Guaifenesin and Codeine

Pronunciation

U.S. Brand Names

Brontex®; Cheracol®; Cheratussin AC; Diabetic Tussin C®; Gani-Tuss® NR; Guaifen-C; Guaifenesin AC; Guaituss AC®; Iophen-C NR; Kolephrin® #1; Mytussin® AC; Robafen® AC; Romilar® AC; Tussi-Organidin® NR; Tussi-Organidin® S-NR

Synonyms

Codeine and Guaifenesin

Generic Available

Yes

Use

Temporary control of cough due to minor throat and bronchial irritation

Restrictions

C-V

Pregnancy Risk Factor

Lactation

Excretion in breast milk unknown/use caution

Contraindications

Based on guaifenesin component: Hypersensitivity to guaifenesin or any component of the formulation

Based on codeine component: Hypersensitivity to codeine or any component of the formulation

Warnings/Precautions

Based on guaifenesin component: Not for persistent cough such as occurs with smoking, asthma, or emphysema or cough accompanied by excessive secretions

Based on codeine component: Use with caution in patients with hypersensitivity reactions to other phenanthrene derivative opioid agonists (morphine, hydrocodone, hydromorphone, levorphanol, oxycodone, oxymorphone); respiratory diseases including asthma, emphysema, COPD, or severe liver or renal insufficiency; some preparations contain sulfites which may cause allergic reactions; tolerance or drug dependence may result from extended use

Not recommended for use for cough control in patients with a productive cough; not recommended as an antitussive for children <2 years of age; the elderly may be particularly susceptible to the CNS depressant and confusion as well as constipating effects of narcotics

Adverse Reactions

Based on guaifenesin component:

Central nervous system: Drowsiness, headache

Dermatologic: Rash

Gastrointestinal: Nausea, vomiting, stomach pain

Based on codeine component:

>10%:

Central nervous system: Drowsiness

Gastrointestinal: Constipation

1% to 10%:

Cardiovascular: Tachycardia or bradycardia, hypotension

Central nervous system: Dizziness, lightheadedness, false feeling of well being, malaise, headache, restlessness, paradoxical CNS stimulation, confusion

Dermatologic: Rash, urticaria

Gastrointestinal: Xerostomia, anorexia, nausea, vomiting,

Genitourinary: Decreased urination, ureteral spasm

Hepatic: Increased LFTs

Local: Burning at injection site

Neuromuscular & skeletal: Weakness

Ocular: Blurred vision

Respiratory: Dyspnea

Miscellaneous: Histamine release

<1%: Convulsions, hallucinations, mental depression, nightmares, insomnia, paralytic ileus, biliary spasm, stomach cramps, muscle rigidity, trembling

Percentage unknown: Increased AST, ALT

Drug Interactions

Increased toxicity: CNS depressant medications produce additive sedative properties

Ethanol/Nutrition/Herb Interactions

Ethanol: Avoid or limit ethanol (may increase CNS depression). Watch for sedation.

Mechanism of Action

Guaifenesin is thought to act as an expectorant by irritating the gastric mucosa and stimulating respiratory tract secretions, thereby increasing respiratory fluid volumes and decreasing phlegm viscosity

Codeine is an antitussive that controls cough by depressing the medullary cough center

Pharmacodynamics/Kinetics

See individual agents.

Dosage

Oral:

Children:

2-6 years: 1-1.5 mg/kg codeine/day divided into 4 doses administered every 4-6 hours (maximum: 30 mg/24 hours)

6-12 years: 5 mL every 4 hours, not to exceed 30 mL/24 hours

Children >12 years and Adults: 5-10 mL every 6 hours not to exceed 60 mL/24 hours

Dietary Considerations

Romilar® AC contains phenylalanine. Diabetic Tussin C® contains phenylalanine 0.03 mcg/5 mL. Kolephrin® #1 contains sodium 1.1 mg/5 mL.

Patient Education

See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Nursing Implications

Administer with a large quantity of fluid. The "NR" in Tussi-Organidin® NR means "Newly Reformulated."

Dental Health: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation).

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

Drowsiness is common; may cause confusion, headache, dizziness, lightheadedness, false feeling of well being, restlessness, paradoxical CNS stimulation, or malaise; may rarely cause hallucinations, mental depression, nightmares, or insomnia

Mental Health: Effects on Psychiatric Treatment

Constipation and drowsiness are common, this effect may be additive when used concurrently with psychotropics

Dosage Forms

Liquid:

Brontex®: Guaifenesin 75 mg and codeine phosphate 2.5 mg per 5 mL (480 mL) [alcohol free; strawberry mint flavor]

Diabetic Tussin C®: Guaifenesin 200 mg and codeine phosphate 10 mg per 5 mL (480 mL) [contains phenylalanine 0.03 mcg/5 mL; cherry vanilla flavor]

Gani-Tuss® NR: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (480 mL) [raspberry flavor]

Guaifen-C: Guaifenesin 75 mg and codeine phosphate 2.5 mg per 5 mL (480 mL) [cherry flavor]

Guaifenesin AC: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (120 mL, 480 mL) [alcohol free, sugar free; raspberry flavor]

Iophen-C NR: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (480 mL) [raspberry flavor]

Kolephrin® #1: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (120 mL) [contains sodium 1.1 mg/5 mL and sodium benzoate]

Tussi-Organidin® NR: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (480 mL) [contains sodium benzoate; raspberry flavor]

Tussi-Organidin® S-NR: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (120 mL) [contains sodium benzoate; raspberry flavor]

Syrup:

Cheracol®: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (120 mL) [contains alcohol 4.75% and benzoic acid]

Cheratussin AC: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (120 mL, 240 mL, 480 mL)

Guaituss AC®: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (120 mL, 480 mL) [contains alcohol; sugar free; fruit-mint flavor]

Mytussin® AC: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (120 mL, 480 mL) [contains alcohol; sugar free; fruit flavor]

Robafen AC: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (120 mL, 480 mL)

Romilar® AC: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (480 mL) [contains benzoic acid and phenylalanine; alcohol free, sugar free, dye free; grape flavor]

Tablet (Brontex®): Guaifenesin 300 mg and codeine phosphate 10 mg

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