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Prescription meds are effective and reliable if taken correctly, but they can be dangerous if abused. Recently, pharmaceutical company Actavis decided to pull their very popular prescription-only cough and cold medication, promethazine with codeine syrup, off the market. The discontinuation of this product is due to the popularity of its recreational use.
What is promethazine with codeine syrup actually used to treat?

Promethazine with codeine syrup is indicated for the temporary relief of coughs and upper respiratory tract symptoms related to allergies or the common cold.

What is promethazine used for?

Promethazine is an antihistamine, similar to products available over-the-counter like Benadryl, Claritin, Zyrtec, and Allegra. Antihistamines are typically used to treat the symptoms associated with the allergies and the common cold—they help reduce inflammation and swelling and dry up excess secretions, for example, watery eyes and runny nose. Promethazine is also used to treat pain, nausea and vomiting, motion sickness, and sedation.

What is codeine used for?

Codeine is an opioid analgesic which is typically used to help relieve pain. It is also an antitussive, meaning that it can be used to help relieve coughing.
What are the common side effects of promethazine with codeine?

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Some common side effects associated with promethazine with codeine syrup include: drowsiness, dizziness, headache, lightheadedness, blurred vision, upset stomach, nausea, constipation, increased sweating, and dry mouth.
How is promethazine with codeine being used recreationally?

The syrup is typically being mixed with soft drinks and then consumed as a drink, in much higher quantities than the usual prescribed dose.
What are the common street names for this medication?

The combination is often known by names such as purple drank, lean, sizzurp, syrup, purp, and others.
Do other companies still make this medication?
Yes. There are four other pharmaceutical companies that currently make this medication:
Caraco Pharmaceuticals
Qualitest Products Inc.
Hi Tech Pharmacal Co Inc.
Wockhardt USA Inc.
Currently, no other pharmaceutical companies have stepped up to discontinue or change their current products. Actavis may have started a trend, although currently this is considered unprecedented decision.

If you are allergic to any drugs like this one, any other drugs, foods, or other substances.
Tell your doctor about the allergy and what signs you had,
like rash;
hives;
itching;
shortness of breath;
wheezing;
cough;
swelling of face,
tongue,throat;
or any other signs.

If you have any of these health problems;
Lung or breathing problems like asthma,
trouble breathing, or sleep apnea,
high levels of carbon dioxide in the blood,
stomach or bowel
block or narrowing.
Overdose
If you think there has been an overdose, call your poison control center or get medical care right away.

Be ready to tell or show what was taken, how much, and when it happened.
HOW IS THIS DRUG BEST TAKEN?
Use this drug as ordered by your doctor.
Read all information given to you.
Follow all instructions closely.
drink with or without food.

Take with food if it causes an upset stomach.
Measure liquid doses carefully.
Use the measuring device that comes with this drug.

If there is none, ask the pharmacist for a device to measure this drug.

HOW DO I STORE AND/OR THROW OUT THIS DRUG?

Store at room temperature.
Protect from light.
Store in a dry place.
Do not store in a bathroom.
Always keep all drugs in a safe place.
Keep all drugs out of the reach of children and pets.

Throw away unused or expired drugs.
Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs.

There may be drug take-back programs in your area.

WHAT DO I DO IF I MISS A DOSE?

If you take this drug on a regular basis, take a missed dose as soon as you think about it.
If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
Do not take 2 doses at the same time or extra doses.

Many times this drug is taken on an as needed basis.
Do not take more often than told by the doctor.
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Promethazine/codeine is an inexpensive drug used as a cough suppressant, a decongestant, and an antihistamine. It helps to stop or reduce coughing and congestion. It is more popular than comparable drugs. Promethazine/codeine is only available as a generic drug; all brands have been discontinued. Generic promethazine/codeine is covered by most Medicare and insurance plans, but some pharmacy coupons and cash prices may be lower. The lowest GoodRx price for the most common version of promethazine / codeine is around $7.08, 67% off the average retail price of $22.11.  

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Life-threatening respiratory depression and death have occurred in children who received codeine. Most of the reported cases occurred following tonsillectomy and/or adenoidectomy, and many of the children had evidence of being an ultra-rapid metabolizer of codeine due to a CYP2D6 polymorphism. Promethazine hydrochloride and codeine phosphate oral solution is contraindicated in children younger than 12 years of age and in children younger than 18 years of age following tonsillectomy and/or adenoidectomy. Avoid the use of promethazine hydrochloride and codeine phosphate oral solution in adolescents 12 to 18 years of age who have other risk factors that may increase their sensitivity to the respiratory depressant effects of codeine.Postmarketing cases of respiratory depression, including fatalities have been reported with use of promethazine in pediatric patients. Children may be particularly sensitive to the additive respiratory depressant effects when promethazine is combined with other respiratory depressants, including codeine.Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Avoid use of opioid cough medications in patients taking benzodiazepines, other CNS depressants, or alcohol
Oral route (Syrup)
Promethazine and codeine use is contraindicated in pediatric patients younger than 6 years. Concomitant use of promethazine products with other respiratory depressants has an association with respiratory depression, and sometimes death, in pediatric patients. Postmarketing cases of respiratory depression, including fatalities, have been reported with a wide range of weight-based promethazine doses in pediatric patients younger than 2 years. Respiratory depression and death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultrarapid metabolizers of codeine due to CYP2D6 polymorphism. Concomitant use of opioids and benzodiazepines may result in profound sedation, respiratory depression, coma, and death. Avoid use of opioid cough medications in patients taking benzodiazepines, other CNS depressants, or alcohol .
Overview
Promethazine and codeine combination is used to relieve cough, runny or stuffy nose, sneezing, or other symptoms caused by allergies or the common cold.

Promethazine is an antihistamine. It works by preventing the effects of a substance called histamine, which is produced by the body. Histamine can cause itching, sneezing, runny nose, and watery eyes. It can sometimes close up the bronchial tubes (air passages of the lungs) and make breathing difficult. Codeine belongs to the group of medicine called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain.      
                                           
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This medicine is available only with your doctor's prescription.
Proper Use
Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. If too much of this medicine is taken for a long time, it may become habit-forming and cause mental or physical    dependence.                                        https://lilcentglobalmedicalpharmacy.com
                                                        This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.            
Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.
Dosing
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.                                        https://www.lilcentglobalmedicalpharmacy.com/       
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For relief of symptoms caused by allergies or the common cold:
For oral dosage form (solution):
Adults and children 12 years of age and older—5 milliliters (mL) (1 teaspoonful) every 4 to 6 hours. Do not take more than 30 mL in 24 hours.
Children younger than 12 years of age—Use is not recommended.
For oral dosage form (syrup):
Adults and children 12 years of age and older—5 milliliters (mL) (1 teaspoonful) every 4 to 6 hours. Do not take more than 30 mL in 24 hours.
Children 6 to 11 years of age—2.5 to 5 mL (0.5 to 1 teaspoonful) every 4 to 6 hours. Do not take more than 30 mL in 24 hours.
Children younger than 6 years of age—Use is not recommended.                                                                          https://www.cosmospharmacy.org/product/buy-hitech-cough-syrup-online/                                           
Missed Dose
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Use & StorageTOP
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Before Using
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.                                                                    https://www.lilcentglobalmedicalpharmacy.com/         
Pediatric
Use of promethazine and codeine combination is not recommended in children younger than 6 years of age for syrup or in children younger than 12 years of age for oral solution, because of the increased risk of respiratory depression.                                    https://www.drrooneypharmacy.com/product/buy-wockhardt-cough-syrup-online/                                   
Promethazine and codeine combination should not be used to relieve pain after surgery to remove tonsils or adenoids in any children. Severe breathing problems and deaths have been reported in some children who received codeine after tonsil or adenoid surgery.
Geriatric
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of promethazine and codeine combination in the elderly. However, elderly patients are more likely to have unwanted effects (eg, confusion, drowsiness) and age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving this medicine.                                                             https://www.lilcentglobalmedicalpharmacy.com/             
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