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RESPIRATORY SYSTEM › COUGH AND COLD PREPARATIONS › COUGH SUPPRESSANTS AND EXPECTORANTS, COMBINATIONS › Opium derivatives and expectorants
opium derivatives and expectorants
R05FA02
Forms & Strengths
- Combination oral liquids containing an opium alkaloid (e.g., codeine or opium tincture) and an expectorant (e.g., guaifenesin)
- Varying concentrations per 5 mL: Opioid component (e.g., codeine phosphate 10 mg) combined with guaifenesin (100 mg to 200 mg)
Adult Dosing
- Typically 5 mL to 10 mL orally every 4 to 6 hours as needed for cough
- Do not exceed maximum daily dosage specific to the individual opioid component (e.g., codeine max 60 mg/dose or 240 mg/day)
Pediatric Dosing
- Contraindicated in pediatric patients under 12 years of age due to severe respiratory depression risks
- Not recommended in adolescents aged 12 to 18 years who have compromised respiratory function
Indications
- Temporary relief of coughs associated with minor throat and bronchial irritation (e.g., due to the common cold)
- Facilitation of expectoration in productive coughs complicated by irritant coughing
Mechanism of Action
- Opium derivative acts centrally on the cough center in the medulla to elevate the threshold for coughing
- Expectorant (guaifenesin) acts locally to increase the volume and reduce the viscosity of respiratory tract secretions
Contraindications
- Known hypersensitivity to opioids, guaifenesin, or any formulation excipients
- Significant respiratory depression or acute/severe bronchial asthma in an unmonitored setting
- Known or suspected gastrointestinal obstruction, including paralytic ileus
- Use in children under 12 years of age and post-tonsillectomy/adenoidectomy pain management
Adverse Reactions
- Central nervous system depression, somnolence, dizziness, and sedation
- Constipation, nausea, vomiting, and dry mouth
- Respiratory depression and shallow breathing
- Pruritus, rash, and urticaria due to histamine release
Drug Interactions
- Concomitant use with CNS depressants (alcohol, benzodiazepines, other opioids) increases risk of profound sedation, respiratory depression, coma, and death
- Monoamine oxidase inhibitors (MAOIs) may precipitate severe adverse interactions or serotonin syndrome when combined with certain opioids
- Anticholinergic drugs may increase the risk of severe constipation and/or urinary retention
Curated Content: Needs Vetting Before Put to Clinical Use