Is there a cough medicine that contains Phenergan (promethazine) without codeine?

Promethazine-Only Cough Preparations Without Codeine

Promethazine alone is not recommended or effective for cough suppression and should not be used as a cough medicine. 1, 2

Why Promethazine Is Not Appropriate for Cough

• Promethazine has no established efficacy for cough suppression according to the American College of Physicians, and is primarily indicated for nausea, allergic conditions, and sedation—not cough management 1

• The British Thoracic Society explicitly recommends against using promethazine for cough management, as it is not indicated for this purpose 1

• The FDA-approved indications for promethazine tablets include antihistaminic effects, antiemetic properties, and sedation, but cough suppression is not among the approved uses 3

What You Should Use Instead

First-Line Recommendation: Dextromethorphan Alone

• Dextromethorphan is the recommended first-line antitussive agent due to its superior safety profile compared to opioid alternatives 1

• Optimal dosing is 30-60 mg (not the standard over-the-counter 15 mg dose, which is often subtherapeutic), with maximum cough reflex suppression occurring at 60 mg 1, 2

• Maximum daily dose should not exceed 120 mg 1

When Promethazine Might Be Added (But Not Alone)

• First-generation sedative antihistamines like promethazine can be added specifically for nocturnal cough due to their sedative properties, but only as an adjunct to an actual antitussive like dextromethorphan—not as monotherapy 1, 2

• This combination approach (dextromethorphan + promethazine) may be appropriate when nighttime cough is disrupting sleep 2

Alternative Non-Pharmacological Options

• Simple home remedies like honey and lemon may be as effective as pharmacological treatments for benign viral cough and should be considered first 1, 2

• Menthol inhalation provides acute but short-lived cough suppression and can be used for quick relief 1

Important Safety Concerns with Promethazine

• Promethazine has been associated with significant sedation, agitation, hallucinations, seizures, and dystonic reactions 4

• Promethazine has documented misuse/abuse potential, particularly in adolescents, with European data showing 557 cases of abuse/misuse/dependence-related adverse reactions, including 310 fatalities (55.6%) 5

• The abuse potential is especially concerning when promethazine is combined with opioids 5

Clinical Algorithm for Cough Management

1. Start with non-pharmacological approaches: honey and lemon mixtures 1, 2

2. If pharmacological treatment needed: Use dextromethorphan 30-60 mg (not promethazine alone) 1, 2

3. For nocturnal cough disrupting sleep: Consider adding a first-generation antihistamine like promethazine to dextromethorphan 2

4. Avoid codeine-containing products: They have no greater efficacy than dextromethorphan but significantly more adverse effects including drowsiness, nausea, constipation, and physical dependence 1, 2

Common Pitfall to Avoid

Do not prescribe or recommend promethazine as a standalone cough medicine—it lacks efficacy for this indication and carries unnecessary risks. If a patient specifically requests "Phenergan for cough," educate them that dextromethorphan is the appropriate antitussive agent. 1, 2