazine's sedative effects can especially benefit individuals struggling with sleep disturbances or insomnia.

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Other Uses of Promethazine

Promethazine's benefits extend beyond its primary medical uses. It has been found to have additional off-label applications in certain respiratory conditions and pain management.

They include:

Respiratory Conditions

Promethazine can assist in managing respiratory symptoms caused by conditions like the common cold, allergies, or bronchitis. Its antihistamine properties can help alleviate congestion, runny nose, and sneezing, relieving individuals experiencing respiratory discomfort.

Pain Management

In some cases, promethazine is used as an adjunct medication to enhance pain management. When combined with certain analgesics, promethazine can improve the effectiveness of pain relief by reducing anxiety, promoting relaxation, and enhancing the pain-relieving effects of the primary medication.

In all its applications, promethazine works by interfering with the actions of certain chemicals in the body, such as histamine and dopamine. Promethazine helps alleviate symptoms by blocking these receptors, providing individuals with much-needed relief.

Is Promethazine Addictive?

Promethazine is a prescription medication that belongs to the class of antihistamines. It is commonly used to treat allergies, nausea, and motion sickness. However, it is also known for its sedative effects and has been used off-label as a sleep aid or recreational drug.

The question of whether promethazine is addictive has been a subject of debate among healthcare professionals and individuals who have used the drug. While it is not classified as a controlled substance by the U.S. Drug Enforcement Administration, there have been reports of promethazine abuse and addiction.

One reason for promethazine's potential for addiction is its sedative effects. The drug can produce a feeling of relaxation and drowsiness, which some individuals may find pleasurable and seek to experience again. This can lead to repeated use and potential dependence.

Additionally, promethazine has been used in combination with codeine, a narcotic pain reliever, to create a recreational drug known as "lean" or "purple drank." This concoction has gained popularity among some individuals, particularly in the hip-hop community. The mixture of promethazine and codeine can produce a euphoric high, leading to potential abuse and addiction.

Furthermore, promethazine has also been reported to have withdrawal symptoms, further supporting the possibility of addiction. These withdrawal symptoms may include anxiety, restlessness, insomnia, nausea, and sweating.

However, it is important to note that not everyone who uses promethazine will become addicted. Factors such as genetics, underlying mental health conditions, and personal history of substance abuse can all play a role in an individual's susceptibility to addiction.

To avoid the potential for promethazine addiction, it is essential to use the medication as prescribed by a healthcare professional and not for recreational purposes.

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Is Promethazine Dangerous?

Promethazine is a medication that belongs to the class of antihistamines and antiemetics. It is commonly used to treat allergies, motion sickness, and nausea. However, there has been some concern about the safety of this medication.

One of the main concerns with promethazine is its sedative effect. This means that it can make people feel very drowsy and sleepy. This can be dangerous, especially if the individual is driving or operating heavy machinery. It is important for individuals taking promethazine to be cautious and avoid any activities that require alertness until they know how the medication affects them.

Another concern with promethazine is its potential for abuse. Due to its sedative effects, some people may use this medication for recreational purposes. This can be dangerous as promethazine is not meant to be used in this way and can lead to serious side effects or addiction.

In addition, promethazine should not be taken with certain medications, such as opioids or alcohol. This can increase the risk of severe respiratory depression, which can be life-threatening. It is important for individuals taking promethazine to consult with their healthcare provider and disclose all medications they are currently taking to avoid any potential interactions.

There have also been reports of promethazine causing severe side effects such as breathing problems, seizures, and allergic reactions. These can be serious and require immediate medical attention. It is important for individuals taking promethazine to be aware of these potential side effects and seek medical help if they experience any of them.

In summary, while promethazine can be an effective medication for certain conditions, it is important to use it with caution and follow the recommended dosage. It should only be used under the supervision of a healthcare provider and individuals should be aware of potential side effects and interactions with other medications.

Promethazine and Codeine: What Are the Risks?

Promethazine is often combined with codeine in certain medications, such as cough syrups. While this combination can be effective in treating symptoms of the common cold or flu, it also carries some risks.

Codeine is a narcotic pain reliever and can cause drowsiness and respiratory depression. When combined with promethazine, which also has sedative effects, the risk of these side effects is increased. This can be especially dangerous for individuals who are not aware of the potential interactions and take a larger dose than prescribed.

In addition, codeine has a high potential for abuse and addiction. Therefore, it is important to use medications containing this combination with caution and only as directed by a healthcare provider.

Furthermore, promethazine with codeine should not be given to children under the age of 12 due to the risk of severe breathing problems. For adolescents between 12-18 years old, it should only be used in certain circumstances and with caution.

Overall, it is important for individuals to understand the potential risks associated with promethazine and codeine combination and use these medications responsibly under medical supervision.

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Can Promethazine Cause Organ Damage?

There is currently no evidence that promethazine can cause organ damage when used as directed. However, there have been some rare cases reported where individuals experienced liver and kidney damage after taking high doses of promethazine.

It is important to note that these cases were not directly linked to promethazine itself, but rather the combination of this medication with other drugs or alcohol. This highlights the importance of using promethazine as directed and avoiding any potential interactions with other substances.

In general, individuals with liver or kidney problems should consult with their healthcare provider before taking promethazine to ensure it is safe for them to use. Additionally, individuals should not exceed the recommended dosage and avoid using promethazine for extended periods of time without medical supervision.

Promethazine: How Do People Take Promethazine?

Promethazine is a medication that belongs to the class of drugs known as antihistamines. It acts by blocking the effects of histamine, a natural substance in the body that is responsible for causing allergic reactions. Beyond its antihistamine properties, promethazine also exhibits sedative and antiemetic (anti-nausea) effects. Let's explore the medical applications of promethazine and its various forms of administration.

Promethazine is commonly prescribed for several medical conditions, including allergies, motion sickness, nausea, and sedation. For allergies, it helps alleviate symptoms such as itching, sneezing, and runny nose by reducing the release of histamine in the body. Its antiemetic properties effectively manage nausea and vomiting associated with various causes, including chemotherapy, surgery, and certain medications.

When it comes to motion sickness, promethazine can be a reliable option. It works by suppressing the signals sent from the inner ear to the brain, which are responsible for triggering motion sickness symptoms. Moreover, due to its sedative effects, promethazine is occasionally prescribed for short-term treatment of insomnia or to induce sedation before surgery.

Promethazine is available in various forms, allowing flexibility in administration. It can be found in tablet form, commonly taken orally with water. Additionally, syrup formulations are particularly suitable for children or individuals who have difficulty swallowing pills. Promethazine is also available in suppository form for those unable to take medications orally, which is inserted rectally for absorption into the bloodstream.

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Potential Side Effects of Promethazine

While promethazine can relieve various conditions, it is essential to be aware of its potential side effects and take necessary precautions. Understanding these aspects ensures safe and effective use.

Common Promethazine Side Effects

Promethazine may cause common side effects, including drowsiness, dry mouth, and blurred vision. Drowsiness is particularly common, and individuals taking promethazine should avoid activities that require mental alertness, such as driving or operating machinery. Dry mouth and blurred vision are usually temporary. They can be managed by maintaining proper hydration and using lubricating eye drops.

Severe or Rare Side Effects of Promethazine

While uncommon, severe or rare side effects associated with promethazine may require immediate medical attention. These include:

Allergic Reactions

Some individuals may experience an allergic reaction to promethazine, presenting symptoms such as rash, itching, swelling, severe dizziness, or difficulty breathing. 

Respiratory Depression

Promethazine, especially in higher doses, can potentially cause respiratory depression, characterized by slowed or shallow breathing. This is more likely to occur in elderly individuals or those with existing respiratory conditions. 

Neuroleptic Malignant Syndrome

Though rare, neuroleptic malignant syndrome (NMS) can occur with promethazine use. Symptoms include high fever, muscle stiffness, altered mental status, and irregular blood pressure. 

Who Is at Risk for Promethazine Use?

Awareness of specific precautions and contraindications related to promethazine use is important. These include:

Pregnancy and Breastfeeding

Promethazine should be used cautiously during pregnancy, especially in the first trimester, as it may increase the risk of certain congenital disabilities. It is also not recommended for breastfeeding mothers due to the potential drug transfer to the infant.

Elderly Individuals

The elderly population may be more susceptible to the side effects of promethazine, particularly drowsiness, dizziness, and confusion. 

Interactions With Other Medications

Promethazine may interact with other medications, including certain antidepressants, antipsychotics, and opioids, potentially causing increased sedation or other adverse effects. 

Promethazine Abuse and Misuse

Promethazine, a medication primarily prescribed for allergies, motion sickness, and sedation, can be abused and misused. Addressing the potential risks associated with such practices is essential to promote responsible usage and safeguard one's well-being.

Potential for Promethazine Abuse and Misuse 

Promethazine abuse refers to using the medication in a manner not prescribed by a healthcare professional or for non-medical purposes. This may involve taking higher doses, more frequent administration, or combining it with other substances to achieve euphoria or sedative effects.

Dangers and risks of recreational use or combining promethazine with other substances can include:

Sedative Effects and Respiratory Depression

Promethazine has sedative properties, and when abused, it can cause excessive drowsiness, impaired coordination, and slowed breathing. Combining promethazine with other central nervous system depressants like alcohol or opioids can intensify these effects, leading to dangerous levels of sedation and respiratory suppression.

Overdose Risk

Taking high doses of promethazine or combining it with other substances significantly increases the risk of overdose. An overdose can result in severe respiratory depression, loss of consciousness, seizures, and even death.

Addiction and Dependence

Regular misuse of promethazine can lead to physical and psychological dependence. It becomes increasingly difficult to discontinue use without experiencing withdrawal symptoms, reinforcing a cycle of misuse.

Here are ways promethazine can be used safely:

  • Medical supervision: It is crucial to use promethazine only as a healthcare professional directs. Seeking medical guidance ensures the medication is used appropriately, at the correct dosage, and for the prescribed duration.

  • Responsible usage: Promethazine should never be shared with others, and it is important to follow the prescribed dosage and administration instructions. Any alterations to the recommended regimen should only be made under medical supervision.

  • Open communication with healthcare providers: Informing healthcare professionals about any existing medical conditions, allergies, or medications before using Promethazine is essential. This allows them to assess potential interactions and contraindications and provide personalized advice for safe usage.

Promethazine Safety and Considerations

Promethazine, a medication commonly prescribed for allergies, motion sickness, and sedation, requires certain safety considerations to ensure its proper and responsible use. By following safety tips and informing healthcare providers about relevant medical information, individuals can enhance their overall safety and minimize potential risks.

Safety tips for individuals using Promethazine:

  • Avoid activities requiring mental alertness while under the influence of Promethazine: Promethazine can cause drowsiness and impair cognitive function. It is advisable to refrain from activities such as driving, operating heavy machinery, or engaging in tasks that demand concentration until the effects of the medication have subsided.

  • Stay hydrated and avoid alcohol or other sedating substances: Promethazine can increase the risk of dehydration, especially in warmer climates. It is important to drink an adequate amount of water while using the medication. Additionally, alcohol or other substances with sedating effects should be avoided, as they can intensify the sedative properties of Promethazine, leading to excessive drowsiness and impaired coordination.

  • Talking to healthcare providers: Informing healthcare providers about any existing medical conditions, allergies, or medications is crucial before using Promethazine. This step allows healthcare professionals to consider potential interactions and contraindications and tailor the treatment plan accordingly. Important information to disclose includes:

  • Existing medical conditions: Certain medical conditions, such as respiratory disorders, liver or kidney impairment, or a history of seizures, may require adjustments in the dosage or usage of Promethazine.

  • Allergies: Informing healthcare providers about known allergies to medications or substances helps prevent adverse reactions or allergic responses to Promethazine.

  • Medications: Provide a comprehensive list of all medications, including prescription, over-the-counter, and herbal supplements, to avoid potential drug interactions or contraindications with Promethazine.

Struggling With Promethazine And/Or Lean Abuse? Talk to The Edge Treatment Center

If you or someone you know is struggling with promethazine and/or lean abuse, it is important to seek help from a professional treatment center. The Edge Treatment Center offers individualized care for substance use disorders, including sober living options, access to medication, and more..

Our team of experienced professionals will work with you to develop a personalized treatment plan that addresses your specific needs and helps you overcome addiction.

Reach out to us today to learn more about our programs and how we can help you on the path to recovery. Remember, there is always hope for a better tomorrow. So don't wait, get the help you need today. Reach out to The Edge Treatment Center now, and let's get a conversation about promethazine going.

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