Akorn Promethazine Cough Syrup

Name: Akorn Promethazine Cough Syrup
SKU: 309
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Akorn Promethazine Cough Syrup (specifically Promethazine with Codeine Oral Solution) is a prescription-only liquid medication previously manufactured by Akorn Operating Company LLC. It combines an antihistamine (promethazine) with an opioid cough suppressant (codeine).

Because of corporate closures, widespread counterfeiting, and severe health risks, it is critical to understand the current legal status, safety concerns, and risks associated with this drug.

Company Bankruptcy & Total Recall

Permanent Discontinuation & Shutdown: In February 2023, Akorn Pharmaceuticals filed for Chapter 7 bankruptcy, shut down all US operations, and terminated its workforce.
Voluntary Nationwide Recall: In April 2023, Akorn issued a total recall of all within-expiry products—including its promethazine formulations—because the company ceased its quality assurance programs and could no longer guarantee drug purity or safety.
No Legitimate Supply: Official Akorn-branded prescription cough syrup is no longer manufactured or legally distributed in pharmacies.

Critical Danger: Illicit Street Counterfeits

Because legitimate Akorn liquid cough syrup is permanently out of production, any product currently encountered on the street or online under the “Akorn” name is a dangerous counterfeit.

In street culture, promethazine-codeine syrup is frequently abused and mixed with sodas (commonly known as “lean,” “purple drank,” or “dirty sprite”). Due to high black-market demand:

Illicit manufacturers produce fake Akorn bottles and labels filled with unknown, unregulated liquids.
These street mixtures routinely contain lethal doses of synthetic opioids (such as illicit fentanyl or nitazenes), unregulated sedatives (like illicit benzodiazepines), or toxic chemicals.
Consuming counterfeit street syrup carries an extreme risk of immediate, fatal overdose.

Medical Uses & Active Ingredients

When legally prescribed prior to its discontinuation, the combination served two main functions:

Promethazine: A first-generation antihistamine that dries up respiratory secretions and causes heavy sedation.
Codeine: A Schedule V controlled substance (opioid) that acts on the brain’s central nervous system to suppress severe coughing.

Severe Health Risks & Black Box Warnings

Promethazine with codeine carries major safety risks, even when taken under medical supervision:

Fatal Respiratory Depression: Both promethazine and codeine depress the central nervous system. Combined—or taken alongside alcohol, benzodiazepines, or other narcotics—they can slow breathing to the point of brain damage, coma, or death.
Pediatric Black Box Warning: Codeine is strictly contraindicated in children under 12 years of age (and adolescents under 18 following certain surgeries like tonsillectomy) due to the risk of sudden, fatal respiratory arrest.
Addiction & Physical Dependency: Codeine is an addictive opioid. Regular use leads to rapid physical tolerance, addiction, and painful withdrawal symptoms upon stopping.

Safe Medical Guidance

If you are dealing with a severe cough or respiratory infection, consult a healthcare professional. Safe, legal, and effective alternatives—both non-opioid prescription medications (e.g., benzonatate) and over-the-counter options (e.g., dextromethorphan)—are readily available.

If you or someone you know is struggling with substance misuse or opioid dependency, free and confidential support is available 24/7 through the SAMHSA National Helpline at 1-800-662-4357 (in the U.S.).