Codeine/Pseudoephedrine

DEA Class;  Rx

Common Brand Names; Notuss-DC

Indicated for the treatment of Congestion with Cough

Codeine

• Hypsesensitivity

• Absolute: acute abdominal condition, diarrhea associated with toxins, pseudomembranous colitis, respiratory depression

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

Pseudoephedrine

• Hypsesensitivity

• Severe HTN, severe CAD

• Nonselective MAO inhibitors: risk of hypertensive reaction

• Newborns, preemies

Codeine

• Drowsiness
• Constipation
• 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
• Blurred vision, histamine release
• Hypotension, With IV use
• Seizure, With excessive doses
• Anaphylactoid reaction (rare)
• Respiratory depression

Pseudoephedrine

• Insomnia
• Restlessness
• Tremor
• Nausea
• Vomiting

Codeine

• Caution in cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder dz, 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

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: codeine and pseudoephedrine excreted in breast milk, use caution

Codeine/pseudoephedrine

oral liquid: Schedule V

• (10mg/30mg)/5mL
• (8mg/30mg)5mL