Promethazine is an antihistamine available in pharmacies across the UK. Due to its sedative properties, promethazine is commonly used as a sleeping aid product, however, it can also be used as an antihistamine for the treatment of allergic conditions including allergic rhinitis, skin itchiness and to help with mild anaphylactic reactions. In today’s post, I will discuss the availability of promethazine cough syrup. Can you get promethazine cough syrup?
What is promethazine?
Promethazine belongs to a group of drugs called antihistamines. Promethazine is a first-generation antihistamine, also called an older-generation antihistamine. This group of antihistamines produce drowsiness and causes sedation. The main mechanism of action of promethazine is ‘blocking’ histamine receptors in the body, hence acting as an antihistamine. Promethazine and other first-generation antihistamines can cross the blood-brain barrier, where they act on type H1 histamine receptors producing sedation. You can learn more about promethazine alternative drugs in a related post.
The legal classification of promethazine
Promethazine is classified as pharmacy-only medicine (P)), which means it can only be purchased from pharmacies including online chemists. Additionally, P-medicines are kept away from the public, usually behind a pharmacy counter.
Can promethazine suppress cough?
Some studies suggest that H1 receptors in the brain (see above) may promote the production of cough (Bolser, 2007). Limited studies support the effectiveness of first-generation antihistamines in the treatment of coughs due to a common cold. On the other hand, some studies strongly support the effectiveness of older-generation antihistamines like promethazine in patients with symptoms of chronic cough (ibid).
Can you buy promethazine cough syrup?
Promethazine cough syrup does not exist in the UK. Promethazine is available as Phenergan Elixir (liquid syrup containing promethazine), which is licensed for the management of allergic conditions. More details in the latter part of this post.
Promethazine however is included in some liquid syrups, which are used to relieve symptoms of colds and influenza at night, alongside other active ingredients, which together help to manage coughs. Cold and flu liquid products available in the UK contain promethazine including:
- Night Nurse Liquid
- Fedril Night Cold and Flu
- Boots Night Cold and Flu Relief Oral Solution
- LloydsPharmacy Night Cold and Flu Relief Oral Solution
- Numark Night Cold and Flu Oral Solution
Promethazine cough syrup: where to get combination medicines containing promethazine?
All products listed above are licensed as pharmacy-only medicines ‘P’. P products can only be purchased from a pharmacy, including online pharmacies. Pharmacy-only medicines are not available to the public for self-selection and usually are kept behind the pharmacy counter.
Night Nurse liquid as promethazine cough syrup
Nigh Nurse liquid is probably the most known and one of the most popular cold and flu product. The active ingredients contained in Night Nurse product include:
- dextromethorphan hydrobromide (15mg / 20ml)
- paracetamol (1000 mg / 20ml)
- promethazine hydrochloride (20 mg / 20ml)
Night Nurse is licensed for the symptomatic management of cold and flu symptoms at night. Nigh Nurse liquid can be used by adults and children over 16 years of age.
Dextromethorphan is a medication commonly added to over the counter cough and cold products. Dextromethorphan is related to morphine; however, it does not have analgesic (pain-reducing) and addictive properties. Overall, there are conflicting results in terms of the effectiveness of dextromethorphan in reducing coughs with many studies and reviews describing the lack of efficacy of this drug (Paul et al, 2007).
Paracetamol is added in the formulation of Night Nurse to help with fever (reduce body temperature), pain and headaches.
Promethazine plays the role of a sedative agent to help with sleep.
How much promethazine is contained in Nigh Nurse liquid?
Each 20ml of Nigh Nurse contains 20mg of promethazine.
Nigh Nurse liquid other restrictions
Patients are advised to read the product information leaflet for more details about Nigh Nurse liquid paying attention to contra-indications (for example patients with a high risk of developing respiratory failure: COPD, pneumonia, acute or exacerbated asthma) and interaction with other medicines. Alternatively, speak to the pharmacist before buying Nigh Nurse.
Alternatives to Night Nurse (syrups containing promethazine)
All products listed below contain promethazine and are produced by the same company (Pinewood Laboratories Ltd), despite having a different name:
- Fedril Nigh Cold and Flu oral solution
- Boots Night Cold and Flu Relief Oral Solution (Boots Pharmacy)
- Lloyds Pharmacy Night Cold and Flu Relief Oral Solution (Lloyds Pharmacy)
- Numark Night Cold and Flu, Oral Solution (chain of independent pharmacies)
The licensed use, restrictions on the sale, and composition for all the above preparations are the same and equivalent to Night Nurse liquid. Active ingredients found in the above products:
- dextromethorphan hydrobromide
- promethazine hydrochloride
The above products can be used to relieve symptoms of colds and influenza including chills, shivers, headaches, sore throats, tickly coughs runny nose and pains in adults and children over 16 years of age.
How much promethazine is included in cold and flu solutions containing this drug?
Fedril, Boots, Lloyds, and Numark’s Night Cold and Flu Oral solution contain 20mg of promethazine per 20mL of the solution, the same amount as the Nigh Nurse oral solution.
Is Phenergan Elixir a promethazine cough syrup?
The only other liquid preparation in the UK which contains promethazine is Phenergan Elixir. Phenergan Elixir is not licensed as cough syrup and should not be used as one.
What is Phenergan Elixir used for?
Phenergan Elixir is a sedative oral antihistamine, licensed for the management of allergic conditions of the upper respiratory tract including a runny nose and allergies affecting the skin and anaphylactic reactions to drugs and other compounds. It is also licensed as an antiemetic drug (to stop nausea) and short-term treatment of insomnia.
The dose depends on the age and indicated use. Please refer to the product information leaflet for more details.
How much promethazine is included in Phenergan Elixir?
Phenergan Elixir contains 5mg/5ml of promethazine, which equals to 20mg/20ml, a similar amount as previously discussed cold and flu products containing promethazine.
Phenergan Elixir age restrictions
Phenergan oral solution is licensed for adults and children over 2 years of age.
Promethazine cough syrup: conclusion
Promethazine cough syrup is not available on in the UK. Cold and flu products containing promethazine and other ingredients including cough suppressants exist. Night Nurse is one well-known example. Promethazine can be purchased as a drug on its own, in the form of syrup and tablets. Promethazine is used mainly for the management of allergies and as a sleeping aid medication. Patients who wish to manage coughs have a choice of different products available from pharmacies and supermarkets. The main products used in the management of coughs include the following drugs:
- dextromethorphan for treatment of dry coughs, available in liquid formulations, for example, Benylin Dry cough, Covonia Original Bronchial Balsam Syrup
- pholcodine for the treatment of dry coughs, available in liquid forms or capsules (Day Nurse)
- guaifenesin for the treatment of chesty coughs
- diphenhydramine hydrochloride (another sedative antihistamine) in combination with levomenthol (for example Benylin Dry Coughs Night Syrup) or dextromethorphan (for example Covonia Night Time Formula)
- herbal preparation containing marshmallow root extract and thyme herb extract (Buttercup Bronchostop Cough Syrup)
Bolser DC (2007). Older-generation antihistamines and cough due to upper airway cough syndrome (UACS): efficacy and mechanism. Lung. 2008;186 Suppl 1(Suppl 1):S74-7. doi: 10.1007/s00408-007-9033-y. Epub 2007 Oct 2. PMID: 17909896; PMCID: PMC3131005. Available at: https://doi.org/10.1007%2Fs00408-007-9033-y Accessed on 54/10/2022
Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM. Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents. Arch Pediatr Adolesc Med. 2007;161(12):1140–1146. doi:10.1001/archpedi.161.12.1140 Available at: https://doi.org/10.1001/archpedi.161.12.1140 Accessed on 15/10/2022
eMC (2022). Dosage instructions, age restrictions and indications reference: The electronic medicines compendium (eMC). Available at https://www.medicines.org.uk Accessed on 15/10/2022