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Codeine/Triprolidine/Pseudoephedrine

    No Brand

    DEA Class;  Rx

    Common Brand Names; Zyrtec D

    • Antitussives, Narcotic Combos

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

    Triprolidine: First generation antihistamine, proplamine-derivative

    Pseudoephedrine: Alpha adrenergic agonist

    Indicated for the treatment of Allergic Rhinitis, Cough, Sinus Congestion

    Codeine

    • Absolute: acute abdominal condition, diarrhea associated w/ 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

    Triprolidine

    • Hypersensitivity, acute asthma, sleep apnea

    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

    • Burning at injection site, blurred vision, histamine release

    • Hypotension, With IV use

    • Seizure, With excessive doses

    • Anaphylactoid reaction (rare)

    • Respiratory depression

    Pseudoephedrine

    • CNS (tremor, restlessness, etc)

    • Insomnia

    • Nausea

    • Vomiting

    Triprolidine

    • Anti-cholinergic

    • Dizziness

    • Drowsiness

    Do not use more than directed

    Adrenergic agent, pseudoephedrine, component may cause arrhythmias, dizziness, insomnia, tremor, weakness

    May cause sedation; caution with tasks requiring cognitive abilities (eg, driving, operating machinery)

    Alcohol may exacerbate sedation and cognitive abilities

    Ask healthcare professional if taking tranquilizers or sedatives as it may exacerbate CNS effects

    Caution with history of diabetes mellitus, hypertension, thyroid disease, increased IOP, heart disease, prostatic hypertrophy, or renal function impairment

    Ask healthcare professional if experience nervousness, dizziness, insomnia

    If hypersensitivity reaction occurs, seek medical help immediately

    Pregnancy category: C

    Lactation: codeine, triprolidine, pseudoephedrine excreted in breast milk, use caution

    Adults

    Syrup: 20 mg/4 mg/60 mg (10 mL) PO q4-6hr, up to 40 mL/24 hr

    Tablet: 1 tab PO q6hr

    Geriatric

    Nonanticholinergic antihistamines should be considered first when treating allergic reactions (Beers Criteria)

    Clearance reduced with advanced age, greater risk of confusion, dry mouth, constipation, and other anticholinergic effects and toxicity

    May exacerbate existing lower urinary conditions or benign prostatic hyperplasia

    Pediatric

    <6 years

    • Not recommended

    6-12 years

    • 5 mL PO q4-6hr, up to 20 mL/24 hr

    >12 years

    • Syrup: 10 mL PO q4-6hr, up to 40 mL/24 hr
    • Tablet: 1 tab PO q6hr

    Codeine/triprolidine/pseudoephedrine

    oral syrup: schedule V

    • (10mg/2mg/30mg)/5mL

    tablet: schedule V

    • 20mg/4mg/60mg