J-Cof DHC

Uses

Doctors prescribe J-COF DHC to patients suffering from cough, stuffy or runny nose, itching and watery eyes caused by allergies or the common cold. J-COF DHC is a cough suppressant, decongestant and antihistamine.

Other, off label uses for this medicine

One ingredient in J-COF DHC relieves pain and helps the consumer feel relaxed.

General Drug Information

Each 5 mL teaspoon contains 7.5 mg of dihydrocodeine bitartrate, 3 mg of brompheniramine maleate and 15 mg of pseudoephedrine hydrochloride.

JayMac Pharmaceuticals manufactures J-COF DHC in a grape-flavored solution for oral use. J-COF DHC is a clear liquid free from sugar, dyes and alcohol.

Administration/Dosage

The usual J-COF DHC prescription calls for 5 mL to 10 mL, which is one to two teaspoons, every four to six hours as needed for adults and children over the age of 12 years. The typical prescription for children between the ages of 6 and 12 years is one-half to one teaspoonful every four to six hours as needed to control symptoms.

Administrators should use an approved measuring device when dispensing J-COF DHC. Using a household spoon may result in adequate doses or dangerous overdoses.

Consumers should not adjust the dosage of J-COF DHC without first consulting a doctor.

Action

Dihydrocodeine is an opioid, sometimes called a narcotic. Dihydrocodeine works directly on the brain’s cough reflex center in the medulla to make the brain apathetic about the need to clear mucus and debris from the lungs. The dihydrocodeine in J-COF DHC acts on other respiratory centers in the brain to cause slow, shallow and irregular breathing patterns.

In other actions, the dihydrocodeine in J-COF DHC works with the central nervous system, or CNS, to relieve pain, cause sedation, calm anxiety and produce a pleasant sense of euphoria. Dihydrocodeine also increases the tone of smooth muscles to make them stiffer and less functional; smooth muscle groups are located in various places around the body, including in the skin, eyes and gastrointestinal tract. Dihydrocodeine also widens blood vessels, known as vasodilation, in a way that can lower blood pressure.

Brompheniramine is an antihistamine that relieves itching and watery eyes. Brompheniramine blocks the production of histamines, which are responsible for causing itching and watery eyes. Brompheniramine also produces sedation and an anticholinergic, or drying, effect.

Pseudoephedrine is a decongestant that relieves stuffy and runny noses. Pseudoephedrine accomplishes this by shrinking the blood vessels that line nasal passages, allowing more room for air to flow through the nose.

The gastrointestinal tract absorbs J-COF DHC. The liver metabolizes dihydrocodeine and brompheniramine. The body eliminates most of the ingredients of J-COF DHC through urine.

Warnings

Physicians should exercise considerable caution when prescribing J-COF DHC to patients with low blood pressure, diabetes or some types of heart disease or thyroid, prostate or eye problems. Elderly patients are more likely to exhibit adverse reactions to J-COF DHC.

The antihistamines in J-COF DHC can cause excitability, especially in children. Individuals who take higher doses than recommended may feel nervous, dizzy or have trouble sleeping.

Respiratory Depression

Although rarely severe at therapeutic doses, respiratory depression is the most dangerous effect produced by opioid drugs. Opioids, like the dihydrocodeine in J-COF DHC, inhibit the brain’s urge to breathe, causing slow, shallow and uneven breathing patterns; inadequate breathing prevents the lungs from exchanging oxygen for carbon dioxide, resulting in oxygen starvation and toxic carbon dioxide levels.

Respiratory depression occurs more frequently in the elderly and in debilitated patients, usually after large doses in consumers unaccustomed to the effects of opioids, or when combining J-COF DHC with other drugs that depresses breathing.

To reduce the risk for respiratory depression, physicians should prescribe J-COF DHC with caution to patients with the breathing problem known as COPD or the heart problem, cor pulmonale. Doctors should use care when suggesting J-COF DHC to patients with severely diminished lung capacity, oxygen starvation, high carbon dioxide levels or pre-existing respiratory depression.

Hypotensive Effect

The dihydrocodeine in J-COF DHC may cause vasodilation resulting in low blood pressure. This risk for hypotension is greater in patients who already have trouble maintaining an adequate blood pressure, either because they have lost a lot of blood or because they have taken another drug that causes hypotension.

J-COF DHC may cause orthostatic hypotension, or blood pressure that plummets when the individual rises from a seated position quickly.

Physicians should administer J-COF DHC with care to patients who are in shock, or not getting enough blood flow, since the vasodilation caused by dihydrocodeine can further reduce already low blood pressure.

Dependence

Anyone who takes opioids like J-COF DHC continually for more than a few weeks can become physically dependent on opioids. An opioid-dependent person suffers withdrawal symptoms when he stops using opioids abruptly. Physicians should use the appropriate degree of precaution when prescribing J-COF DHC.

Precautions

The dihydrocodeine in J-COF DHC can make the consumer feel dizzy or drowsy and impair his physical or mental performance. A consumer should not operate heavy machinery or drive a motor vehicle until he knows how J-COF DHC affects him.

Special Risk Consumers

Some consumers may be more sensitive to the effects of J-COF DHC, especially elderly or debilitated patients. Individuals with some medical conditions should use J-COF DHC cautiously, especially those with Addison’s disease, asthma, depression of the central nervous system or coma, COPD and decreased lung capacity due to emphysema, severe obesity, cor pulmonale or severe curvature of the spine. Those with diabetes, head injury, high or low blood pressure and some types of thyroid, prostate and urinary problems should use J-COF DHC with care.

Physicians should exercise care when prescribing J-COF DHC to patients with the severe mental problem known as toxic psychosis and to those with delirium tremens, commonly known as “DTs.” J-COF DHC may sometimes induce or aggravate seizures.

Contraindications

J-COF DHC is not appropriate for all patients. Individuals with a known hypersensitivity to dihydrocodeine, codeine or any other component of this drug should not use J-COF DHC. Caretakers should not administer J-COF DHC in any setting where an opioid is inappropriate, such as in patients with asthma, high carbon dioxide levels cases of respiratory depression in unmonitored settings or in locations without resuscitation equipment.

Patients suffering from the type of bowel obstruction known as paralytic ileus should not use J-COF DHC.
Patients taking the type of hypertension or antidepressant known as an MAOI should not take products containing antihistamines, as MAOIs intensify the way J-COF DHC depresses the central nervous system and enhances its drying, or anticholinergic, effects.

Products containing antihistamines, including J-COF DHC, is not appropriate for lower respiratory tract symptoms affecting the lungs. Individuals with severely high blood pressure, asthma, peptic and some types of heart disease, urinary or eye problems should not use J-COF DHC.

J-COF DHC is not for pregnant women and is inappropriate for premature or newborn infants.

Pregnancy, Labor and Delivery, Breastfeeding

Pregnant women should only take J-COF DHC when the benefits clearly outweigh possible risks, especially in the first trimester of pregnancy.

Babies born to women who take J-COF DHC regularly during pregnancy will be born opioid-dependent and suffer withdrawal symptoms during the first days of life. The infant will seem irritable and cry excessively. Other neonatal withdrawal symptoms are tremors, hyperactive reflexes, increased rapid breathing, increased stools, sneezing, yawning, vomiting and fever. The intensity of these symptoms does not necessarily correlate with the dosage or duration of the mother’s J-COF DHC use.

Caregivers should not administer J-COF DHC during labor and delivery, as this may cause respiratory depression in the newborn.

The ingredients in J-COF DHC may pass into human milk and onto a nursing baby. Nursing mothers should not use J-COF DHC.

Special Risk Patients

J-COF DHC is not appropriate for use in children under the age of two years - children of this age group are more susceptible to respiratory arrest, coma and death.

Antihistamines are not appropriate for infants - increased susceptibility to anticholinergic effects, such as CNS excitation and increased tendency toward convulsions. Very young children may be more sensitive to the effects of J-COF DHC, especially the way pseudoephedrine shrinks blood vessels.

Antihistamines may cause excitability in older children.

Physicians should exercise caution when prescribing J-COF DHC to elderly patients.

The liver is responsible for metabolizing dihydrocodeine, so physicians should closely monitor the effects of J-COF DHC on consumers with impaired liver function.

Physicians should exercise caution and prescribe lower doses of J-COF DHC to patients with impaired kidney function.

Opioids like the dihydrocodeine in J-COF DHC can cause spasms in the valve that controls the flow of pancreatic juices and bile into the small intestine in patients with biliary disease, including pancreatitis.

Drug Interactions

J-COF DHC can interact with other medications in unsafe or unfavorable ways.

The pseudoephedrine in J-COF DHC may decrease the effectiveness of some medications for high blood pressure, especially methyldopa, mecamylamine, reserpine and veratrum alkaloids.

J-COF DHC depresses the central nervous system; using J-COF DHC with other CNS depressants enhances these effects. Examples of other CNS depressants include other opioid pain relievers, sedatives, muscle relaxants, general anesthetic, anti-nausea drugs, anti-psychotic medications, other tranquilizers and alcohol. When a patient needs both J-COF DHC and the other CNS depressant, physicians should reduce the dose of one or both medications.

The dihydrocodeine in J-COF DHC can interact with MAOIs to cause CNS excitation and high blood pressure. Beta-blockers, used to treat high blood pressure, glaucoma and migraines, can increase the effects of the pseudoephedrine in J-COF DHC, as can MAOIs.

Side Effects

All medications, including J-COF DHC, can cause side effects in some people. Consumers have most frequently reported feeling lightheaded, dizzy and drowsy after using J-COF DHC; others have experienced headache, fatigue, sedation, sweating, nausea and vomiting, constipation, itching and skin reactions. Except for constipation, most of these non-serious side effects disappear with continued use at therapeutic doses.

The dihydrocodeine in J-COF DHC is associated with adverse reactions including respiratory depression, orthostatic hypotension, confusion, diarrhea and pinpoint pupils. Opioids like dihydrocodeine can suppress the cough reflex when the consumer needs to clear mucus and debris from the lungs. Other reactions to dihydrocodeine include abdominal pain, dry mouth, indigestion, loss of appetite and urinary retention. Opioids may also cause spasms of the biliary tract.

Individuals may suffer hypersensitivity reactions including hallucinations, vivid dreams, tissue masses, severe sleepiness and some types of kidney problems.

The pseudoephedrine and brompheniramine in J-COF DHC are associated with side effects including extreme fatigue, nausea, giddiness, dry mouth, blurred vision and irregular heartbeat. These ingredients may cause increased irritability or excitement, especially in children. J-COF DHC may cause flushing, an uncomfortable warmth and redness spreading across the face and neck.

Overdose

J-COF DHC overdose is a serious and sometimes fatal condition. Overdoses from prescription drugs kill about 15,000 people every year in the United States.

Symptoms of J-COF DHC overdose include pinpoint pupils, respiratory depression, extreme sleepiness that worsens to stupor, loss of consciousness or coma. The victim may have limp muscles and cold, clammy skin, along with seizures and collapse of the heart and circulatory system. Death may occur.

J-COF DHC overdose requires immediate, professional care. Emergency department staff will administer ipecac to induce vomiting along with medications to induce bowel movements. Nurses will give activated charcoal to absorb excess medication from an alert patient’s stomach, or pump the patient’s stomach as necessary. Nurses will start intravenous fluids to stabilize the patient’s blood pressure and establish an airway or place the patient on a ventilator to help him breathe. Doctors may order naloxone to counteract respiratory depression, but naloxone may cause withdrawal symptoms in opioid-dependent patients, complicating overdose recovery efforts.

Abuse

Recreational users target J-COF DHC because of the way dihydrocodeine gets them high. J-COF DHC is a DEA class III drug, meaning it poses a moderately high potential for abuse when compared to other drugs. To reduce this threat, consumers can only purchase J-COF DHC with a prescription.

Recreational use and abuse of opioids like J-COF DHC increase the consumer’s risk for developing adverse reactions, overdose, addiction and physical dependence.

Withdrawal

Anyone who uses J-COF DHC legally or illegally for more than a few weeks can become physically dependent on dihydrocodeine and suffer withdrawal when he stops using this product abruptly. Withdrawal usually begins a few hours after the last dose of J-COF DHC and last for five or more days. Symptoms of dihydrocodeine include irritability, restlessness, insomnia, extreme perspiration, anxiety, and palpitations.

To avoid these withdrawal symptoms, physicians recommend tapering J-COF DHC use over the course of a few days. While this technique works for most people, overpowering and persistent withdrawal symptoms keep many individuals from quitting J-COF DHC at the appropriate time.

Detox

Many healthcare institutions now offer detoxification services to help people overcome opioid withdrawal. These procedures typically include drugs that lower opioid levels along with medications to ease withdrawal symptoms.

Rapid detox is a humane and efficient approach to detoxification, using anesthesia and sedatives alongside the usual detoxification and anti-withdrawal drugs. Rapid detox patients doze in comfortable “twilight sleep” during detoxification instead of enduring unpleasant and demoralizing withdrawal symptoms.

Storage

Keep J-COF DHC at temperatures between 59 and 86 degrees Fahrenheit in a tight, light-resistant container. Caretakers should keep J-COF DHC out of the reach of children.

Miscellaneous information

JayMac Pharmaceuticals began marketing J-COF DHC on June 30, 2008.

Facts

  • J-Cof DHC