Lean is a recreational drug mixture built around prescription cough syrup containing two active ingredients: codeine, an opioid painkiller, and promethazine, a sedating antihistamine. The syrup is mixed with soda and sometimes hard candy to mask its bitter taste. It goes by several other names, including purple drank, sizzurp, and dirty Sprite.
The Core Ingredients
The prescription cough syrup at the center of lean contains 10 mg of codeine and 6.25 mg of promethazine per teaspoon, along with 7% alcohol in a flavored syrup base. Codeine is an opioid that suppresses coughing and produces feelings of relaxation and euphoria at higher doses. Your liver converts codeine into morphine, which is the compound actually responsible for the high.
Promethazine is an antihistamine with strong sedative properties. On its own it causes drowsiness, but when paired with codeine, it increases and prolongs the sedative effects of the opioid. The FDA label states directly that promethazine is “additive to the depressant effects of codeine,” meaning the two drugs amplify each other rather than simply working side by side. This combination is what makes lean feel intensely relaxing, and also what makes it dangerous.
What Gets Mixed In
Because the syrup tastes unpleasant on its own, users pour it into a cup of soda, typically a lemon-lime soft drink like Sprite or a grape-flavored soda. Jolly Rancher hard candies are commonly dissolved in the mixture to add sweetness and color. The purple or pinkish tint of many promethazine-codeine syrups is where the name “purple drank” comes from. The final drink looks and tastes like a sweet, candy-flavored soda, which obscures how much of a drug it actually contains.
How These Ingredients Affect the Body
Codeine and promethazine both slow down the central nervous system, but through different pathways. Codeine activates opioid receptors in the brain, producing pain relief, euphoria, and drowsiness. Promethazine blocks histamine receptors and has anticholinergic effects, adding its own layer of sedation on top of the opioid. Together they create a deep, sluggish calm that users describe as feeling heavy or “leaning,” which is likely the origin of the name.
The real danger of this pairing is respiratory depression. Both codeine and promethazine independently slow breathing, and combining them compounds that risk. At recreational doses, which are well above the prescribed amount, breathing can become dangerously shallow. Adding alcohol, benzodiazepines, or other sedatives to the mix pushes the risk even higher. The FDA warns that promethazine alone “may lead to potentially fatal respiratory depression,” and layering codeine on top narrows the margin between a high and an overdose considerably.
Recreational Doses vs. Medical Doses
A standard prescribed dose of this cough syrup is one teaspoon (5 mL), containing 10 mg of codeine. Recreational users typically pour several ounces of syrup into a cup of soda, consuming many times the therapeutic dose in a single sitting. Because the syrup is diluted in a sweet drink and sipped slowly, it’s easy to lose track of how much codeine has been consumed. The slow sipping also extends the duration of the high, keeping the body under the influence of both drugs for hours.
Long-Term Physical Consequences
Regular lean use carries the same addiction risk as any other opioid. Codeine produces physical dependence, meaning withdrawal symptoms like muscle aches, nausea, anxiety, and insomnia set in when use stops. Tolerance builds quickly, pushing users to drink larger amounts to achieve the same effect, which increases overdose risk over time.
The sugar load from the soda and candy also takes a toll. People who use opioids chronically tend to consume high amounts of sugar and fewer nutritious foods. Combined with dry mouth, a common side effect of both promethazine and opioids, this creates ideal conditions for severe tooth decay and gum disease. Reduced saliva flow means the mouth can’t neutralize acids or wash away sugar the way it normally would, so dental damage accumulates faster than it otherwise would.
The 7% alcohol content in the syrup itself adds another variable. While small in a single teaspoon, the amounts used recreationally deliver a meaningful dose of alcohol alongside the codeine and promethazine, further taxing the liver.
Legal Classification
Under federal law, promethazine-codeine cough syrup is classified as a Schedule V controlled substance, the least restrictive category. Schedule V applies specifically to cough preparations containing no more than 200 mg of codeine per 100 mL. Codeine in other forms, such as pure codeine tablets, is classified under the stricter Schedule II. Products containing up to 90 mg of codeine per dosage unit combined with other non-narcotic ingredients, like Tylenol with Codeine, fall under Schedule III. Despite the relatively low scheduling of the cough syrup, it still requires a prescription, and possessing it without one is illegal.
Over-the-Counter Substitutes
When prescription codeine syrup is unavailable or too expensive, some people make versions of lean using over-the-counter cough medicines containing dextromethorphan (DXM). DXM is not an opioid, but at high doses it produces dissociative and hallucinogenic effects that are quite different from the sedation of codeine. This substitution carries its own set of risks, including rapid heart rate, high blood pressure, and serotonin syndrome when combined with certain other substances. “Fake lean” made with DXM is a fundamentally different drug experience despite looking similar in the cup.