Classes
DEA Class; Rx
Common Brand Names; Dihistine DH, Zodryl DAC Liquid, Ryna-C
- Antitussives, Narcotic Combos
Description
Codeine: Narcotic agonist analgesic with antitussive activity, mu receptor agonist
Chlorpheniramine: Histamine H1-receptor antagonist
Pseudoephedrine: Sympathomimetic; alpha adrenergic agonist
Indications
Indicated for Allergic Rhinitis, Cough, Sinus Congestion
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
Adverse Effects
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
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
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 and Lactation
Pregnancy category: C
Lactation: codeine, chlorpheniramine and pseudoephedrine excreted in breast milk, use caution
Maximum Dosage
10 mL PO q4-6hr, up to 40 mL/24 hr
Pediatric
<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
How supplied
Codeine/chlorpheniramine/pseudoephedrine
elixir oral: Schedule V
- (10mg/2mg/30mg)/5mL
liquid oral: Schedule V
- (8mg/2mg/30mg)/5mL