Codeine/Guaifenesin/Pseudoephedrine

DEA Class; Rx

Common Brand Names; Cheratussin DAC, Lortuss EX, Tricode GF, Virtussin DAC

Codeine: Narcotic agonist analgesic with antitussive activity, mu receptor agonist

Guaifenesin: Reduces viscosity of secretions by increasing amount of respiratory tract fluid

Pseudoephedrine: Alpha adrenergic agonist

Codeine

• Children <12 years of age

• Post-operative management in children <18 years following tonsillectomy and/or adenoidectomy

• Patients with significant respiratory depression, acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment

• Concurrent use of monoamine oxidase inhibitors (MAOIs) or use of MAOIs within last 14 days

• Known or suspected gastrointestinal obstruction, including paralytic ileus

Guaifenesin

• Self-medication in chronic or persistent coughs

• Hypersensitivity

Pseudoephedrine

• Hypsesensitivity

• Severe HTN, severe CAD

• Nonselective MAO inhibitors: risk of hypertensive reaction

• Newborns, preemies

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

• Hypotension, With IV use

• Seizure, With excessive doses

• Anaphylactoid reaction (rare)

• Respiratory depression

Guaifensesin

• Headache

• Rash

• Nausea

• Vomiting

Pseudoephedrine

• CNS (tremor, restlessness, etc)

• Insomnia

• Nausea

• Vomiting

Codeine

• Caution in cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder disease, head injury, hepatic impairment, hypothyroidism, increased 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

Guaifenesin

• Often comes in combos, check brand name/other constituents

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 category: C

Lactation: contraindicated in nursing women