Promethazine is a common over-the-counter medication used to treat allergies, motion sickness, nausea, and vomiting. It’s often combined with codeine or dextromethorphan in prescription cough syrups and tablets. This has led many people to wonder – is promethazine a narcotic?
What is Promethazine?
Promethazine is a first-generation antihistamine. It was first developed in the 1940s and approved for medical use in the United States in 1951. Promethazine works by blocking the effects of histamine, a chemical responsible for many of the symptoms caused by allergic reactions. When histamine is released, it triggers reactions like sneezing, runny nose, watery eyes, hives, and other allergy symptoms. Promethazine prevents histamine from binding to receptors and blocks these effects to provide relief from allergies.
In addition to treating allergies, promethazine also has several other uses. It can help prevent and treat motion sickness and is often used for this purpose. Promethazine is also effective for treating and preventing nausea and vomiting. For this reason, it’s commonly given to patients prior to surgery or receiving anesthesia to limit nausea. It’s also used to manage nausea and vomiting in pregnancy, and to treat nausea associated with migraines or chemotherapy.
Is Promethazine a Narcotic?
Promethazine itself is not technically considered a narcotic. The term narcotic refers to opiate drugs like morphine, codeine, and heroin that come from the opium poppy plant. Narcotics have very strong pain-relieving effects but also carry a high risk of abuse and addiction.
While promethazine is not an opiate and doesn’t directly produce the euphoric high associated with narcotics, it does have several properties similar to narcotic drugs:
- Central nervous system depressant – Promethazine slows down brain activity and nervous system functions.
- Sedative effects – Promethazine can cause relaxation and drowsiness.
- Potential for dependence – With long-term use, users can develop a tolerance and dependence on promethazine.
- Abuse potential – Some abusers use promethazine to self-treat anxiety, produce euphoria, or amplify the effects of narcotics and alcohol.
For these reasons, promethazine is classified as a hypnotic and sedative drug. It shares some properties with narcotics but is not technically considered one itself. However, in high doses it can produce similar effects to narcotic drugs.
Promethazine with Codeine
One reason why people may think promethazine is a narcotic is because of its frequent use combined with the narcotic drug codeine. Prescription cough syrups and tablets containing promethazine and codeine combinations are often prescribed to suppress coughs.
Common combination products include:
- Promethazine with codeine syrup
- Promethazine/codeine cough syrup
- Promethazine/codeine tablets
In these products, promethazine acts as a sedative while the codeine acts as a narcotic. The sedative effects of the promethazine allow the codeine to work better as a cough suppressant. When combined, promethazine and codeine create a synergistic effect.
However, because these combination products contain codeine, they are considered narcotic medicines and carry the same risks of addiction, dependence, and abuse as other narcotics. The promethazine just enhances the effects of the codeine.
Is Promethazine a Controlled Substance?
While promethazine alone is not technically a narcotic, it is still a controlled medication due to its potential for abuse. In the United States, promethazine is classified as a Schedule V controlled substance by the Drug Enforcement Administration (DEA).
Schedule V drugs have an accepted medical use but also carry a potential for dependence and abuse with long-term use. Other Schedule V drugs include some cough suppressants and antidiarrheal medicines.
Even though promethazine has low potential for abuse and low risk of dependence compared to other controlled drugs, it must still be used cautiously under medical supervision. Using promethazine without a prescription or taking it in ways other than prescribed can be considered drug abuse.
Side Effects of Promethazine
When used correctly under medical supervision, promethazine is generally safe and effective. However, there are some potential side effects to be aware of:
- Drowsiness – Drowsiness is the most common side effect. It can impair coordination and judgment.
- Dry mouth and blurred vision – Like other antihistamines, promethazine can cause dry mouth and blurred vision.
- Dizziness – Promethazine may cause a temporary drop in blood pressure leading to dizziness.
- Confusion – Confusion and disorientation may occur, especially in elderly patients.
- Constipation – Opioid medications like codeine can cause severe constipation.
- Difficulty urinating – Some people may have trouble fully emptying the bladder while on promethazine.
- Slowed breathing – In rare cases, promethazine may cause dangerously slowed breathing.
These side effects are usually mild. But additive side effects may occur when promethazine is combined with alcohol or other drugs that depress the central nervous system. This increases the risks of driving or operating machinery while impaired.
Risk of Addiction and Dependence
While promethazine alone has relatively low potential for dependence and addiction, there are some risks to be aware of:
- Dependence – Taking promethazine regularly for more than a few weeks can lead to dependence. Stopping suddenly can cause withdrawal symptoms like restlessness, insomnia, and rebound nausea.
- Tolerance – Over time, the body adapts to promethazine and more may be needed to get the same effects. This increases the risks of overdose.
- Addiction – Like other sedatives, promethazine does carry a risk of psychological and physical addiction. This is more likely at high doses or combining with alcohol or narcotics.
- Misuse – Some people misuse promethazine to self-treat anxiety, produce euphoria, or enhance the effects of pain pills and alcohol.
The risks of dependence and addiction are higher with long-term use of promethazine, high doses, or inappropriate use. Always take promethazine only as directed by a doctor and be cautious combining it with other substances.
Abuse of Promethazine
While less common than abuse of opioids and other controlled substances, promethazine misuse does occur. Some ways promethazine may be abused include:
- Taking more than the recommended dosage to get high
- Using it without a medical need as a sedative
- Combining with alcohol or medicines to enhance effects
- Crushing tablets to snort or inject the drug
- Forging prescriptions to illegally obtain promethazine
- Stealing promethazine from pharmacies
- Ordering promethazine without a prescription online
Those addicted to other drugs like opioids also sometimes abuse promethazine to enhance and prolong their high. The dangers of promethazine abuse are increased when it is taken in ways other than prescribed.
Signs of Promethazine Addiction and Abuse
Some signs that may indicate someone is abusing promethazine include:
- Excessive drowsiness or sedation
- Slurred speech
- Poor concentration and judgment
- Confused thinking
- Lack of coordination
- Weakness
- Headaches
- Insomnia
- Nausea or vomiting
- Constipation
- Itching
- Hallucinations
- Agitation or irritability
- Depression when not taking the drug
- “Nodding off” during conversations
- Doctor shopping to obtain more promethazine
- Prescriptions frequently “lost” or “stolen”
- Hiding or sneaking doses of the drug
Those addicted to promethazine may take excessive doses seeking euphoria or use it to relieve withdrawal from other drugs. They may also try to obtain promethazine illegally. Abuse puts users at risk of overdose.
Dangers of Promethazine Abuse
While promethazine misuse is less common than opioid painkiller abuse, there are still serious risks, including:
- Excessive sedation – High doses can slow heart rate and breathing to dangerous levels.
- Overdose – High amounts can cause overdose leading to coma or death.
- Respiratory depression – Especially risky when combined with other depressant drugs and alcohol.
- Liver damage – Long-term abuse can harm the liver.
- Psychosis – Abuse can cause delirium, hallucinations, and psychotic effects.
Those abusing promethazine also put themselves at increased risk of accidents and injuries while driving or operating machinery when impaired.
Treatment for Promethazine Addiction
While less common than addictions to alcohol, heroin, or prescription painkillers, promethazine addiction does sometimes occur. Treatment options include:
- Medical detox – To safely wean off promethazine under medical supervision. Prevents dangerous withdrawal symptoms.
- Addiction therapy – Behavioral counseling helps identify triggers and develop coping skills.
- Support groups – Peer support provides accountability during recovery.
- Dual diagnosis treatment – Many addicts also struggle with co-occurring mental health disorders that require treatment.
A customized treatment plan combining medical, psychological, and social support provides the best chance for overcoming promethazine addiction long-term.
Conclusion
While promethazine is not technically classified as a narcotic, it does share some properties similar to other addictive drugs. Promethazine has sedative effects and can lead to dependence when abused or used long-term. The risks of addiction are increased when promethazine is combined with narcotics like codeine or abused recreationally.
Signs of promethazine addiction include excessive sedation, slurred speech, and “doctor shopping” to obtain more of the drug. Dangers include slowed breathing, liver damage, and accidental overdose. But comprehensive addiction treatment can help break the cycle of promethazine abuse.
When used responsibly under medical supervision, promethazine can be a safe and effective treatment for allergies, nausea, or coughs. But it’s important to be aware of its potential risks and get help if you suspect you or a loved one may be developing an addiction.
| Promethazine Facts | Description |
|---|---|
| What is it? | A first-generation antihistamine drug |
| Common uses | Allergies, motion sickness, nausea, vomiting, sedation |
| Controlled substance? | Yes, Schedule V in the U.S. |
| Potential for dependence/abuse? | Moderate risk, increased when combined with other drugs |
| Overdose effects | Excessive sedation, slowed breathing, coma, death |
| Classification | Sedative-hypnotic drug, not technically a narcotic |