Codeine, guaifenesin, and pseudoephedrine

Generic Name: codeine, guaifenesin, and pseudoephedrine (KOE deen, gwye FEN e sin, and soo doe e FED rin)Brand names: Ambifed CD, Ambifed CDX, Ambifed-G CD, Ambifed-G CDX, Biotussin DAC, Cheratussin DAC, Codafed, Codahistine Expectorant, Halotussin DAC, Maxifed CD, Medent C, Phenhist Expectorant, ...show all 53 brand names.Robitussin-DAC, Ryna-CX, Novahistine Expectorant, Nucofed Expectorant, Tussar-2, Deproist with Codeine, Co-Histine Expectorant, Decohistine Expectorant, Dihistine Expectorant with Codeine, Dihistine Expectorant, Novadyne Expectorant, Nucochem Pediatric Expectorant, Nucochem Expectorant, Nuco-Tuss Pediatric Expectorant, Nucodine Pediatric, Cycofed Expectorant, KG-Fed Expectorant, Nucodine Expectorant, Deconsal C Expectorant, Guaiatussin DAC, Guiatuss DAC, Mytussin DAC, Guiatussin DAC, Cycofed Pediatric Expectorant, KG-Fed Pediatric Expectorant, Nucofed Pediatric Expectorant, Tussar SF, Phenylhistine Expectorant, Nuco-Tuss Expectorant, Nucochem, Guaifen DAC, Dihistine, Gua PC, Guaifenesin DAC Liquid, Novagest with Codeine, Codafed Pediatric, Maxifed-G CD, Maxifed-G CDX, Maxifed CDX, Suttar-2, Suttar SF

What is codeine, guaifenesin, and pseudoephedrine?

Codeine is a narcotic cough suppressant.

Guaifenesin is an expectorant. It helps loosen mucus congestion in your chest and throat, making it easier to cough out through your mouth.

Pseudoephedrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose).

The combination of codeine, guaifenesin, and pseudoephedrine is used to treat stuffy nose and cough, and to reduce chest congestion caused by the common cold, infections, or allergies.

Codeine, guaifenesin, and pseudoephedrine may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about codeine, guaifenesin, and pseudoephedrine?

Do not use a cough or cold medicine if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take cough or cold medicine before the MAO inhibitor has cleared from your body. Do not use any other over-the-counter cough or cold medication without first asking your doctor or pharmacist. If you take certain products together you may accidentally take too much of one or more types of medicine. Read the label of any other medicine you are using to see if it contains guaifenesin or pseudoephedrine. Codeine may be habit-forming and should be used only by the person it was prescribed for. Codeine should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children.

What should I discuss with my healthcare provider before taking codeine, guaifenesin, and pseudoephedrine?

severe or uncontrolled high blood pressure;
severe coronary artery disease; or
if you are breast-feeding a baby.

If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before taking codeine, guaifenesin, and pseudoephedrine, tell your doctor if you are allergic to any drugs, or if you have:

heart disease or high blood pressure;
ischemic heart disease (reduced circulation of blood to the heart);
asthma, COPD, sleep apnea, or other breathing disorders;
diabetes;
a thyroid disorder;
glaucoma;
liver or kidney disease;
a history of head injury or brain tumor;
epilepsy or other seizure disorder;
enlarged prostate, urination problems;
a stomach or intestinal disorder;
Addison's disease or other adrenal gland disorders;
if you have recently had surgery on your stomach, intestines, kidney, or bladder.
gallbladder disease;
mental illness; or
a history of drug or alcohol addiction.

If you have any of these conditions, you may not be able to use this medication, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Codeine can cause addiction or withdrawal symptoms in a newborn. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Codeine can pass into breast milk and may harm a nursing baby. The use of codeine by some nursing mothers may lead to life-threatening side effects in the baby. Do not use this medication if you are breast-feeding a baby. Codeine may be habit-forming and should be used only by the person it was prescribed for. This medication should never be shared with another person, especially someone who has a history of drug abuse or addiction. Older adults may be more likely to have side effects from this medication.

How should I take codeine, guaifenesin, and pseudoephedrine?

Take this medication exactly as it has been prescribed by your doctor. Do not use the medication in larger amounts, or use it for longer than recommended. Cough or cold medicine is usually taken only for a short time until your symptoms clear up.

Take codeine, guaifenesin, and pseudoephedrine with food if it upsets your stomach. Always ask a doctor before giving cough or cold medicine to a child. Death can occur from the misuse of cough or cold medicine in very young children.

Measure the liquid form of this medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Call your doctor if your cough does not improve after 5 days of treatment, or if you also have a fever.

If you need to have any type of surgery, tell the surgeon ahead of time if you have taken a cold medicine within the past few days.

Store this medicine at room temperature, away from heat, light, and moisture.

Keep track of how much of this medication has been used. Codeine is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

See also: Codeine, guaifenesin, and pseudoephedrine dosage in more detail

What happens if I miss a dose?

Since cough or cold medicine is usually taken only as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of codeine can be fatal.

Overdose symptoms may include nausea, vomiting, feeling restless or nervous, extreme dizziness or drowsiness, confusion, cold and clammy skin, shallow breathing, slow heart rate, pinpoint pupils, fainting, or coma.

What should I avoid while taking codeine, guaifenesin, and pseudoephedrine?

Do not drink alcohol while you are taking this medication. Alcohol can increase some of the side effects of codeine. Do not use any other over-the-counter cold, allergy, or cough medicine without first asking your doctor or pharmacist. Guaifenesin and pseudoephedrine are contained in many medicines available over the counter. If you take certain products together you may accidentally take too much of a certain drug. Read the label of any other medicine you are using to see if it contains guaifenesin or pseudoephedrine. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). This medication can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.

Codeine, guaifenesin, and pseudoephedrine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking this medication and call your doctor at once if you have any of these serious side effects:

fast, pounding, or uneven heartbeat;
slow heart rate, weak pulse, fainting, weak or shallow breathing;
severe dizziness, anxiety, restless feeling, or nervousness, headache, tremors;
confusion, unusual thoughts or behavior;
seizure (convulsions);
urinating less than usual or not at all; or
increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure).

Less serious side effects include:

dizziness or headache;
constipation;
nausea, vomiting, upset stomach, loss of appetite;
feeling excited or restless;
sleep problems (insomnia);
increased sweating;
warmth, tingling, or redness under your skin; or
mild skin rash or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Codeine, guaifenesin, and pseudoephedrine Dosing Information

Usual Adult Dose for Cold Symptoms:

codeine/guaifenesin/PSE 10 mg-100 mg-30 mg/5 mL oral liquid:10 mL orally every 6 hours. Do not exceed 40 mL in 24 hours.codeine/guaifenesin/PSE 10 mg-400 mg-20 mg oral tablet,codeine/guaifenesin/PSE 10 mg-400 mg-30 mg oral tablet,codeine/guaifenesin/PSE 10 mg-400 mg-40 mg oral tablet,codeine/guaifenesin/PSE 20 mg-400 mg-20 mg oral tablet,codeine/guaifenesin/PSE 20 mg-400 mg-30 mg oral tablet,codeine/guaifenesin/PSE 20 mg-400 mg-40 mg oral tablet, or1 tablet orally every 4 to 6 hours, not to exceed 6 tablets in 24 hours.codeine/guaifenesin/PSE 10 mg-400 mg-60 mg oral tablet,codeine/guaifenesin/PSE 20 mg-400 mg-60 mg oral tablet, or1 tablet orally every 4 to 6 hours, not to exceed 4 tablets in 24 hours.

Usual Pediatric Dose for Cold Symptoms:

codeine/guaifenesin/PSE 10 mg-100 mg-30 mg/5 mL oral liquid:2 years to 5 years:2.5 mL orally every 6 hours. Do not exceed 10 mL in 24 hours.6 years to 12 years:5 mL orally every 6 hours. Do not exceed 20 mL in 24 hours.13 years or older:10 mL orally every 6 hours. Do not exceed 40 mL in 24 hours.codeine/guaifenesin/PSE 10 mg-400 mg-20 mg oral tablet,codeine/guaifenesin/PSE 10 mg-400 mg-30 mg oral tablet,codeine/guaifenesin/PSE 10 mg-400 mg-40 mg oral tablet, codeine/guaifenesin/PSE 20 mg-400 mg-20 mg oral tablet,codeine/guaifenesin/PSE 20 mg-400 mg-30 mg oral tablet, orcodeine/guaifenesin/PSE 20 mg-400 mg-40 mg oral tablet:12 years or older: 1 tablet orally every 4 to 6 hours. Do not exceed 6 tablets in 24 hours.6 years to 11 years:1/2 tablet orally every 4 to 6 hours. Do not exceed 3 tablets in 24 hours.codeine/guaifenesin/PSE 10 mg-400 mg-60 mg oral tablet, orcodeine/guaifenesin/PSE 20 mg-400 mg-60 mg oral tablet:12 years or older: 1 tablet orally every 4 to 6 hours. Do not exceed 4 tablets in 24 hours.6 years to 11 years:1/2 tablet orally every 4 to 6 hours. Do not exceed 2 tablets in 24 hours.

What other drugs will affect codeine, guaifenesin, and pseudoephedrine?

Before taking this medication, tell your doctor if you regularly use other medicines that make you sleepy (such as allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by codeine or guaifenesin.

Also tell your doctor if you are using any of the following drugs:

medicines to treat high blood pressure;
indomethacin (Indocin);
methyldopa (Aldomet); or
a beta-blocker such as atenolol (Tenormin), metoprolol (Lopressor, Toprol), propranolol (Inderal), sotalol (Betapace), and others.

This list is not complete and there may be other drugs that can interact with codeine, guaifenesin, and pseudoephedrine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about codeine, guaifenesin, and pseudoephedrine.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed
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