codeine/guaifenesin (Mytussin AC, Tussi-Organidin NR, Cheratussin AC, Guiatuss AC, Iophen C-NR)
Classes: Antitussives, Narcotic Combos
Dosing and uses of Mytussin AC, Tussi-Organidin NR (codeine/guaifenesin)
Adult dosage forms and strengths
codeine/guaifenesin
oral liquid: Schedule V
- 10mg/100mg
- (10mg/300mg)/5 mL
Cough
Temporary control of cough caused by minor throat and bronchial irritation
Loosens mucus and thins bronchial secretions
Usual: 5 mL PO q4hr, up to 40 mL/day
Maximum: 60 mL (codeine 120 mg)/24 hr
Other Information
Give with food or milk if GI upset
Administer with special measuring device for accurate dose
Pediatric dosage forms and strengths
codeine/guaifenesin
oral liquid: Schedule V
- 10mg/100mg
- (10mg/300mg)/5 mL
Cough
<2 years: Not recommended
2 to <6 years: base dose on codeine 1 mg/kg/day PO divided QId
2 years: 1.5 mL (3 mg codeine) PO q4-6hr, up to 6 mL/24 hr
3 years: 1.75 mL (3.5 mg codeine) PO q4-6hr, up to 7 mL/24 hr
4 years: 2 mL (4 mg codeine) PO q4-6hr, up to 8 mL/24 hr
5 years: 2.25 mL (4.5 mg codeine) PO q4-6hr, up to 9 mL/24 hr
6 to <12 years: 2.5 mL-5 mL (5 mg-10 mg codeine) PO q4-6hr, up to 20 mL/24 hr
12 years and older: 5 mL-10 mL(10-20 mg codeine) PO q4-6hr, up to 40 mL/24 hr
Mytussin AC, Tussi-Organidin NR (codeine/guaifenesin) adverse (side) effects
>10%
Codeine
- Drowsiness
- Constipation
1-10%
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
Frequency not defined
Codeine (serious)
- Hypotension, With IV use
- Seizure, With excessive doses
- Anaphylactoid reaction (rare)
- Respiratory depression
Guaifensesin
- Headache
- Rash
- Nausea
- Vomiting
Warnings
Contraindications
Codeine
- Absolute: acute abdominal condition, diarrhea associated w/ toxins, pseudomembranous colitis, respiratory depression
- Relative: asthma (acute), inflammatory bowel disease, respiratory impairment
Guaifenesin
- Do not use as self-medication in chronic or persistent coughs
- Hypersensitivity
Cautions
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
Guaifenesin
- Often comes in combos, check brand name/other constituents
Pregnancy and lactation
Pregnancy category: C; category D if used for prolonged periods or in high doses at term
Lactation: excreted in breast milk; caution advised
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Mytussin AC, Tussi-Organidin NR (codeine/guaifenesin)
Codeine
Half-Life: 3-4 hr
Onset: 30-60 min
Metabolism: Inactive but metabolized to morphine by CYP2D6 (missing in 5-10% of population)
Duration: 4-6 hr
Peak Plasma Time: 0.5-1 hr
Protein Bound: 25%
Excretion: urine, feces
Guaifenesin
Half-Life: 1 hr
Onset: 30 min
Duration: 4-6 hr
Metabolism: liver
Metabolite: b-(2-methoxyphenoxy) lactic acid
Excretion: urine
Mechanism of action
Codeine: Narcotic agonist analgesic with antitussive activity, mu receptor agonist
Guaifenesin: Reduces viscosity of secretions by increasing amount of respiratory tract fluid