February 26, 2024

Michigan Poison and Drug Information Center at WSU issues warning about antihistamine misuse

The Michigan Poison and Drug Information Center at the Wayne State University School of Medicine has issued a warning to the public about the increasing misuse of the medication promethazine in Michigan and the United States.

Promethazine is an antihistamine and antiemetic in cough and cold products available as a single active ingredient or co-formulated with other ingredients like acetaminophen, dextromethorphan and codeine, a prescription opioid.

Misuse occurs in combination with prescription and non-prescription medicinal products, most notably with prescription-strength cough syrups containing codeine. A combination of cough syrup with soda or hard candy is commonly known as “purple drank,” “sizzurp,” “Texas tea,” and “lean.”

People who misuse promethazine in combination with other substances can experience:

  • euphoria
  • excessive relaxation
  • sedation
  • shallow breathing (when mixed with an opioid)
  • flushed skin
  • dry mouth
  • dilated pupils
  • agitation
  • delirium
  • hallucinations

Severe effects include:

  • psychosis
  • seizures
  • cardiac dysrhythmias
  • Hypotension
  • Tachycardia
  • QT prolongation

The risk for Torsades de pointes, an uncommon and distinctive form of polymorphic ventricular tachycardia, is low except for adults who have used excessive amounts of promethazine.

Health care professionals who suspect substance misuse should anticipate promethazine misuse alone or in combination with other drugs. Promethazine with codeine prescription fills is reported on the Michigan Automated Prescription Monitoring System. Clinicians who suspect promethazine misuse should contact the Poison Helpline at the center as soon as possible for treatment guidance from the center’s clinical toxicology consultants.

The center encourages anyone experiencing substance misuse or mental health concerns to seek care as soon as possible. Local services can be found on the Substance Abuse and Mental Health Services Administration website at www.samhsa.gov or by calling 1-800-662-HELP (4357).

In Michigan, visit www.michigan.gov/mdhhs for resources from the Substance Use, Gambling and Epidemiology division at the Michigan Department of Health and Human Services.

The Poison Helpline at the center can be reached 24/7/365 at 1-800-222-1222. Help is free, confidential and provided by a team of qualified and board-certified healthcare experts. For more resources, visit www.mipoisonhelp.org.


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