Dosing and uses of Triacin-C (codeine/triprolidine/pseudoephedrine)
Adult dosage forms and strengths
codeine/triprolidine/pseudoephedrine
oral syrup: schedule V
- (10mg/2mg/30mg)/5mL
tablet: schedule V
- 20mg/4mg/60mg
Allergic Rhinitis, Cough, Sinus Congestion
Syrup: 20 mg/4 mg/60 mg (10 mL) PO q4-6hr, up to 40 mL/24 hr
Tablet: 1 tab PO q6hr
Pediatric dosage forms and strengths
codeine/triprolidine/pseudoephedrine
oral syrup: Schedule V
- (10mg/2mg/30mg)/5mL
tablet: schedule V
- (20mg/4mg/30mg)/5mL
Allergic Rhinitis, Cough, Sinus Congestion
<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
Geriatric dosage forms and strengths
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
Triacin-C (codeine/triprolidine/pseudoephedrine) 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
Pseudoephedrine
- CNS (tremor, restlessness, etc)
- Insomnia
- Nausea
- Vomiting
Triprolidine
- Anti-cholinergic
- Dizziness
- Drowsiness
Warnings
Contraindications
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
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
Pseudoephedrine
- Mild-mod HTN, cardiac dz, hyperthyroidism, hyperglycemia, BPH, DM, glaucoma
- Many combo formulations are switching to phenylephrine d/t 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
Triprolidine
- May cause dizziness, drowsiness
Pregnancy and lactation
Pregnancy category: C
Lactation: codeine, triprolidine, pseudoephedrine excreted in breast milk, use caution
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 Triacin-C (codeine/triprolidine/pseudoephedrine)
Mechanism of action
Codeine: Narcotic agonist analgesic with antitussive activity, mu receptor agonist
Triprolidine: First generation antihistamine, proplamine-derivative
Pseudoephedrine: Alpha adrenergic agonist
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
Triprolidine
Half-Life: 3.2 hr
Onset: 15-60 min
Duration: 4-6 hr
Peak Plasma:Time: 1.5-2 hr
Concentration: 5.5-6 ng/mL
Metabolism: unknown
Excretion: unknown
Pseudoephedrine
Half-Life: 5-8 hr
Onset: 30 min
Duration: 4-6 hr Peak PlasmaTime: 1.97 hr
Metabolism: liver, by N-demethylation
Metabolites: inactive
Clearance: 7.3-7.6 mL/min/kg
Excretion: urine
