Skip to content

Codeine/Guaifenesin/Pseudoephedrine

    Brands

    DEA Class; Rx

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

    • Antitussives, Narcotic Combos

    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

    Temporary relief of nasal congestion and cough associated with respiratory tract infections and related conditions, such as sinusitis, pharyngitis, bronchitis, and asthma, when these conditions are complicated by tenacious mucus or mucus plugs and congestion

    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

    Adults

    5-10 mL PO q6-8hr, up to 40 mL/24 hr

    Pediatric

    <12 years: Contraindicated

    ≥12 years: As adults; 5 mL-10 mL PO q6-8hr, up to 40 mL/24 hr

    Codeine/guaifenesin/pseudoephedrine

    oral liquid: Schedule V

    • (8mg/200mg/30mg)/5mL (Tricode GF)
    • (10mg/100mg/30mg)/5mL (Cheratussin DAC, Lortuss EX, Virtussin DAC)