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  • When you’re experiencing cold or allergy symptoms like coughing, sneezing, or a runny nose, your health care provider may prescribe cough syrup that contains codeine and promethazine. 

    Also known as codeine cough syrup, this medication can make you feel relaxed and euphoric, or even “high.” That’s why some people abuse it, which can lead to addiction and overdose. 

    If you or someone you love misuses codeine cough syrup, it’s important to seek professional help. 

    What Is Codeine Cough Syrup?

    Codeine is a prescription opioid that impacts the central nervous system (CNS) to reduce pain and suppress cough. It belongs to a group of opioids called opiates, which are naturally derived from the opium poppy plant. 

    Codeine is used in numerous cough syrups, including Tuzistra XR. Many cough syrups that contain codeine also contain a nasal decongestant such as guaifenesin (brand name Mucinex) or phenylephrine (brand name Preparation H). 

    However, many people use the term “codeine cough syrup” to refer specifically to cough syrups that contain codeine and promethazine, as these syrups pose a higher risk for abuse and addiction. 

    What Is Promethazine?

    Promethazine is an antihistamine that helps decrease allergy symptoms such as sneezing, runny nose, watery eyes, and itchiness of the eyes, nose, and throat. It also has sedative (calming) effects. 

    Codeine Cough Syrup Brand Names

    Cough syrups that contain codeine and promethazine are sold under the following brand names:

    • Pentazine with Codeine
    • Phenergan with Codeine
    • Pentazine VC, which also contains phenylephrine
    • Phenergan VC with Codeine, which also contains phenylephrine
    • Prometh with Codeine, which also contains guaifenesin

    In most cases, these cough suppressant medications are no longer available over-the-counter (OTC) and require a prescription from a doctor. That’s because they have a high potential for abuse.

    Side Effects Of Codeine Cough Syrup

    The most common side effects of codeine cough syrup include:

    • constipation
    • drowsiness
    • dizziness
    • nausea and/or vomiting
    • dry mouth
    • sweating
    • trouble urinating 
    • headache
    • anxiety
    • irritability

    Call your doctor if you experience serious side effects such as noisy or shallow breathing, confusion, extreme drowsiness, extreme weakness, tremors, muscle twitches, high fever, seizures, changes in heart rate, or hallucinations. 

    Codeine cough syrup can also pass into breast milk and cause side effects such as shallow breathing, extreme drowsiness, and confusion in infants. 

    Thus, the United States Food and Drug Administration (FDA) recommends that you don’t use codeine cough syrup while breastfeeding. 

    Codeine Cough Syrup Abuse

    When taken as prescribed, codeine cough syrup can provide great relief for cough, cold, flu, and allergy symptoms. 

    However, some people abuse the substance by taking it in a manner not prescribed, including: 

    • taking a higher dose than prescribed
    • taking it more frequently than prescribed
    • using it with other drugs, such as alcohol, marijuana, or benzodiazepines (which include Xanax, Ativan, and Klonopin) 

    Codeine cough syrup abuse is most common among teenagers and young adults, and continued abuse can lead to:

    • tolerance, which means you need increasingly higher doses of the syrup to achieve the desired effects
    • physical dependence, which means your body relies on the syrup to function normally
    • codeine addiction (also called substance use disorder), which means you feel unable to control your use of the syrup

    Sizzurp & Purple Drank

    Additionally, some people abuse codeine cough syrup by mixing it with soda. They may also add hard candy to make it sweeter or alcohol to make it stronger. This mixture is often called purple drank, lean, sizzurp, or barre.

    Learn more about Purple Drank, Lean, & Sizzurp

    Signs Of Codeine Cough Syrup Abuse & Addiction

    If you’re concerned that you or someone you know is abusing or addicted to codeine cough syrup, look for the following signs:

    • withdrawing from family and friends 
    • neglecting responsibilities at work or school 
    • frequently visiting the pharmacy
    • frequently displaying side effects of codeine cough syrup, such as sweating, anxiety, irritability, and drowsiness  
    • feeling unable to stop using codeine cough syrup despite wanting to

    Codeine Cough Syrup Withdrawal

    When you’re addicted to and physically dependent on codeine cough syrup, you may experience withdrawal symptoms when you try to stop using it. 

    Opioid withdrawal symptoms can include:

    • insomnia
    • anxiety
    • irritability
    • frequent yawning
    • dilated pupils
    • watery eyes
    • runny nose
    • sweating
    • chills
    • loss of appetite
    • nausea and/or vomiting
    • diarrhea
    • back pain
    • stomach cramps
    • muscle aches

    Codeine Cough Syrup Overdose

    People who struggle with codeine cough syrup abuse or addiction face the risk of overdose, which occurs when you ingest too much of the syrup. This risk increases if you mix the syrup with alcohol. 

    Signs of opioid overdose include:

    • breathing problems, such as shallow breathing or slow breathing
    • clammy, cold skin
    • bluish lips and fingernails 
    • tiny pupils
    • lightheadedness
    • severe drowsiness 
    • itchiness 
    • muscle twitches
    • low blood pressure
    • weak or slow pulse
    • loss of consciousness 

    Because both codeine and promethazine have depressant effects that can slow your breathing and heart rate, a codeine cough syrup overdose may be fatal. 

    Call for emergency services immediately if you or someone else experiences the above symptoms. 

    Treatment Options For Codeine Cough Syrup Addiction

    Whether you started using codeine in cough syrup or pill form, it’s not recommended to try recovering from substance use disorder on your own. 

    Thankfully, a variety of treatment options exist to help you safely recover and avoid relapse:

    Medical Detox

    During medical detox, a team of health care professionals will closely monitor your physical and mental health as you stop using codeine. 

    To make the detoxification process more comfortable, they may prescribe medications such as:

    • clonidine, which can decrease withdrawal symptoms like sweating, anxiety,  irritability, muscle aches, stomach cramps, and runny nose
    • sleep aids to treat insomnia
    • antidepressants to treat anxiety and irritability

    Medication-Assisted Treatment

    To address severe codeine cough syrup addiction, a medication-assisted treatment (MAT) program may also be recommended.

    Along with behavioral therapy and counseling, MAT may include medications like:

    • buprenorphine, which can help discourage misuse and abuse
    • naltrexone, which can reduce the chance of relapse
    • methadone, which can ease withdrawal symptoms and reduce cravings for codeine

    Inpatient Treatment

    Your health care provider may recommend staying at an inpatient drug rehab center after you’re physically and mentally stabilized from withdrawal. There, you’ll receive 24/7 supervision and medical advice to support your recovery. 

    In most cases, you’ll also have access to individual and group therapy, where you’ll learn important coping skills to prevent relapse. Many treatment centers also offer wellness activities like yoga, meditation, and exercise. 

    Outpatient Treatment

    If you have a strong support system at home, you might consider outpatient treatment instead of inpatient treatment. With this option, you’ll regularly attend a drug abuse treatment center while still living at home.  

    If you or someone you love is struggling with codeine cough syrup abuse or addiction, please contact an Ark Behavioral Health specialist to learn about our treatment programs.

    Written by Ark Behavioral Health Editorial Team
    ©2024 Ark National Holdings, LLC. | All Rights Reserved.
    This page does not provide medical advice.

    University of Michigan: Michigan Medicine - Codeine and Promethazine
    U.S. National Library of Medicine: MedlinePlus - Codeine
    U.S. National Library of Medicine: MedlinePlus - Codeine overdose
    U.S. National Library of Medicine: MedlinePlus - Opiate and opioid withdrawal
    U.S. National Library of Medicine: MedlinePlus - Promethazine

    Medically Reviewed by
    Kimberly Langdon M.D.
    on February 14, 2023
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