
promethazine / codeine
Promethazine with codeine is a combination medication containing a phenothiazine and an opioid. It's used to treat cough and nasal symptoms caused by respiratory infections or allergies in adults. Promethazine with codeine comes as an oral solution that's taken by mouth every 4 to 6 hours. It's meant for short-term use only because it can be habit-forming. Possible side effects of this medication include sleepiness, dizziness, and dry mouth. Avoid drinking alcohol while taking promethazine with codeine because doing so can result in slowed breathing, a dangerous interaction.
What is Promethazine with codeine?
What is Promethazine with codeine used for?
- Respiratory symptoms caused by allergies or the common cold, including cough, runny nose, and sneezing
How Promethazine with codeine works
Promethazine with codeine is a combination of two medications that work together:
- Promethazine is a phenothiazine that acts like an antihistamine. It treats symptoms like runny nose by blocking a chemical called histamine.
- Codeine is an opioid receptor agonist. It eases cough by attaching to opioid receptors in the brain that control the urge to cough.
Drug facts
| Common Brands | Phenergan with codeine |
|---|---|
| Drug Class | Phenothiazine / Opioid |
| Controlled Substance Classification | Schedule V |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
Risks and warnings for Promethazine with codeine
Promethazine with codeine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Potential for dependence and misuse
- Risk factors: History of alcohol or substance misuse | Taking more promethazine with codeine than prescribed | Suddenly stopping promethazine with codeine
The codeine in promethazine with codeine carries a risk of addiction or misuse, even at recommended doses. In serious cases, addiction and misuse of an opioid medication can lead to overdose and death. Your healthcare professional (HCP) will prescribe the lowest amount of promethazine with codeine for the shortest period of time needed to treat your symptoms. If you've taken promethazine with codeine for 5 days and your cough hasn't gotten better, then this medication isn't likely a good choice for you. In this case, contact your prescriber to discuss alternatives.
Dangerously slow breathing (respiratory depression)
- Risk factors: Older adults | Children younger than 12 years old | Children younger than 18 years old after tonsil or adenoid surgery | Taking medications that can cause slow breathing | Drinking alcohol | Having medical conditions that affect breathing | Taking higher doses of promethazine with codeine | Ultra-rapid metabolizers of promethazine with codeine | Breastfed babies from mothers taking promethazine with codeine
Promethazine with codeine can cause dangerously slow breathing, which can be life-threatening. This can happen at any time, but you're at higher risk 1 to 3 days right after you start promethazine with codeine or if your HCP raises your dose. Drinking alcohol and taking other medications, like benzodiazepines, can also raise your risk for this dangerous side effect. You also might be at risk if you have certain genetics that affect the way your body processes promethazine with codeine.
You're recommended to ask your prescriber about getting naloxone (Narcan) before you start promethazine with codeine so that you can have it available in case of an accidental overdose. If you or your loved one notice you have trouble breathing or have bluish-colored lips, fingers, or toes, call 911 to get medical help right away.
Difficulty concentrating and extreme sleepiness
- Risk factors: Taking higher doses of promethazine with codeine | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Promethazine with codeine can cause extreme sleepiness and lower your ability to think, react, and focus. Your risk is higher if you're taking other medications that can make you sleepy, such as benzodiazepines, muscle relaxants, and sleep medications. Make sure you know how this medication affects you before driving a car or doing activities that require your concentration. Talk to your HCP right away if you feel too sleepy from taking promethazine with codeine.
Risk of accidental overdose
To prevent accidentally taking too much promethazine with codeine, only use a accurate milliliter measuring device, such as an oral medication syringe, to measure your dose. If you don't already have one at home, ask your pharmacist.
Serious medication interactions
Promethazine with codeine can interact with many medications. For example, taking certain medications, like erythromycin (Ery-tab) and ritonavir (Norvir), can raise the level of codeine and put you at higher risk for breathing problems. And starting certain medications, like rifampin (Rifadin) or carbamazepine (Tegretol), while you're already taking promethazine with codeine might lower the level of codeine and put you at risk for withdrawal symptoms.
Before starting promethazine with codeine, make sure your care team is aware of all the medications you're currently taking. Don't start or stop any medications without first checking with your care team.
Harm to newborn babies
If you take promethazine with codeine during pregnancy, you can pass the medication to your unborn baby. Long-term use during pregnancy can cause your unborn baby to become dependent on opioids. Once your baby is born, they can experience withdrawal symptoms, such as high-pitched crying, poor feeding and sucking behavior, trembling, irritability, abnormal sleep patterns, and seizures. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if not recognized and treated in time. Let your healthcare provider know if you've used promethazine with codeine during pregnancy or if you notice these symptoms in your baby.
Low blood pressure
Promethazine with codeine can cause extremely low blood pressure, including a drop in blood pressure when you stand from a sitting or lying down position. This can lead to dizziness and fainting. To avoid falling, get up slowly if you've been sitting or lying down. If dizziness or lightheadedness doesn't go away, talk to your HCP.
Low adrenal hormone levels
Though rare, opioids like promethazine with codeine can cause your adrenal hormone levels to drop. This is more likely to happen after taking opioids for longer than 1 month. Symptoms include nausea, vomiting, not feeling hungry, tiredness, dizziness, and weakness. Let your HCP know right away if you experience these symptoms because you might need to stop promethazine with codeine and be treated with corticosteroids.
Seizures
- Risk factors: History of seizure conditions
Opioids can cause people with a history of seizures to have seizures more often. Promethazine with codeine can also raise your risk of seizures in certain situations. Let your HCP know if you have seizures more often while taking promethazine with codeine.
Neuroleptic malignant syndrome (NMS)
- Risk factors: Taking other antipsychotic medications
The promethazine in promethazine with codeine can cause a rare, but life-threatening condition called neuroleptic malignant syndrome (NMS). Symptoms include fever, sweating, stiff muscles, confusion, not aware of your surroundings, and fast or irregular heartbeat. If you experience any of these symptoms while taking promethazine with codeine, seek medication attention as soon as possible. You HCP will likely have you stop taking promethazine with codeine and switch you to something else.
Difficulty controlling body movements
- Risk factors: Taking other antipsychotic medications | Dehydrated | Children
The promethazine in promethazine with codeine can cause uncontrolled body movements, such as eye-twitching or lip-smacking. The risk is higher for people who are dehydrated. If you experience any uncontrolled movements and aren't able to stop them, talk to your HCP right away.
Caution in certain medical conditions
People with certain medical conditions shouldn't take promethazine with codeine.
For example, this medication can't be taken by people with certain stomach-related conditions, such as slow movement of the gut. The codeine in this medication can worsen gut movement.
Promethazine with codeine isn't appropriate for people with head injuries, brain tumors, or other brain-related medical conditions. This is because this medication can slow breathing and lower oxygen levels in the brain, which can be dangerous.
Before starting promethazine with codeine, make sure to let your medical team know about what medical conditions you have so that they can check to see if this medication is safe for you to take.
Risk of inaccurate lab results
Promethazine with codeine can interfere with certain lab tests. For example, it can cause pregnancy tests to have false-positive or false-negative results. It can also cause blood sugar tests to be falsely high. Make sure to tell your HCP you're taking promethazine with codeine if you're receiving any lab tests.
Side effects of Promethazine with codeine
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Sleepiness
- Trouble concentrating
- Lightheadedness
- Dizziness
- Headache
- Dry mouth
- Nausea
- Vomiting
- Constipation
- Trouble breathing
- Sweating
Less Common Side Effects
- Tired feeling
- Falling
- Swelling of the arms or legs
- High or low blood pressure
- Blurry vision
- Confusion
- Sensitivity to light
- Hallucinations
- Heartburn
- Diarrhea
- Stomach pain
Promethazine with codeine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Dangerously slow breathing: trouble breathing; bluish-colored lips, fingers, or toes
- Accidentally taking too much (overdose): not responding to sound or touch, slowed breathing, extreme sleepiness, slow heartbeat, upper right-sided stomach pain, dark urine, cold or clammy skin, yellowing of your skin or eyes
- Opioid withdrawal: anxiety, suicidal thoughts, restlessness, runny nose, yawning, sweating, chills, wide pupils, irritability
- Neuroleptic malignant syndrome (NMS): fever, sweating, stiff muscles, confusion, not aware of your surroundings, fast or irregular heartbeat
The following Promethazine with codeine side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Bluish lips or skin
chills
clay-colored stools
cold sweats
confusion
dark urine
decrease in the frequency of urination
decrease in the urine volume
difficult or troubled breathing
difficulty in passing urine (dribbling)
dizziness
dizziness, faintness, or lightheadedness when getting up from lying or sitting position
fast, pounding, or irregular heartbeat or pulse
feeling of warmth
headache
high fever
hives or welts, itching, or rash
increased sweating
irregular, fast or slow, or shallow breathing
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
loss of bladder control
noisy breathing
not breathing
pale or blue lips, fingernails, or skin
rectal bleeding
redness of the face, neck, arms, and occasionally, upper chest
redness of the skin
seeing, hearing, or feeling things that are not there
seizures
severe muscle stiffness
shakiness in the legs, arms, or hands
stomach pain
sweating
tightness in the chest
tiredness
trembling or shaking of the hands or feet
unpleasant breath odor
unusual tiredness or weakness
unusually pale skin
vomiting of blood
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Bad dreams
blurred or loss of vision
confusion as to time, place, or person
continuing ringing or buzzing or other unexplained noise in the ears
difficulty having a bowel movement
disturbed color perception
double vision
drowsiness
false or unusual sense of well-being
halos around lights
hearing loss
holding false beliefs that cannot be changed by fact
increased sensitivity of the skin to sunlight
night blindness
overbright appearance of lights
redness or other discoloration of the skin
relaxed and calm feeling
severe sunburn
sleepiness
trouble sleeping
tunnel vision
unusual excitement, nervousness, or restlessness
vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Promethazine with codeine
Pros
- Starts to work within 20 minutes
- Available as a lower-cost generic medication
- Good option for people who don't want to take tablets
Cons
- Doesn't work as well as other medications
- Not safe for children
- Not the best choice to take while pregnant or breastfeeding
- Contains alcohol
Pharmacist tips for Promethazine with codeine
- Since promethazine with codeine works rather quickly, you only have to take it as needed when you're having symptoms. Most people continue to feel effects for about 4 to 6 hours after a dose, but it's possible for it to last up to 12 hours.
- You can take promethazine with codeine with or without food. If it's upsetting your stomach, try taking it with food to help.
- Store the medication at room temperature. Be sure to use a medication dose cup, spoon, or syringe to measure out your dose. Using household teaspoons might cause you to take the wrong amount of promethazine with codeine.
- If you've been taking promethazine with codeine regularly for a period of time and want to stop, talk with your prescriber first. They might need to lower your dose slowly over time before you can stop completely. This is to help you avoid withdrawal symptoms, such as anxiety, sweating, chills, and irritability.
- Promethazine with codeine causes dizziness and sleepiness. Avoid activities that require you to be alert (like driving) until you know how it affects you. Avoid alcohol because it can worsen sleepiness and dizziness, and can also harm your ability to think or react.
- Constipation can happen from promethazine with codeine. Drink enough water each day and add more foods with fiber to your diet. Speak to your care team if these lifestyle changes aren't enough to help with this side effect. They can recommend medications or a change in your treatment.
- Let your prescriber know if you're pregnant before starting promethazine with codeine. It isn't recommended during pregnancy because it raises the risk for birth defects and complications at birth, including neonatal abstinence syndrome.
- Tell your healthcare team if you're breastfeeding. It's typically recommended to avoid promethazine with codeine because the opioid medication can get into breast milk. This raises the risk for serious side effects to your baby (e.g., sleepiness, slowed breathing).
- Store promethazine with codeine out of reach from children, pets, or visitors. If you don't need to take promethazine with codeine anymore, choose a medication take-back option to get rid of it safely. This lowers the risk of accidental overdose and helps prevent medication misuse.
Promethazine with codeine dosage
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 6.25mg/10mg/5ml | 473 ml | $11.99 | $0.03 |
Typical dosage for Promethazine with codeine
Each 5 mL of promethazine with codeine contains 10 mg of codeine and 6.25 mg of promethazine.
- Adults: The typical dose is 5 mL by mouth every 4 to 6 hours as needed. Don't take more than 30 mL (6 teaspoonfuls) in a day.
Interactions between Promethazine with codeine and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Bromopride
- Calcium Oxybate
- Cisapride
- Dronedarone
- Furazolidone
- Iproniazid
- Isocarboxazid
- Linezolid
- Magnesium Oxybate
- Mesoridazine
- Methylene Blue
- Moclobemide
- Nalmefene
- Naltrexone
- Nialamide
- Phenelzine
- Pimozide
- Piperaquine
- Potassium Oxybate
- Procarbazine
- Rasagiline
- Safinamide
- Saquinavir
- Selegiline
- Sodium Oxybate
- Sparfloxacin
- Terfenadine
- Thioridazine
- Toloxatone
- Tranylcypromine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Acepromazine
- Alfentanil
- Alfuzosin
- Almotriptan
- Alprazolam
- Amifampridine
- Amineptine
- Amiodarone
- Amisulpride
- Amitriptyline
- Amitriptylinoxide
- Amobarbital
- Amoxapine
- Amphetamine
- Amprenavir
- Anagrelide
- Anileridine
- Apomorphine
- Aprepitant
- Aripiprazole
- Aripiprazole Lauroxil
- Armodafinil
- Arsenic Trioxide
- Asenapine
- Astemizole
- Atazanavir
- Azithromycin
- Baclofen
- Benperidol
- Benzhydrocodone
- Benzphetamine
- Boceprevir
- Bosentan
- Bromazepam
- Bromopride
- Brompheniramine
- Buprenorphine
- Bupropion
- Buserelin
- Buspirone
- Butabarbital
- Butorphanol
- Calcium Oxybate
- Cannabidiol
- Carbamazepine
- Carbinoxamine
- Carisoprodol
- Carphenazine
- Ceritinib
- Cetirizine
- Chloral Hydrate
- Chlordiazepoxide
- Chloroquine
- Chlorpheniramine
- Chlorpromazine
- Chlorzoxazone
- Cimetidine
- Cinacalcet
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clobazam
- Clofazimine
- Clomipramine
- Clonazepam
- Clopidogrel
- Clorazepate
- Clozapine
- Cobicistat
- Cocaine
- Codeine
- Conivaptan
- Crizotinib
- Cyclobenzaprine
- Cyclosporine
- Dabrafenib
- Darunavir
- Dasatinib
- Degarelix
- Delamanid
- Delavirdine
- Desipramine
- Deslorelin
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexamethasone
- Dexmedetomidine
- Dextroamphetamine
- Dextromethorphan
- Dezocine
- Diazepam
- Dibenzepin
- Dichloralphenazone
- Difenoxin
- Dihydrocodeine
- Diltiazem
- Diphenhydramine
- Diphenoxylate
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Doxepin
- Doxylamine
- Dronedarone
- Droperidol
- Duloxetine
- Efavirenz
- Eletriptan
- Encorafenib
- Enflurane
- Entrectinib
- Enzalutamide
- Epinephrine
- Erythromycin
- Escitalopram
- Esketamine
- Eslicarbazepine Acetate
- Estazolam
- Eszopiclone
- Ethchlorvynol
- Ethopropazine
- Ethylmorphine
- Etravirine
- Fenfluramine
- Fentanyl
- Fingolimod
- Flecainide
- Flibanserin
- Fluconazole
- Fluoxetine
- Fluphenazine
- Flurazepam
- Fluspirilene
- Fluvoxamine
- Formoterol
- Fosamprenavir
- Fosaprepitant
- Foscarnet
- Fosnetupitant
- Fosphenytoin
- Fospropofol
- Fostemsavir
- Frovatriptan
- Gabapentin
- Gabapentin Enacarbil
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Halothane
- Hexobarbital
- Histrelin
- Hydrocodone
- Hydromorphone
- Hydroxychloroquine
- Hydroxytryptophan
- Hydroxyzine
- Ibutilide
- Idelalisib
- Iloperidone
- Imatinib
- Imipramine
- Indinavir
- Inotuzumab Ozogamicin
- Isoflurane
- Isradipine
- Itraconazole
- Ivabradine
- Ivacaftor
- Ivosidenib
- Ketamine
- Ketazolam
- Ketobemidone
- Ketoconazole
- Lapatinib
- Lasmiditan
- Lefamulin
- Lemborexant
- Lenvatinib
- Levocetirizine
- Levofloxacin
- Levomilnacipran
- Levorphanol
- Lisdexamfetamine
- Lithium
- Lofepramine
- Lofexidine
- Lomitapide
- Lopinavir
- Lorazepam
- Lorcaserin
- Loxapine
- Lumacaftor
- Lumefantrine
- Macimorelin
- Magnesium Oxybate
- Meclizine
- Mefloquine
- Melitracen
- Melperone
- Meperidine
- Mephobarbital
- Meprobamate
- Meptazinol
- Mesoridazine
- Metaxalone
- Methacholine
- Methadone
- Methamphetamine
- Methdilazine
- Methocarbamol
- Methohexital
- Methotrimeprazine
- Metoclopramide
- Metrizamide
- Metronidazole
- Mibefradil
- Midazolam
- Mifepristone
- Milnacipran
- Mirabegron
- Mirtazapine
- Mitotane
- Modafinil
- Molindone
- Moricizine
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nafarelin
- Nafcillin
- Nalbuphine
- Naratriptan
- Nefazodone
- Nelfinavir
- Netupitant
- Nevirapine
- Nicomorphine
- Nilotinib
- Nitrazepam
- Nitrous Oxide
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Olanzapine
- Ondansetron
- Opipramol
- Opium
- Opium Alkaloids
- Orphenadrine
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxazepam
- Oxcarbazepine
- Oxycodone
- Oxymorphone
- Ozanimod
- Palbociclib
- Paliperidone
- Palonosetron
- Panobinostat
- Papaveretum
- Paregoric
- Paroxetine
- Pasireotide
- Pazopanib
- Pentamidine
- Pentazocine
- Pentobarbital
- Perampanel
- Perazine
- Periciazine
- Perphenazine
- Phenobarbital
- Phenytoin
- Pimavanserin
- Piperacetazine
- Pipotiazine
- Piritramide
- Pitolisant
- Ponesimod
- Porfimer
- Posaconazole
- Potassium Oxybate
- Prazepam
- Prednisone
- Pregabalin
- Primidone
- Procainamide
- Procarbazine
- Prochlorperazine
- Promazine
- Promethazine
- Propafenone
- Propofol
- Protriptyline
- Quazepam
- Quetiapine
- Quinidine
- Quinine
- Ramelteon
- Ranitidine
- Ranolazine
- Remifentanil
- Remimazolam
- Remoxipride
- Revefenacin
- Ribociclib
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rizatriptan
- Rolapitant
- Saquinavir
- Scopolamine
- Secobarbital
- Secretin Human
- Selpercatinib
- Sertindole
- Sertraline
- Sevoflurane
- Sibutramine
- Siponimod
- Sodium Oxybate
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Solifenacin
- Sorafenib
- Sotalol
- St John's Wort
- Sufentanil
- Sulpiride
- Sumatriptan
- Sunitinib
- Suvorexant
- Tacrolimus
- Tapentadol
- Telaprevir
- Telavancin
- Telithromycin
- Temazepam
- Terbinafine
- Tetrabenazine
- Thiethylperazine
- Thiopental
- Thiopropazate
- Thioridazine
- Tianeptine
- Tilidine
- Tiotropium
- Tizanidine
- Tolonium Chloride
- Topiramate
- Toremifene
- Tramadol
- Trazodone
- Triazolam
- Triclabendazole
- Trifluoperazine
- Trifluperidol
- Triflupromazine
- Trimeprazine
- Trimipramine
- Triptorelin
- Tryptophan
- Vandetanib
- Vardenafil
- Vemurafenib
- Venlafaxine
- Verapamil
- Vilazodone
- Vinflunine
- Voclosporin
- Voriconazole
- Vortioxetine
- Zaleplon
- Ziprasidone
- Zolmitriptan
- Zolpidem
- Zopiclone
- Zotepine
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aminolevulinic Acid
- Belladonna
- Belladonna Alkaloids
- Betel Nut
- Evening Primrose
- Midodrine
- Phenylalanine
How much does Promethazine with codeine cost?
$11.99
Promethazine with codeine contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Promethazine with codeine will not be safe for you to take.
- Children younger than 12 years of age
- Children younger than 18 years of age for pain management after tonsil or adenoid surgery
- Severely slowed breathing (respiratory depression)
- Severe asthma
- Conditions that cause blockage of the stomach passageway
- Allergy to promethazine
- Allergy to codeine or another opioid
- Current or recent (within 2 weeks) use of a monoamine oxidase inhibitor (MAOI)
What are alternatives to Promethazine with codeine?
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