How Long Does Promethazine Stay in Your System?

Promethazine is the generic name of a prescription drug used to control allergic reactions, prevent motion sickness and nausea, and act as a sedative.[1] While promethazine alone can lead to dependence, the combination of promethazine and codeine in cough syrups and cold medicines presents an additional addiction risk.

Knowing how long promethazine stays in your system is important if you’re concerned about substance use, drug tests, and interactions with other medications. In addition, if you’re taking promethazine with codeine, you might want to know how long codeine stays in your system.

Let’s take a closer look.

What Is Promethazine?

Promethazine hydrochloride is an FDA-approved prescription drug classed as a phenothiazine derivative but often referred to as an antihistamine. It’s an antiemetic for nausea and vomiting, a sedative and sleep aid, and an antihistamine that reduces allergy symptoms like a runny nose, sneezing, watery eyes, and itching.

Promethazine was previously sold under the brand name Phenergan, but it was discontinued.[2] Except for rectal suppositories sold under the brand name Promethegan, the generic equivalent is available by prescription only.[3]

Is Promethazine Addictive?

Studies show that promethazine can be addictive when taken alone, mainly because of its sedative effects. Promethazine can also enhance the effects of opioids. When combined with codeine in cough syrups, the risk of codeine dependence goes up.[4]

Is Promethazine a Controlled Substance?

Promethazine is not a controlled substance under the U.S. Drug Enforcement Administration (DEA). However, promethazine combined with codeine is a Schedule V drug due to its opioid content. This classification means that promethazine with codeine has a lower potential for abuse compared to Schedule IV drugs like Xanax® and Valium®. However, it still contains narcotics that can lead to dependence or misuse.[5]

How Does Promethazine Work in the Body?

Promethazine affects the central nervous system (CNS) by blocking histamine receptors and affecting neurotransmitters like dopamine and acetylcholine. These effects reduce allergic reactions, prevent nausea, and cause sedation.[1]

Tablets and syrups are absorbed in the stomach and small intestine and metabolized in the liver before excretion, mainly through urine. Promethazine in suppository form is absorbed through the lining of the rectum, creating a different absorption rate. Injected promethazine acts faster than oral or rectal forms.[6]

How Long Does Promethazine Stay in Your System?

Promethazine’s elimination half-life ranges from 10 to 19 hours, which means it can remain in the body for several days after the last use. However, detection in drug tests varies depending on dosage, metabolism, and individual health factors.[7]

• Blood tests: Up to 24 hours
• Urine tests: 2 to 4 days[8]
• Saliva tests: 1 to 2 days
• Hair tests: Up to 90 days (rarely used for detection)

Knowing how long promethazine stays in your system is important for medical safety, drug interactions, and substance use monitoring:

• Medical monitoring: Some healthcare providers check for promethazine levels if a patient is experiencing unexpected sedation or dizziness.[1]
• Substance use: Promethazine is misused for its sedative effects, and prolonged use can lead to unintentional overdose when combined with other drugs.
• Legal or workplace testing: Specialized tests may be ordered if drug-related impairment is suspected.[4]

False positives can occur, with promethazine sometimes causing a positive result for amphetamines in urine testing. While drug tests don’t typically include promethazine, codeine in combination with certain medications can cause positive results for opioids in urine, blood, and hair tests.[9]

The Dangers of Promethazine and Codeine Combination: Lean (Purple Drank)

“Lean,” also called Purple Drank or Sizzurp, is a combination of codeine and promethazine cough syrup mixed with soda and candy to mask its strong taste. While it may seem like just another trend, Lean is far from harmless. It’s an opioid-based concoction that can lead to addiction, overdose, and even death.[10, 11]

Why Is Lean So Dangerous?

The main risk of Lean comes from its two active ingredients:

• Codeine, an opioid, can cause euphoria, drowsiness, and respiratory depression. In large amounts, it slows breathing to dangerous levels, especially when combined with alcohol or other depressants.
• Promethazine enhances the sedative effects of codeine and can contribute to dangerous levels of sedation.

Many people underestimate how addictive and harmful Lean is. Frequent use leads to tolerance, meaning users need higher doses to feel the same effects.[12]

The Physical and Mental Effects of Lean

People who drink Lean may experience the following:

• Euphoria and relaxation
• Dizziness
• Impaired coordination
• Slowed breathing and heart rate
• Memory loss
• Confusion
• Hallucinations
• Overdose and death

Long-term misuse results in severe withdrawal symptoms, including shaking, nausea, muscle pain, and extreme cravings, making it very difficult to quit without professional help.[14]

The Risk of Overdose and Death

Lean is especially dangerous when mixed with alcohol, benzodiazepines (Valium®, Xanax®, etc.), or other opioids. These combinations drastically increase the risk of fatal respiratory depression. Many high-profile musicians and celebrities have publicly struggled with Lean addiction, with some suffering life-threatening overdoses.[13]

Getting Help for Promethazine, Codeine, and Lean Addiction

If you or a loved one is struggling with addiction, recovery is possible. Since codeine is an opioid, medical detox and structured addiction treatment programs can help manage withdrawal safely.

At Engage Wellness Acton, we provide treatment programs and comprehensive support for individuals overcoming prescription drug addiction. That includes opiate detox, medication-assisted treatment, and mental health treatments like cognitive behavioral therapy (CBT) for substance use disorders, including the misuse of Lean and other opioids.

Admitting you’re struggling with substances like promethazine and codeine can be difficult. But you’re not alone. The sooner you reach out for support, the sooner you’ll experience a healthier, more fulfilling life.

We’re with you every step of the way.

Learn more about our treatment center and how we can help you or a loved one take the first step toward well-being and a healthier future. Verify your insurance or contact Engage Wellness Acton today!

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