Promazine (Sparine): How This Phenothiazine Works, Why Sparine Was Discontinued, and What Telehealth Can Still Do

Last updated: August 24, 2026

Promazine is a first-generation phenothiazine. The historic U.S. brand is Sparine. It sits in the same chemical family as chlorpromazine, but clinicians historically treated it as a weaker antipsychotic. People still search “promazine 25 mg,” “promazine side effects,” and “Sparine” after seeing an old bottle, a family chart, or a paper from another country.

In the United States, Sparine oral products on the original Wyeth Ayerst application are listed as discontinued. DrugBank states promazine is not currently approved for use in the United States. That is the first fact to settle before anyone tries to refill it through a telehealth visit.

This guide covers what promazine is, what it was used for, why liquid formulations still appear in overseas literature, and which parts of agitation or psychosis care a licensed telehealth clinician can still handle. It is educational. It is not a diagnosis, a refill promise, or a claim that any insurance plan will pay for a specific medicine.

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What is promazine?

According to DrugBank (DB00420), promazine is a phenothiazine used to manage schizophrenia. The same monograph describes actions similar to chlorpromazine but with less antipsychotic activity. Historic uses included short-term treatment of disturbed behavior and use as an antiemetic.

Drugs@FDA NDA 010942 lists SPARINE (promazine hydrochloride) products from Wyeth Ayerst:

• 30 mg/mL oral concentrate, discontinued
• 10 mg/5 mL oral syrup, discontinued
• 100 mg/mL oral concentrate, discontinued

The original approval action on that application is dated November 12, 1957. Labels are not posted on that Drugs@FDA overview page. Marketing status for those listed strengths is Discontinued. There is no TE code and they are not marked as reference listed drugs on that table.

A 2024 review in Drugs in Context (Matrone et al., PMC11610565) still discusses liquid promazine for psychomotor agitation in settings where the syrup remains available. That paper is European-clinic authorship. It does not put a current U.S. retail product back on the market.

Do not confuse promazine with promethazine (Phenergan). Promethazine is a different phenothiazine used mainly for allergy, nausea, and sedation. MedlinePlus and DailyMed pages for promethazine do not describe Sparine.

What was promazine used for?

DrugBank’s summary: schizophrenia management, short-term disturbed behavior, and antiemetic use, with weaker antipsychotic activity than chlorpromazine.

Matrone and colleagues describe promazine as an aliphatic phenothiazine first-generation antipsychotic used for psychomotor agitation, aggressive behavior, schizophrenia, and other psychotic disorders in jurisdictions where it is still marketed. Their Table of liquid antipsychotics lists promazine oral syrup at 25 mg/5 mL and 50 mg/5 mL as an adjunct for short-term moderate-to-severe psychomotor agitation, and for agitation and restlessness in older patients, in those markets.

The same review cites mid-20th-century hospital series (Azima and Durost; Graffeo’s three-year Sparine series in 180 chronically psychotic inpatients) that reported improvement in agitation with fewer extrapyramidal reactions than chlorpromazine in those older datasets. Those papers are historical. They are not a modern FDA label and they are not a reason to restart a discontinued U.S. product at home.

If you or a family member still have leftover Sparine, do not take it to “see if it still works.” Expired phenothiazines, unknown storage, and no current U.S. labeling are a safety problem, not a shortcut.

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How was promazine taken?

There is no current U.S. DailyMed professional label to quote milligram-by-milligram the way we can for live products. What we can say from retrieved sources:

• Historic U.S. Sparine forms on NDA 010942 were oral syrup and oral concentrates (10 mg/5 mL syrup; 30 mg/mL and 100 mg/mL concentrates).
• Search volume still clusters on “promazine 25 mg” and “25mg promazine.” The 2024 liquid-antipsychotic review describes a 25 mg/5 mL syrup in markets that still sell it. That is not proof a 25 mg U.S. tablet is still marketed.
• Matrone et al. report oral peak plasma concentrations about 2 to 4 hours after a dose, extensive hepatic metabolism, and urinary excretion of metabolites.
• The same review notes withdrawal symptoms after abrupt stop and recommends a gradual taper over 3 to 4 weeks when a person is actually taking the drug under a clinician.

A U.S. telehealth visit cannot legally “transfer” a discontinued Sparine prescription the way it can continue many current oral antipsychotics. The useful visit is a new evaluation: what symptoms remain, what else is on the med list, and which currently marketed options fit.

What side effects and class risks matter?

Matrone et al. describe promazine as generally better tolerated for extrapyramidal symptoms than chlorpromazine in the older comparative series they cite (they quote 4% EPS with chlorpromazine vs 0% with promazine in one historic comparison). They still list drowsiness, dry mouth, constipation, and interaction risk, especially in older adults with other conditions.

They also note a lower propensity for hyperprolactinemia relative to some other first-generation agents, and they flag use in dementia-care units as a real-world pattern, not as an endorsement. Antipsychotics as a class carry a well-known dementia-related mortality warning on currently marketed U.S. labels. Promazine does not get a free pass because Sparine left the U.S. market.

LiverTox on chlorpromazine (updated October 5, 2017) is the closest phenothiazine liver monograph we retrieved. Chlorpromazine can cause mild enzyme rises and is a classic cause of acute cholestatic injury (estimated about 1 in 500 exposed in the historic literature). LiverTox states most other phenothiazines used for psychosis have also been implicated in similar cholestatic jaundice. Promazine is in that chemical class. That is a class caution, not a promazine-specific incidence rate from a dedicated LiverTox chapter.

Other phenothiazine-class problems people should know before they hunt an old bottle:

• Sedation, low blood pressure on standing, dry mouth, constipation, blurred vision
• Movement effects: acute dystonia, parkinsonism, akathisia, tardive dyskinesia with longer exposure
• Rare neuroleptic malignant syndrome
• Sun sensitivity and impaired heat regulation
• Additive effects with alcohol and other CNS depressants

If someone is in crisis, call or text 988. If there is a medical emergency (high fever with rigidity, collapse, uncontrolled vomiting), use 911.

Why is Sparine gone in the United States?

Drugs@FDA lists the Sparine oral products on NDA 010942 as discontinued. DrugBank states promazine is currently not approved for use in the United States. PubChem’s compound record (CID 4926) quotes older secondary language that Sparine became obsolete because of weak antipsychotic action and a higher burden of adverse effects relative to better options. We did not retrieve a single FDA “withdrawal for safety” letter in this run; discontinued marketing status is what the official table shows.

Newer antipsychotics and remaining first-generation options (haloperidol, chlorpromazine, fluphenazine, perphenazine, and others that still have U.S. labels) replaced day-to-day use. Searching “promazine side effects” often mixes leftover U.S. interest with current use in other countries.

When is telehealth enough?

HHS telehealth policy (last updated February 5, 2026) keeps broad Medicare flexibilities for behavioral health: patients can receive behavioral/mental telehealth in the home, without geographic originating-site limits, including audio-only when video is not possible. An in-person visit within six months of an initial Medicare behavioral telehealth service is not required through December 31, 2027.

What a Klarity-style visit can usually do:

• Take a history of agitation, anxiety, psychosis, or insomnia and screen for safety
• Review old Sparine or “25 mg promazine” records so nobody restarts a dead product by accident
• Discuss currently marketed options when a medicine is appropriate
• Coordinate labs or an in-person exam when movement symptoms, fever, jaundice, or cardiac symptoms need a room visit

What telehealth cannot do: ship discontinued Sparine, treat acute psychomotor agitation that needs a hospital or injection bay, or promise that a plan will pay for any named drug. Coverage varies by plan. Verify benefits before you book if cost is the deciding factor.

Klarity’s network includes 2,000+ licensed providers. Care is for people who may qualify after a clinical evaluation, not a cart checkout.

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Promazine vs chlorpromazine vs promethazine

People mix these three names constantly.

• Promazine (Sparine): aliphatic phenothiazine antipsychotic/agitation agent. U.S. Sparine oral NDA products discontinued. Not a current U.S. first-line option.
• Chlorpromazine (Thorazine): the prototype phenothiazine. Still discussed and still has a U.S. clinical footprint. LiverTox calls it a well-known cause of cholestatic injury. See Klarity’s chlorpromazine pillar if you need that drug specifically.
• Promethazine (Phenergan): a different phenothiazine used for allergy, nausea, and sedation. Not an antipsychotic substitute for Sparine.

Frequently asked questions

Is promazine the same as Sparine?

Sparine is the historic brand. The active ingredient is promazine hydrochloride. Drugs@FDA lists those Sparine oral presentations as discontinued.

Can I get promazine 25 mg online in the U.S.?

Do not expect a U.S. telehealth clinician to prescribe a product that DrugBank lists as not currently approved here and that FDA lists as discontinued on the Sparine NDA. Ask about currently marketed treatments for the actual symptom: agitation, psychosis, anxiety, or nausea.

Is promazine a controlled substance?

Phenothiazine antipsychotics are not scheduled the way stimulants or benzodiazepines are. Discontinuation and approval status still block a routine U.S. e-prescription.

What should I do with leftover Sparine?

Do not take it. Ask a pharmacist about take-back. Then book an evaluation if symptoms are still active.

The bottom line

Promazine is a first-generation phenothiazine. Sparine was the U.S. brand. Oral Sparine products on NDA 010942 are discontinued, and DrugBank states the molecule is not currently approved for U.S. use. Liquid promazine still appears in overseas agitation literature. If an old chart or a 25 mg search brought you here, the next step is a current evaluation, not a hunt for Sparine.

Insurance coverage for visits and any replacement medicine may vary by plan. Confirm benefits before you rely on a specific copay.

See if you may qualify for online mental health care →

This article is for education. It does not diagnose, treat, or replace a licensed clinician. If you are in crisis, call or text 988. For a medical emergency, call 911.