Last week, 30-year-old rapper Lil Wayne was hospitalized after suffering seizures. While details are still…
Sizzurp and Seizures
Sizzurp, also commonly known as purple drank, is an addictive recreational drug concoction typically made with a prescription-strength cough syrup that contains the antihistamine promethazine and the opioid narcotic codeine. The concoction initially saw limited use in the hip-hop music community, and has since gained significant popularity among some fans of this music and in certain other population groups. In early 2013, a prominent celebrity proponent of sizzurp use, known publicly as Lil’ Wayne, experienced repeated bouts of involuntary convulsions, or seizures. Although no one knows for sure why this problem developed in his particular case, sizzurp is known for the seizure-promoting effects of both of its two active ingredients.
Promethazine/codeine syrup has been available on the US market for decades, and doctors usually prescribe it for the relief of cough or sinus problems associated with the presence of allergies, colds or certain other respiratory problems. Its use in sizzurp or purple drank originated in the early 2000s, when people looking for a new type of recreational drug experience began combining the syrup with additives such as non-cola sodas, alcohol, or melted pieces of a popular type of candy called a Jolly Rancher. When used in common street doses, the drug effects of sizzurp include sedation (sleep promotion), an intense form of pleasure known as euphoria, significant changes in mental status, and loss of muscle coordination. People who add alcohol to their sizzurp formulas typically experience additional effects such as heightened euphoria, increased levels of muscle dysfunction, speaking difficulties and an increase in impulsive or unpredictable behavior.
Generally speaking, seizures occur when too many of the brain’s main nerve cells, known as neurons, activate at the same time and “overexcite” the central nervous system. One of the key factors in this overexcitement is an imbalance in the brain levels of two important neurotransmitting chemicals, called glutamate and GABA (gamma-aminobutyric acid). Glutamate acts as the brain’s primary promoter of neuron activity; under the influence of this chemical, neurons communicate with each other more easily and more often. GABA acts as the brain’s main inhibitor of neuron activity; under the influence of this chemical, neurons communicate with each other less easily and less often. According to Columbia University’s Department of Neuroscience, most seizures begin when there’s too much glutamate circulating in the brain. Paradoxically, excessive GABA output can also lead to seizure onset.
Anyone can have a seizure under certain circumstances. A given individual’s likelihood of seizure activity is commonly known as his or her seizure threshold, or balance between the exciting and inhibiting factors in neuron communication. The major influence on a person’s seizure threshold is hereditary; other factors that contribute to the set point of this threshold include age (increased susceptibility in younger people) and the effects of an extremely high fever. Some experts believe that people with the recurring seizure disorder epilepsy have unusually low seizure thresholds; the same scenario may also hold true for people who have isolated seizures.
Effects of Sizzurp
As stated previously, sizzurp’s most common main ingredients are the antihistamine (anti-allergy) medication promethazine and the opioid narcotic cough suppressant and pain reliever codeine. One of the known potential side effects of promethazine use is the promotion of seizure activity; the medication produces this effect by lowering a person’s seizure threshold and increasing the likelihood that the brain will activate too many neurons at once. Codeine use can also lower a person’s seizure threshold in a highly similar way. When used together in promethazine/codeine syrup (or in any other context), these two medications produce additive results; this means that they can trigger worse seizure-related side effects than either one of them would trigger independently.
Doctors usually control the seizure-related risks of promethazine/codeine syrup use by screening their patients and identifying people with histories of epilepsy or isolated seizures. In most cases, they will avoid use of the syrup altogether in individuals who report these histories; in other cases, they may only prescribe the syrup in reduced doses or for limited periods of time. Unfortunately, people who use sizzurp as a recreational drug don’t typically go through any kind of screening process; instead, they use the drug in a setting completely lacking in medical oversight or input. In practical terms, this means that they expose themselves to an unpredictable risk for seizure development. It’s also important to remember that the codeine content of sizzurp makes the drug addictive. For this reason, even people aware of their own specific seizure tendencies, like Lil’ Wayne, may continue their use of the drug even after serious health problems emerge.