Substance Use
Promethazine Use, Abuse, and Related Harms in the United States Saranrat Wittayanukorn Conrad* Saranrat Conrad Henry Appiah Sara Karami Celeste Mallama Sheheryar Muhammad Rajdeep Gill Rose Radin
Background: Promethazine, an antihistamine, is widely used in the U.S. and indicated for several conditions. There have been reports of promethazine-containing products (PP) abuse with/without other substances.
Objectives: To quantify dispensing of selected PP (promethazine single-entity [SE], promethazine-codeine combination [CC], and promethazine combination [CO] products, excluding codeine) and harms associated with their abuse.
Methods: We used the IQVIA U.S. Launch Edition database (2010-2022) to estimate annual prescriptions dispensed for PP from U.S. outpatient retail pharmacies. We examined the frequency and utilization-adjusted rates of poison center (PC) cases and emergency department (ED) visits associated with PP abuse by using the National Poison Data System (2010-2022) and National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (2016-2021).
Results: The estimated total prescriptions dispensed for PP decreased 41% from 20.8 million (M) in 2010 to 12.3M in 2022. Promethazine SE was the most commonly dispensed PP (55%). Overall, PC abuse cases involving PP declined from 2010 (n=232) to 2022 (n=99); 2,383 PC abuse cases involving PP were observed. Promethazine CC had higher utilization-adjusted annual rates of PC abuse cases (18.9-26.1 per 1M prescriptions dispensed) than promethazine SE (10.4-14.7) or promethazine CO (2.4-5.0). Among single-substance PP PC abuse cases, minor effect was the most common medical outcome category. Annual national estimates of ED visits involving promethazine SE (1,772 visits) and promethazine CC abuse (1,411 visits) usually involved additional substances. The annual utilization-adjusted rate of ED visits involving abuse of promethazine CC (93.1) was higher than for promethazine SE (40.6).
Conclusions: Amid declining retail dispensing of PP in the U.S., national PC and ED visit data suggest that PP abuse-related harms are relatively uncommon, declining, and often involve promethazine CC.