Can you take promethazine with codeine?

PromethazineDrug groupsPhenothiazinePromethazine is a depressant, anticholinergic and antiallergic active ingredient from the group of phenothiazines, which is administered, among other things, for restless and agitated states, nausea and allergic reactions. Promethazine can be administered orally, parenterally, rectally and topically. In contrast to other active substances from the same group, it is only weakly antipsychotic. Promethazine is a substrate of CYP2D6, has a high interaction potential and can prolong the QT interval. Possible adverse effects include confusion, sedation, blurred vision, dry mouth, constipation, and urination disorders. Promethazine is also abused as a sedative intoxicant, especially in combination with codeine.

synonymous: Promethazinum, Promethazini hydrochloridumPhEur, Promethazinhydrochlorid


No drugs containing promethazine are currently on the market in Switzerland. The last preparation, Rhinathiol Promethazin® with the expectorant carbocistein, was taken off the market on January 31, 2009. However, drugs are still available in many countries.

The original preparation is Phenergan®. Promethazine was developed in the 1940s by Rhône-Poulenc, which is now part of Sanofi.

Structure and properties

Promethazine (C.17H20N2S, Mr = 284.4 g / mol) belongs to the phenothiazines and exists as a racemate. Medicines contain it as promethazine hydrochloride, a white, crystalline, practically odorless and hygroscopic powder that is very easily soluble in water.


Promethazine (ATC D04AA10, ATC R06AD02) has antihistamines (antiallergic), anticholinergic, antiserotonergic, sedating, hypnotic, weakly antipsychotic, hardly any antidopaminergic as well as antiemetic and antivertiginous properties. The effects occur about 20 minutes after ingestion and last 6 to 12 hours.

application areas

The most important areas of application are shown below. Promethazine is not approved for these indications in all countries.


Promethazine is misused as an intoxicant due to its calming (sedative) properties. Along with codeine, it is the most important component of the → Purple Drank. Several deaths have been reported in this regard. We therefore urgently advise against misuse.


According to the specialist information. Promethazine is administered orally (drops, tablets), parenterally (injection solution), rectally (suppositories) and topically (cream).


The complete precautionary measures can be found in the product information sheet.


Promethazine is a substrate of CYP2D6 and has a high potential for interaction. Drug interactions have been described with central depressant drugs, with anticholinergics, antidepressants, MAO inhibitors, adrenaline, antihypertensive drugs, anti-epileptic drugs and drugs that prolong the QT interval.

unwanted effects

Possible undesirable effects include (selection):

  • Insomnia, confusion, restlessness, paradoxical CNS stimulation
  • Sedation, fatigue
  • Extrapyramidal Disorders
  • Increase in intraocular pressure, accommodation disorders
  • Feeling of a stuffy nose
  • Dry mouth, thirst, cholestasis, constipation
  • sweat
  • Micturition disorders
  • Skin reactions

Promethazine can increase the QT interval and very rarely cause irregular heartbeat. Overdosing can be life threatening.

see also

Rhinathiol Promethazin®, Antihistamines, Phenothiazines, Purple Drank

  • Pharmaceutical product information (CH, D, USA)
  • Cantisani C. et al. Topical promethazine side effects: our experience and review of the literature. Biomed Res Int, 2013, 2013, 151509 Pubmed
  • European Pharmacopoeia PhEur
  • Lynch K.L. et al. Promethazine use among chronic pain patients. Drug Alcohol Depend, 2015, 150, 92-7 Pubmed
  • Shapiro B.J. et al. Promethazine misuse among methadone maintenance patients and community-based injection drug users. J Addict Med, 2013, 7 (2), 96-101 Pubmed
  • Sneader W. Drug discovery: a history. Chichester: Wiley, 2005
  • Starke P.R., Weaver J., Chowdhury B.A. Boxed warning added to promethazine labeling for pediatric use. N Engl J Med, 2005, 352 (25), 2653 Pubmed

Conflicts of Interest: None / Independent. The author has no relationships with the manufacturers and is not involved in the sale of the products mentioned.

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