Dosing & Uses
Dosage Forms & Strengths
codeine/chlorpheniramine/pseudoephedrine
elixir oral: Schedule V
- (10mg/2mg/30mg)/5mL
liquid oral: Schedule V
- (8mg/2mg/30mg)/5mL
Allergic Rhinitis, Cough, Sinus Congestion
10 mL PO q4-6hr, up to 40 mL/24 hr
Dosage Forms & Strengths
codeine/chlorpheniramine/pseudoephedrine
elixir oral: Schedule V
- (10mg/2mg/30mg)/5mL
liquid oral: Schedule V
- (8mg/2mg/30mg)/5mL
Allergic Rhinitis, Cough, Sinus Congestion
<6 years: not recommended
6-12 years: 5 mL PO q4-6hr, up to 20 mL/24 hr
>12 years: 10 mL PO q4-6hr, up to 40 mL/24 hr
Adverse Effects
>10%
Codeine
- Drowsiness
- Constipation
1-10%
Codeine
- Bradycardia, hypotension, tachycardia
- Confusion, dizziness, false feeling of well being, headache, lightheadedness, malaise, paradoxical CNS stimulation, restlessness, weakness
- Rash, urticaria
- Anorexia, nausea, vomiting, xerostomia
- LFT's increased
- Ureteral spasm, urination decreased
- Dyspnea
- Burning at injection site, blurred vision, histamine release
Frequency Not Defined
Chlorpheniramine
- Anticholinergic
- Somnolence
- Constipation
- Diarrhea
- Nausea
- Vomiting
- Blurred vision
Codeine (serious)
- Hypotension, With IV use
- Seizure, With excessive doses
- Anaphylactoid reaction (rare)
- Respiratory depression
Pseudoephedrine
- CNS (tremor, restlessness, etc)
- Insomnia
- Nausea
- Vomiting
Warnings
Contraindications
Codeine
- Absolute: acute abdominal condition, diarrhea associated with toxins, pseudomembranous colitis, respiratory depression
- Relative: asthma (acute), inflammatory bowel disease, respiratory impairment
Chlorpheniramine
- Acute asthma, sleep apnea
Pseudoephedrine
- Hypsesensitivity
- Severe HTN, severe CAD
- Nonselective MAO inhibitors: risk of hypertensive reaction
- Newborns, preemies
Cautions
Codeine
- Cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder dz, head injury, hepatic impairment, hypothyroidism, incr ICP, prostatic hypertrophy, renal impairment, seizures w/ epilepsy, urethral stricture, urinary tract surgery
- Risk of life threatening side effects in nursing babies, especially if mother is an ultra rapid metabolizer of codeine
- Ibuprofen is more effective than codeine for pain from musculoskeletal injuries in children
Chlorpheniramine
- May cause hypotension, with IV use; seizure (with excessive doses), anaphylactoid reactions (rare) or respiratory depression reported
Pseudophedrine
- Mild-mod HTN, cardiac disease, hyperthyroidism, hyperglycemia, BPH, DM, glaucoma
- Many combo formulations are switching to phenylephrine due to restrictions arising from easy conversion to methamphetamine (The Combat Methamphetamine Epidemic Act of 2005 bans OTC sales of cold medicines that contain ingredients commonly used to make methamphetamine such as pseudoephedrine)
- Lactation
Pregnancy & Lactation
Pregnancy category: C
Lactation: codeine, chlorpheniramine and pseudoephedrine excreted in breast milk, use caution
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Codeine
Half-Life: 3-4 hr
Onset: 30-60 min
Metabolism: Inactive but metabolized to morphine by CYP2D6 (missing in 5-10% of population)
Duration: 4-6 hr
Peak Plasma Time: 0.5-1 hr
Protein Bound: 25%
Bioavailability: 53%
Vd: 3-6 L/kg
Excretion: Urine (90%), feces
Chlorpheniramine
Half-Life: 10-13 hr (children); 14-24 hr (adults)
Duration: 24 hr
Onset: 6 hr
Peak Plasma Time: 2-3 hr
Protein Bound: 29-37%
Vd: 4-7 L/kg (children); 6-12 L/kg (adults)
Metabolism: GI mucosa, liver
Metabolites: Monodesmethylchlorpheniramine, didesmethylchlorpheniramine
Excretion: Urine
Sedative effect: Low
Antihistamine activity: Moderate
Anticholinergic acitivity: Moderate
Pseudoephedrine
Half-Life: 3 hr (children); 9-16 hr (adults)
Onset: 30 min (decongestant)
Duration: 3-8 hr
Peak Plasma Time: 1.97 hr
Metabolism: Liver, by N-demethylation
Vd: 2.5 L/kg (children); 2.64-3.51 L/kg
Metabolites: Inactive
Clearance: 7.3-7.6 mL/min/kg
Excretion: Urine (43-96%)
Mechanism of Action
Codeine: Narcotic agonist analgesic with antitussive activity, mu receptor agonist
Chlorpheniramine: Histamine H1-receptor antagonist
Pseudoephedrine: Sympathomimetic; alpha adrenergic agonist
Images
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
