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WHAT ARE THE RISKS AND WARNINGS FOR PROMETHAZINE CODEINE?
Promethazine / 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 ADDICTION, ABUSE, AND MISUSE
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Risk factors: Personal or family history of substance abuse | History of mental illness
Like other opioid-containing medications, promethazine / codeine has a potential for abuse, misuse, or addiction, which can lead to complications such as overdose and death. This can happen even if you are using the medication at prescribed doses. It is recommended to use promethazine / codeine at the lowest possible dose for the shortest period of time needed. If you are using this medication for 5 days and don’t feel any better, contact your provider to discuss alternatives.
TROUBLE BREATHING
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Risk factors: Children under 18 years of age | History of breathing problems (COPD, sleep apnea, asthma) | Taking other medications that slow down breathing
It’s not recommended for children under 18 years old to take promethazine / codeine. This medication can cause children to stop breathing, especially if they are taking other medications that also affect breathing. This can be life-threatening. People who have breathing problems such as chronic obstructive pulmonary disease (COPD), sleep apnea, asthma, or are taking other medications that can affect breathing (opioids, sleeping medications) also have a higher risk of this problem. Please discuss if promethazine / codeine is the safest option for you with your provider before starting it.
EXTREME DROWSINESS
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Risk factors: Taking promethazine / codeine at the same time as benzodiazepines or alcohol
Taking promethazine / codeine with benzodiazepines or alcohol can cause you to be extremely sleepy. This can be life-threatening and even lead to a coma or death. Do not drink alcohol while taking promethazine / codeine. If you take benzodiazepines regularly, discuss alternatives with your provider. There are safer options for treating a cough.
MULTIPLE DRUG INTERACTIONS
Promethazine / codeine is known to interact with many medications. Some of these interactions can be dangerous or life-threatening. Make sure to tell both your healthcare provider and your pharmacist about all medications and over-the-counter products you are taking before you start promethazine / codeine, even if you only take them once in a while or as needed.
WITHDRAWAL IN NEWBORNS
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Risk factors: Taking promethazine / codeine consistently during pregnancy
Promethazine / codeine is not safe to use during pregnancy. The codeine in promethazine / codeine can cause newborns to experience withdrawal symptoms, and this is life-threatening for infants. If you are pregnant, do not take this medication. There are safer alternatives.
LOW BLOOD PRESSURE
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Risk factors: History of certain heart problems
Promethazine / codeine can cause your blood pressure to drop to extremely low levels. This can cause you to pass out or fall. People with certain heart conditions are more likely to experience this side effect. Make sure your provider knows all medical conditions you have before taking promethazine / codeine.
ADDISON’S DISEASE (ADRENAL INSUFFICIENCY)
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Risk factors: Using promethazine / codeine longer than 1 month
Promethazine / codeine can prevent your adrenal glands from releasing normal amounts of your natural stress hormones. Without the right amount of these hormones, your body can’t fight off infections properly. This is called Addison’s disease or adrenal insufficiency. While promethazine / codeine rarely causes this, your risk is higher if you have been taking this medication every day for over a month. Talk to your healthcare provider if you notice unexplained nausea, vomiting, loss of appetite, fatigue, weakness, dizziness, or low blood pressure.
SEIZURES
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Risk factors: History of seizures
If you’ve ever had seizures or if you have seizures conditions like epilepsy, taking promethazine / codeine can cause you to have seizures more often. Make sure your healthcare provider knows if you have a history of seizures before you start taking this medication.
NEUROLEPTIC MALIGNANT SYNDROME
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Risk factors: Taking antipsychotics
Promethazine / codeine can cause a life-threatening condition called Neuroleptic Malignant Syndrome (NMS). This is very rare but needs to treated right away. People who take either typical or atypical antipsychotic medications have a higher risk of this happening. Make sure your provider and pharmacist know all the medications you take before starting promethazine / codeine. Symptoms of NMS include high fever, muscle stiffness, confusion, sweating, and changes in heart rate and blood pressure. If you notice any of these symptoms, seek medical help immediately.
UNCONTROLLABLE BODY MOVEMENTS
Very rarely promethazine / codeine causes uncontrollable movements of your face, tongue, and other body parts. This is called extrapyramidal symptoms (EPS). Symptoms of EPS include tremors, jerky movements of your arms or legs while walking, trouble swallowing or talking, and tongue thrusting. Tell your provider right away if you notice any unusual body movements.
LOW WHITE BLOOD CELL COUNT
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Risk factors: Undergoing certain chemotherapies
Promethazine / codeine can lower the number of white blood cells in your body. These are the cells that fight off infections, and without the right amount, you can get sick easier and have a harder time getting better. This side effect is rare but can be life-threatening. Your risk of this is higher if you have or are using chemotherapy that affects your bone marrow. You might have to have blood tests done if you are regularly taking promethazine / codeine to make sure your white blood cells are at a normal level.
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