Codeine/​Chlorpheniramine/​Phenylephrine

DEA Class; Rx

Common Brand Names; Novahistine DH

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

Chlorpheniramine: Histamine H1-receptor antagonist

Phenylephrine: Alpha-adrenergic stimulator with weak beta-adrenergic activity; produces systemic vasoconstriction of arteries and arterioles.

Codeine

• Hypersensitivity

• Acute abdominal condition, diarrhea associated w/ toxins, pseudomembranous colitis, respiratory depression

• Asthma (acute), inflammatory bowel disease, respiratory impairment

Chlorpheniramine

• Acute asthma, sleep apnea

Phenylephrine

• Hypsesensitivity

• Severe HTN, severe CAD

• Within 14 days of nonselective MAO inhibitor therapy (risk of hypertensive reaction)

• Newborn, 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

Chlorpheniramine

• Anticholinergic

• Somnolence

• Constipation

• Diarrhea

• Nausea

• Vomiting

• Blurred vision

Codeine

• Hypotension, with IV use

• Seizure, with excessive doses

• Anaphylactoid reaction (rare)

• Respiratory depression

Phenylephrine

• Hypertension

• Severe peripheral and visceral vasoconstriction

• Pallor

• Reflex tachycardia

• Anxiety

• Dizziness

• Headache

• Insomnia,Nervousness

• Restlessness

• Metabolic acidosis

• Gastric irritation

• Nausea

• Decreased renal perfusion

• Extravasation of IV administration may lead to necrosis and sloughing of surrounding tissue

• Excitability

Codeine

• Cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder disease, head injury, hepatic impairment, hypothyroidism, increased ICP, prostatic hypertrophy, renal impairment, seizures with 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 CNS depression (patient should not operate heavy machinery

• Caution in patients with asthma, thyroid dysfunction, hypertension, ischemic heart disease, increased intraocular pressure, or prostatic hyperplasia/urinary obstruction

Phenylephrine

• Caution in diabetes mellitus, cardiovascular disease, prostatic hyperplasia, hyperthyroidism, and increased intraocular pressure

Pregnancy category: C

Not known whether distributed in breast milk, use caution