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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