Chronic promethazine misuse and the possibility of dependence: a brief review of antihistamine abuse and dependence

Parker, Stephen; Gioannis, Angelo De; Page, Colin B.

doi:10.3109/14659891.2012.707285

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…Consistent with previous observations ( Agnich et al, 2013 ; Burns and Boyer, 2013 ; Carr, 2006 ; Elwood, 2001 ; Höjer and Tellerup, 2018 ; NIDA, 2014 ; Page et al, 2009 ; Parker et al, 2013 ; Peters et al, 2007 ), most recorded ADRs related here to either ‘drug abuse’ and ‘intentional product misuse’, involving young adult (19–25 years) males. Although considered a vulnerable category with respect to prescription drug abuse ( Agnich et al, 2013 ; Burns and Boyer, 2013 ; Cherian et al, 2018 ; NIDA, 2014 ; Peters et al, 2007 ), adolescents (10–18 years) were here reported in only a minority (23/1543:1.5%) of cases.…”

Section: Discussionsupporting

confidence: 89%

“…data on worldwide promethazine prescriptions) are not available, it was unclear if what observed was a substantial number of cases, indicative of clinically meaningful abuse potential, or a passing trend for promethazine misuse by a very small number of individuals. However, consistent with previous suggestions (Montastruc et al, 2011), the value of the current study was that its rationale was driven by a proper, detailed, Tellerup, 2018;NIDA, 2014;Page et al, 2009;Parker et al, 2013;Peters et al, 2007), most recorded ADRs related here to either 'drug abuse' and 'intentional product misuse', involving young adult (19-25 years) males. Although considered a vulnerable category with respect to prescription drug abuse (Agnich et al, 2013;Burns and Boyer, 2013;Cherian et al, 2018;NIDA, 2014;Peters et al, 2007), adolescents (10-18 years) were here reported in only a minority (23/1543:1.5%) of cases.…”

Section: Limitationssupporting

confidence: 76%

“…A multicomponent approach is recommended, including monitoring drug utilisation, tracking users’ posts on social media, and exploring healthcare databases; this will enable performing proactive and effective post-marketing surveillance and pharmacovigilance approaches. This has proved to be a relevant, efficient and accurate strategy, for example with gabapentinoids, which have recently been rescheduled in the UK ( Borg et al, 2011 ; Eickhoff et al, 2012 ; Jouanjus et al, 2019 ; Novak et al, 2016 ; Parker et al, 2013 ; Schifano and Chiappini, 2019 ; Throckmorton et al, 2018 ). In this context, the role of the Web is rapidly spreading, playing a significant role in the marketing, sale and distribution of drugs, hence facilitating continuous changes in drug scenarios ( Orsolini et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

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Beyond the ‘purple drank’: Study of promethazine abuse according to the European Medicines Agency adverse drug reaction reports

et al. 2021

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Background: Promethazine is a medicinal product, available on its own or in combination with other ingredients including dextromethorphan, paracetamol and/or expectorants. Anecdotal reports have however indicated that promethazine may have a misuse potential, especially in adolescents. Objective: We here aimed at studying how this phenomenon has been reported to the European Monitoring Agency Adverse Drug Reactions database. Methods: After a formal request to the European Monitoring Agency, the promethazine-specific dataset has been studied, performing a descriptive analysis of misuse/abuse/dependence-related adverse drug reaction reports. The study was approved by the University of Hertfordshire (LMS/PGR/UH/03234). Results: The analysis of promethazine data showed increasing levels of misuse/abuse/ dependence issues over time (2003–2019). Out of a total number of 1543 cases of adverse drug reactions, the abuse/misuse/dependence-related cases reported were 557, with ‘drug abuse’ (300/557: 53.8%) and ‘intentional product misuse’ (117/557: 21.0%). being the most represented adverse drug reactions. A high number of fatalities were described (310/557: 55.6%), mostly recorded as ‘drug toxicity/drug abuse’ cases, with opiates/opioids having been the most commonly reported concomitant drugs used. Conclusion: Anecdotal promethazine misuse/abuse reports have been confirmed by European Monitoring Agency data. Promethazine misuse/abuse appears to be an alarming issue, being associated with drug-related fatalities. Thus, healthcare professionals should be warned about a possible misuse of promethazine and be vigilant, as in some countries medicinal products containing promethazine can be purchased over the counter. Since promethazine is often available in association with opioids, its abuse may be considered a public health issue, with huge implications for clinical practice.

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Section: Discussionsupporting

confidence: 89%

Section: Limitationssupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Beyond the ‘purple drank’: Study of promethazine abuse according to the European Medicines Agency adverse drug reaction reports

et al. 2021

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“…The concoction is probably named after the color of the syrup’s dye and pursued in order to achieve euphoric and relaxing sensations [ 6 , 61 ]. Arrhythmia (manifesting as a prolongation of the QT interval in electrocardiogram), delirium, psychoses, substance dependence, and withdrawal syndrome are some of the known consequences of its misuse, as well as tardive dyskinesia resulting from the antagonism of D 2 dopaminergic receptors [ 62 ].…”

Section: Resultsmentioning

confidence: 99%

Pharmacological Aspects of Over-the-Counter Opioid Drugs Misuse

Sobczak

Goryński

2020

Molecules

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Several over-the-counter (OTC) drugs are known to be misused. Among them are opioids such as codeine, dihydrocodeine, and loperamide. This work elucidates their pharmacology, interactions, safety profiles, and how pharmacology is being manipulated to misuse these common medications, with the aim to expand on the subject outlined by the authors focusing on abuse prevention and prevalence rates. The reviewed literature was identified in several online databases through searches conducted with phrases created by combining the international non-proprietary names of the drugs with terms related to drug misuse. The results show that OTC opioids are misused as an alternative for illicit narcotics, or prescription-only opioids. The potency of codeine and loperamide is strongly dependent on the individual enzymatic activity of CYP2D6 and CYP3A4, as well as P-glycoprotein function. Codeine can also be utilized as a substrate for clandestine syntheses of more potent drugs of abuse, namely desomorphine (“Krokodil”), and morphine. The dangerous methods used to prepare these substances can result in poisoning from toxic chemicals and impurities originating from the synthesis procedure. OTC opioids are generally safe when consumed in accordance with medical guidelines. However, the intake of supratherapeutic amounts of these substances may reveal surprising traits of common medications.

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Promethazine abuse

2013

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Chronic promethazine misuse and the possibility of dependence: a brief review of antihistamine abuse and dependence

Cited by 5 publications

References 14 publications

Beyond the ‘purple drank’: Study of promethazine abuse according to the European Medicines Agency adverse drug reaction reports

Beyond the ‘purple drank’: Study of promethazine abuse according to the European Medicines Agency adverse drug reaction reports

Pharmacological Aspects of Over-the-Counter Opioid Drugs Misuse

Promethazine abuse

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