Codeine, Caffeine, Pheniramine, Phenylephrine, and Salicylic Acid

  • Generic Name or Active Ingridient: Codeine
Drug Class: Codeine, Caffeine, Pheniramine, Phenylephrine, And Salicylic Acid > Codeine > Opiate > Opioids > Opioid Agonist > Analgesic.


Doctors recommend preparations containing codeine, caffeine, pheniramine, phenylephrine, and salicylic acid to relieve symptoms associated with allergies, upper respiratory infections, and the common cold. These ingredients work together to soothe a nagging cough, stuffy or runny nose, lethargy, and mild discomfort.

Pharmaceutical companies combine codeine, caffeine, pheniramine, phenylephrine, and salicylic acid into one product, known as a polydrug, to control dosages and make it easier for the consumer to use.

General Drug Information

The brand name product Tussirex contains codeine, caffeine, pheniramine, phenylephrine, and salicylic acid. Small doses of codeine ease coughing while large doses relieve pain. Large doses of codeine also produce a pleasant, euphoric feeling that makes it a target for recreational drug abusers. The other ingredients do not produce euphoria, so recreational users do not intentionally target these ingredients.

Drug manufacturers extract codeine from the opium poppy plant. Chemists classify codeine as an opioid drug because it binds to special opioid receptors located on nerve endings in a way that changes how the brain interprets signals traveling along those nerves. Examples of other drugs that act as opioids include morphine, Fentanyl, and OxyContin.


Codeine, caffeine, pheniramine, phenylephrine, and salicylic acid polydrugs are available as syrup for oral use. Consumers should use an approved measuring device to administer this drug to prevent insufficient doses or dangerous overdoses, especially when giving this product to children. To avoid stomach upset, consumers can take this drug with food.

The prescribing physician and pharmacist filling the prescription for codeine, caffeine, pheniramine, phenylephrine, and salicylic acid polydrugs should give the patient clear instructions of how to take the drug; consumers should follow these instructions closely and never exceed prescribed daily dosages. To avoid side effects and physical dependence, patients should take only enough of this drug to relieve symptoms and stop using codeine, caffeine, pheniramine, phenylephrine, and salicylic acid preparations when they no longer suffer symptoms.

Patients should avoid discontinuing codeine products abruptly, as sudden cessation may cause withdrawal symptoms in those using this product regularly for more than a few weeks. These patients should taper daily codeine use over the course of several days to avoid unpleasant physical and psychological withdrawal symptoms.

This product may cause breathing problems in children and elderly patients; prescribing physicians should start these patients on the lowest possible dose and monitor their condition closely, especially during the beginning of treatment and after dosage increases.


Codeine, caffeine, pheniramine, phenylephrine, and salicylic acid work in different but complimentary ways to reduce symptoms.

Pheniramine is an antihistamine that reduces the level of histamines in the body, relieving the itchy, watery eyes and runny nose caused by high histamine levels.

Phenylephrine is a decongestant. It works by shrinking blood vessels in the nose and upper airway to create more space for air to flow through nasal passages. Phenylephrine stimulates the central nervous system.

Caffeine is a stimulant that relieves drowsiness caused by allergies and upper respiratory infections. Caffeine also reduces headaches and body aches.

Salicylic acid is a metabolite of aspirin, a common pain reliever. Aspirin and its metabolites work by reducing prostaglandin levels. Prostaglandins are a type of hormone that send pain messages to the brain, cause cells to leak fluids resulting in swelling and inflammation, and for triggering fever.

Codeine and other opioids act directly on the central nervous system, or CNS, to cause a variety of neurological effects. Codeine depresses the hypothalamus, which is the breathing center of the brain, to make the brain apathetic about the need to cough phlegm and debris from the lungs and airway. Other notable CNS actions include pain relief, sedation, relaxation, euphoria.

Codeine can cause other, less noticeable neurological effects that change the way someone thinks, feels and behaves. With continued codeine use, some of these changes cause serious problems with his ability to think clearly, sort out his emotions, and react to social situations appropriately.

Opioids cause other changes that cause the consumer to become physically dependent upon codeine and suffer withdrawal symptoms when he stops using this drug. Caffeine, pheniramine, phenylephrine, and salicylic acid do not produce dependence but these drugs can worsen withdrawal symptoms. Chronic use can cause drug levels to climb to toxic levels.


Products containing codeine may cause physical dependence resulting in withdrawal symptoms when the consumer stops taking opioids.


Even though it contains an ingredient to reduce sleepiness, products containing codeine, caffeine, pheniramine, phenylephrine, and salicylic acid can make the consumer feel dizzy, drowsy, or impair his ability to think clearly. Combining this product with other drugs or alcohol can enhance these effects. Consumers should avoid driving a motor vehicle or operating other heavy machinery until they know how this drug affects them.


Codeine, caffeine, pheniramine, phenylephrine, and salicylic acid polydrugs may not be suitable for everyone. Physicians should gather a detailed medical history before prescribing this product, as this polydrug might worsen a pre-existing medical condition. Some illnesses can change the way this drug works.

Patients suffering from high blood pressure, diabetes, or glaucoma should avoid phenylephrine.

Someone with a known hypersensitivity or allergy to codeine or other opioids should not use this polydrug. Patients with serious breathing problems, such as acute asthma, should avoid codeine use. Codeine use may be dangerous for patients with a history of the serious digestive tract problem known as paralytic ileus.

Pregnancy, Labor and Delivery, Breastfeeding

The FDA classifies codeine products as Pregnancy Category C drugs, meaning researchers have not yet established if this drug will affect the reproductive capabilities of male and female consumers. Scientists have not determined the long-term effects this drug can have on an unborn baby. A baby born to a woman who takes codeine regular during the last three months of pregnancy may suffer withdrawal symptoms, feeding problems, breathing difficulties, seizures, or even death in the first weeks or months of life. A pregnant woman should use this product only if the benefits to the mother clearly outweigh any possible harm to the fetus.

A mother can pass codeine to a nursing baby though breast milk. Mothers should avoid breastfeeding while taking codeine, caffeine, pheniramine, phenylephrine, and salicylic acid polydrugs, or choose a different drug to relieve symptoms.

Drug Interactions

Codeine, caffeine, pheniramine, phenylephrine, and salicylic acid can interact with other medications to produce unwanted or unsafe results. Patients should give a list of all medications, including prescription and non-prescription drugs, to the prescribing physician to reduce the risk for dangerous drug interactions. Consumers should not change the way they take any medication while using this polydrug without first consulting a doctor or pharmacist.

Patients who have taken an MAO inhibitor for depression or high blood pressure within 14 days should not use this product. Doing so may cause dangerous, even fatal, adverse effects.

Side effects

All drugs can cause side effects, including codeine, caffeine, pheniramine, phenylephrine, and salicylic acid. Most side effects are not serious and disappear with continued use at therapeutic doses, but some adverse reactions can be serious.
Consumers should continue using this medication but notify the prescribing physician if the non-serious side effects do not go away or worsen with continued use. Common, non-serious side effects include:

  • Dizziness or drowsiness
  • Headache
  • Dry mouth, nose or throat
  • Nausea and vomiting
  • Diarrhea or constipation
  • Increased sweating or urination
  • Feeling excited or restless
  • Insomnia
  • Blurred vision
  • Dry eyes
  • Ringing in the ears
  • Mild skin rash or itching

Caffeine can cause other mild side effects including a rapid heart rate, anxiety, trouble sleeping, and nervousness.

Patients experiencing serious side effects should consult with a doctor immediately. Serious side effects include:

  • Fast or pounding heartbeat
  • Feeling faint
  • Tightness or congestion in the chest
  • Easy bruising or bleeding
  • Unusual weakness
  • Severe dizziness, anxiety, restlessness or nervousness
  • Seizures
  • Painful or difficult urination


Drug manufacturers usually offer these polydrugs with doses of codeine, caffeine, pheniramine, phenylephrine, and salicylic acid too low to pose a risk for overdose but it is still possible to consume toxic amounts of this drug. Each year, about 15,000 people die in the United States after taking an overdose of prescription drugs like this one. The number of prescription drug overdose deaths tripled in the decade between 1999 and 2008.

Any potential victims of overdose should contact poison control center at 1-800-222-1222 or go to the nearest emergency room.
Overdose symptoms include:

  • Abdominal pain
  • Cold, clammy skin
  • Confusion
  • Extreme drowsiness
  • Fainting
  • Feelings of warmth or tingling
  • Pinpoint pupils
  • Restlessness or nervousness
  • Seizure
  • Shallow or stopped breathing
  • Vomiting

Overdose can present other symptoms, including fast or uneven heart rate. Codeine overdose can cause loss of consciousness and death.

Pheniramine overdose can cause additional symptoms, including:

  • Blurred vision
  • Dry mouth
  • Enlarged pupils
  • Ringing in the ears
  • Rapid heartbeat
  • Convulsions
  • Delirium
  • Depression
  • Difficulty urinating, especially in men with enlarged prostates
  • Disorientation
  • Drowsiness
  • Excitation
  • Fever
  • Hallucinations
  • Nervousness
  • Unsteadiness
  • Tremor
  • Flushed skin
  • Nausea
  • Vomiting

Consuming polydrugs increases the risk for acute caffeine poisoning, which produces symptoms including insomnia, restlessness, tremors, delirium, or fast or irregular heartbeats.


The United States DEA classifies drugs according to their relative potential for abuse. The DEA sometimes ranks codeine as a schedule II narcotic posing a relatively high risk for abuse, but classifies this polydrug as a class II because someone would probably throw up before drinking enough to get high. However, it is still possible to abuse this product by taking it in combination with other opioids.

Recreational drug abuse increases the risk for becoming dependent on opioids because these consumers tend to use stronger doses more frequently than do people using this drug for therapeutic purposes.

Recreational users do not target caffeine, pheniramine, phenylephrine, and salicylic acid since these drugs do not get the consumer high. However, chronic use of this polydrug can cause these drugs to accumulate to toxic levels so abusing codeine, caffeine, pheniramine, phenylephrine, and salicylic acid polydrugs can cause serious health hazards.


An opioid-dependent person experiences withdrawal symptoms when he stops using codeine suddenly. Opioid withdrawal symptoms often come in two waves, with the first set of symptoms beginning a few hours after the last dose of codeine.

Early symptoms of withdrawal include:

  • Agitation
  • Anxiety
  • Muscle aches
  • Increased tearing
  • Insomnia
  • Runny nose
  • Sweating
  • Yawning

Later, the individual might develop other symptoms including:

  • Abdominal cramping
  • Diarrhea
  • Dilated pupils
  • Goose bumps
  • Nausea
  • Vomiting

Left uninterrupted, these withdrawal symptoms persist for about five days before fading by themselves as the body cleanses itself of the toxic effects of codeine. These symptoms do not return unless the person takes more codeine and returns to an opioid-dependent state.

Someone can reduce the severity of withdrawal symptoms by taking non-opioid drugs, like Imodium for diarrhea and acetaminophen for body aches. These drugs do not interrupt the detoxification process. He could take more codeine to stop symptoms completely, but relapse reverses the effects of detoxification and returns him to an opioid-dependent state.

Caffeine, pheniramine, phenylephrine, and salicylic acid do not produce dependence causing withdrawal symptoms but toxic levels of these drugs can make the patient feel worse or cause dangerous complications.


About 2 million Americans are dependent on opioids like codeine. Each of these people will require some form of detoxification to stop withdrawal symptoms and cleanse their bodies of the toxic effects of codeine. Someone can perform detoxification at home alone, with the help of an outpatient clinic, at a hospital or mental health facility, or in a specialized detoxification center.

Outpatient clinics provide opioid replacement drugs like methadone and buprenorphine. These drugs mimic the effects of codeine well enough to reduce withdrawal symptoms during tapering but do not get the consumer high. Inpatient clinicians administer detoxification drugs to lower opioid levels along with anti-withdrawal drugs to make the patient more comfortable.

Rapid detox is a safe and efficient approach to detoxification. During rapid detox, an anesthesiologist sedates and anesthetizes the patient before giving him the usual detoxification and anti-withdrawal drugs. Rapid detox patients doze in a comfortable “twilight sleep,” unaware of uncomfortable withdrawal symptoms. Patients awaken a few hours later - refreshed, renewed, and ready for rehabilitation.


Consumers and caregivers should store codeine, caffeine, pheniramine, phenylephrine, and salicylic acid polydrugs at room temperature between 59 and 86 degrees Fahrenheit, away from light and humidity.