Codeine, Brompheniramine and Guaifenesin

  • Generic Name or Active Ingridient: Codeine

Uses

Doctors prescribe medications containing codeine, brompheniramine, and guaifenesin to relieve symptoms associated with allergies or the common cold. Symptoms can include cough, runny nose and watery eyes.

General Drug Information

Codeine, brompheniramine, and guaifenesin treat different symptoms. Strong doses of codeine relieve pain while lower doses suppress cough. Brompheniramine relieves watery eyes and an itchy, runny nose. Guaifenesin thins secretions in the lungs and nose to relieve nasal stuffiness and chest congestion.

Drug makers extract codeine from the opium poppy plant. Scientists classify codeine as an opioid drug because it binds to opioid receptors in the nervous system to change the way the brain interprets pain signals.

Administration/Dosage

Drug makers are likely to offer codeine, brompheniramine, and guaifenesin products in a syrup form for oral use. Patients should always take preparations containing these ingredients exactly as prescribed.

Action

Codeine, brompheniramine, and guaifenesin work in different ways to relieve symptoms.

When something irritates the lungs, the body sends a signal through the central nervous system to the medulla, which serves as the cough center of the brain. Codeine depresses the medulla to suppress the cough - codeine makes the brain apathetic about the need to cough. Codeine makes it easier for patients to sleep through the night or participate in daily activities undisturbed by cough.

Codeine causes other neurological effects, the most immediately noticeable being sedation, relaxation and euphoria. These effects make codeine attractive to recreational drug abusers. Chronic codeine use causes some of the neurological actions of codeine to become more permanent, altering how the consumer feels, thinks, and behaves. In time, these alterations can interfere with the individual’s ability to work, take care of children or other responsibilities, and interact with others. These neurological effects may also cause the individual to become dependent on codeine and suffer physical and psychological effects when he stops using this drug.

Guaifenesin is an expectorant. It thins secretions in the nose and lungs to make it easier for the body to expel them. Guaifenesin helps clear fluid from the lungs and phlegm from the throat.

Brompheniramine is an antihistamine. Allergens, like pollen or a virus, irritate the upper respiratory tract and cause the body to release histamines. These histamines attach to cells in the eyes, nose, throat and windpipe. Histamines then cause these cells to leak fluids, resulting in watery eyes, runny nose, and an itchy nose and throat. Brompheniramine reduces histamine levels to soothe these symptoms.

Warnings

It is possible to become physically dependent on codeine. Doctors suggest patients who use codeine regularly for longer than a few weeks taper drug use to avoid uncomfortable withdrawal symptoms.

Precautions

Anyone who is allergic to codeine, brompheniramine, or guaifenesin should avoid products containing these ingredients. An allergic reaction is a serious medical emergency that could result in serious injury or death. Symptoms of an allergic reaction include itching, rash, hives, and swelling of the face, eyes, mouth, and lips. Someone suffering signs of an allergic reaction should seek emergency medical assistance.

Codeine can cause the consumer to become dizzy, drowsy, or impair his ability to make decision. Alcohol and some drugs enhance these effects. Anyone using codeine products should avoid driving or operating heavy machinery until she determines how codeine affects her.

Guaifenesin is a common ingredient in many products; using too much guaifenesin may cause serious side effects. Consumers should check the labels of all products for the presence of guaifenesin.

Contraindications

Codeine, brompheniramine, and guaifenesin products are not appropriate for all patients. Some medical conditions interfere with the way these products work; products containing these ingredients can aggravate some medical conditions.

Physicians should learn a patient’s complete medical history before prescribing products containing codeine, brompheniramine, and guaifenesin. Clinicians should prescribe this product with care to patients with a history of:

  • Adrenal gland disorders
  • Asthma, COPD, emphysema or other breathing disorders
  • Curvature of the spine
  • Enlarged prostate
  • Epilepsy or other seizure disorder
  • Heart disease
  • Heart rhythm disorder
  • History of depression, mental illness or drug addiction
  • History of head injury, increased cranial pressure, or brain tumor
  • Liver or kidney disease
  • Stomach or intestinal disorder
  • Thyroid disorder

Patients with severe high blood pressure, severe heart blood vessel disease, glaucoma or peptic ulcers should not use codeine or brompheniramine. Individuals suffering an asthma attack or who are having trouble urinating should not use this product. This medication is not appropriate for anyone who is taking GHB or has used an MAO inhibitor within 14 days. Patients with diabetes, stroke, sleep apnea, and slow or irregular breathing may not be able to take this medication.

Pregnancy, Labor and Delivery, Breastfeeding

The FDA has classified codeine products as Pregnancy Category C, meaning scientists do not yet know how this drug affects reproductive capabilities of men or women, or how it affects a fetus. Pregnant women should only use products containing codeine, brompheniramine, and guaifenesin when the benefits to the mother clearly outweigh any potential risk to the unborn baby.

Drug Interactions

Codeine, brompheniramine, and guaifenesin can interact with other medications in unsafe or unwanted ways. Patients should supply a list of all prescription and non-prescription drugs to the clinician before taking a medication containing these ingredients.

Cimetidine, furazolidone, HIV protease inhibitors, MAOIs, sodium oxybate, and tricyclic antidepressants increase the risk for side effects caused by codeine and brompheniramine. Codeine and brompheniramine increases the likelihood of side effects associated with other opioid pain medications. Naltrexone, quinidine, and rifamycins make codeine and brompheniramine less effective.

Muscle relaxants, sedatives, tranquilizers, some anti-seizure and anti-depressants, and cough and cold medications can enhance the drowsiness caused by codeine and guaifenesin. Physicians should adjust dosages of one or both medications for patients taking Tagamet, quinidine, Narcan, or Vivitrol along with codeine and guaifenesin products.

Side effects

Codeine, brompheniramine, and guaifenesin products may cause unwanted side effects. Most of these side effects are not serious and go away with continued use at therapeutic doses but a few side effects can be serious.

Common side effects include:

  • Constipation
  • Diarrhea
  • Dizziness
  • Drowsiness
  • Dry mouth, nose or throat
  • Excitability
  • Headache
  • Loss of appetite
  • Nausea
  • Skin rash or itching
  • Thickening of mucus secretions
  • Upset stomach
  • Vomiting
  • Warmth, redness or tingling under the skin

Serious side effects include:

  • Blurred vision, double vision, or other vision changes
  • Confusion
  • Hallucinations
  • Unusual thoughts or behavior
  • Fainting
  • Fast, slow, or irregular heartbeat
  • Headache
  • Lightheadedness
  • Loss of coordination
  • Mood or mental changes
  • Nervousness
  • Ringing in the ears
  • Seizures
  • Severe dizziness
  • Severe drowsiness
  • Shallow breathing
  • Slow or weak pulse
  • Tremor
  • Trouble sleeping
  • Uncontrolled muscle movements
  • Unusual bruising or bleeding
  • Unusual weakness or tiredness
  • Urinating less than usual or not at all
  • Weakness

Overdose

Overdose of codeine, brompheniramine, and guaifenesin combination products is a serious and sometimes fatal condition. Overdose of prescription drugs like this claim about 15,000 lives each year in the United States. The number of deaths associated with prescription drug overdose is rising- in 2009, there were nearly three times as many overdoses from these drugs as there were in 1999.

Possible victims of overdose should seek medical care immediately by going to the nearest emergency department or by telephoning poison control center at 1-800-222-1222.

Symptoms of an overdose of codeine, brompheniramine, and guaifenesin include blurred vision, confusion, hallucinations, seizures, severe dizziness, lightheadedness, or headache, severe drowsiness, shallow breathing, or an unusually fast, slow, or irregular heartbeat. Patients may also experience nausea or vomiting, sweating, and cold, clammy skin or blue-colored lips or fingernails, weak or limp muscles, or pinpoint pupils. The patient may faint or have a seizure.

Abuse

Codeine causes a pleasant euphoria that makes it an attractive target for recreational drug abusers. The United States DEA classifies many codeine products as schedule II narcotics, meaning they pose a relatively high potential for abuse.

Withdrawal

Anyone who uses codeine products regularly for more than a few weeks can become physically dependent on opioids and suffer withdrawal symptoms when he stops using codeine. These withdrawal symptoms usually appear in two phases, with the first set of symptoms beginning a few hours after the last dose of codeine.

Initially, the patient might feel agitated, anxious, and have trouble sleeping. He might experience watery eyes, a runny nose, muscle aches, and sweat or yawn excessively. Later, he may develop stomach cramps, diarrhea, nausea and vomiting, loss of appetite, goose bumps, and dilated pupils.

Withdrawal symptoms worsen gradually, reaching their worst on or about the fourth day. Left uninterrupted, these symptoms fade and do not return unless the individual becomes dependent on drugs again.

Brompheniramine and guaifenesin do not cause physical dependence resulting in withdrawal symptoms but chronic use of these medications in patients struggling with codeine dependence can cause unwanted or unsafe physical effects.

Detoxification

About 2 million Americans are dependent on opioid drugs like codeine. Each of these individuals must participate in some form of detoxification to achieve an opioid-free state. Detoxification cleanses the body of the toxic effects of codeine and permanently stops withdrawal symptoms. Detoxification can take place at home without anti-withdrawal medications, at home using anti-withdrawal drugs supplied by an outpatient clinic, at a hospital, or at a dedicated inpatient detoxification clinic.

Outpatient clinics usually offer opioid replacement drugs, like methadone or buprenorphine, to control withdrawal symptoms in patients dependent on codeine or other opioids. Inpatient detoxification specialists administer detoxification drugs to lower opioid levels and anti-withdrawal drugs to manage symptoms.

Rapid detox is a safe, effective approach to detoxification. Specially trained anesthesiologists sedate and anesthetize patients before administering the usual detoxification and anti-withdrawal drugs. Rapid detox patients doze in a comfortable “twilight sleep” during detoxification, unaware of the uncomfortable withdrawal symptoms that may have prevented recovery in the past.

Storage

Consumers should store codeine, brompheniramine, and guaifenesin preparations at room temperature and away from excessive heat and humidity. Patients should dispose of unused portions when they no longer need codeine, brompheniramine, and guaifenesin to ease cold and allergy symptoms.