Codeine, Phenylephrine, and Promethazine – Oral Route

Codeine, Phenylephrine, and Promethazine is a combination of medicines that are used to treat coughs and congestion that is caused by the common cold or allergies to a range of substances

Overview

Codeine, Phenylephrine, and Promethazine provides a temporary relief from the symptoms of the common cold.

However, Codeine, Phenylephrine, and Promethazine are not cures for allergies and will not eradicate a common cold or protect against future viral infections. The medication is intended only to mask the impact of the conditions and improve the quality of life for the patient while the condition subsides.

Of the three active medications contained in this combination, codeine is a pain relief medication that belongs to a group of drugs called the narcotic analgesics. It is also referred to commonly as an opioid. These drugs work by impacting the central nervous system (CNS) to reduce or numb pain in various areas of the body.

Phenylephrine is part of a group of medicines called decongestants, which clear the nasal passages by narrowing the blood vessels.

Promethazine is part of a group of medications called antihistamines. These drugs numb the impact of histamine, which the body produces naturally. Histamine can be over-produced when a person suffers an allergic reaction – such as to dust, pollen or animals such as cats and dogs – and can lead to irritations such as watery eyes, itchiness, blocked nose and sneezing. In severe cases, it can also lead to labored breathing due to causing the air passages of the lungs to close up.

The medication combination is designed for short-term use, and should not be taken continuously or over long periods of time. If symptoms of colds and allergies persist, patients should speak to their doctors for alternative treatment suggestions and advice.

The Codeine, Phenylephrine, and Promethazine combination is also marketed and sold under the brand name Promethazine VC with Codeine in the United States.

Type of medication

  • Syrup
  • Elixir

Conditions treated

  • Common cold (pain relief)
  • Blocked nose, congestion
  • Allergies (symptoms)

Side effects

Some people may suffer from side effects when they start to take Codeine, Phenylephrine, and Promethazine. Patients are unlikely to suffer all of the reported side effects, but it is fairly common to experience at least one in the first stages of your treatment plan. If you experience any severe side effects, you should stop taking the medication and contact your doctor or pharmacist for advice.

These are the side effects that could be related to taking Codeine, Phenylephrine, and Promethazine. If you experience any of the milder effects, they should pass shortly after you begin your treatment. However, if they persist, or if they feel severe, get in touch with your health care professional for advice on what to do. It could be that the Codeine, Phenylephrine, and Promethazine combination is not suitable for you.

  • Chills or fever
  • Pain in the chest
  • Pain in the abdomen
  • Bloated feeling
  • Blurry vision
  • Bleeding from the gums
  • Constipation
  • Diarrhea
  • Change in the color of the stools – either becoming black and tarry, or grey colored
  • Cold sweats
  • Persistent cough or wheezing
  • Confusion or anxiety
  • Difficulty breathing, or a tight feeling in the chest; inability to take a deep breath
  • Convulsions or seizures
  • Difficulty in passing urine or emptying the bladder
  • Decrease in the amount of urine passed during each attempt
  • Headache
  • Loss of control of the bladder
  • Nausea or vomiting
  • Excessive sweating
  • Pain when passing urine
  • Pale skin, or blue appearance of the lips
  • Fainting
  • Dizziness when getting up suddenly, having been in the sitting or lying position
  • Changes in the breathing patterns, e.g. slower, quicker or more irregular
  • Persistent sore throat
  • Mouth sores, such as ulcers, cold sores or white spots in the mouth
  • Shakiness, particularly in the limbs
  • Stiffness in the muscles
  • Skin rash, or itchy skin
  • Pounding in the head or ears
  • Bleeding from unusual places, or without a known cause
  • Bad breath
  • Jaundice (yellowing of the skin or eyes)
  • Blood in the vomit
  • General feeling of weakness, particularly in the muscles
  • Easily bruised skin, or bruises that have appeared without known reason
  • Double vision
  • Sensitivity to light
  • Discoloration of the skin, e.g. red, purple or blue tone
  • Temporary confusion in identifying colors
  • Increased sensitivity to sunlight, including severe sunburn from just a little exposure
  • Restlessness
  • Feeling unusually relaxed or calm
  • Difficulty sleeping, or interrupted sleep

Dosage

For adults, the recommended dosage of the Codeine, Phenylephrine, and Promethazine syrup is 5 ml taken orally every four to six hours. However, if you do not feel that you need to take the medication at any time – for example, if your symptoms have improved – you can skip a dose. Codeine, Phenylephrine, and Promethazine is a medication that can be taken as needed rather than needing to be taken for a certain timescale.

The maximum dosage of Codeine, Phenylephrine, and Promethazine for any 24 hour period is 30 ml, adding up to no more than six applications. This is broken down as follows: codeine: 60 mg; promethazine 37.5 mg; phenylephrine: 30 mg).

For children over the age of 12, the recommended dosage and instructions for use of Codeine, Phenylephrine, and Promethazine are the same as for adults. However, codeine should not be taken by obese children or by those that have sleep-related conditions such as sleep apnea. Likewise, do not administer this medication to children that have suffered from lung disease, as it can trigger dangerous breathing difficulties.

Patients can take this medication with or without a meal. However, patients may prefer to take Codeine, Phenylephrine, and Promethazine syrup with a meal to prevent common symptoms such as nausea, light-headedness, tiredness or headaches.

Major drug interactions

There are many other drugs that have a major interaction with Codeine, Phenylephrine or Promethazine; therefore, it is particularly important with this medication that patients go through their medical history and any other medicines they may be taking in detail before starting this treatment. A drug interaction is when one or more drugs react when mixed together. If this reaction happens within the human body, it can cause unpleasant, unknown and even dangerous side effects. It could also cause some or all of your medications to become ineffective, and could make any of your conditions worse.

Not all drug interactions mean that you shouldn’t take some medications at the same time; it may just mean that your doctor should adjust the dosages you are taking, or offer you further healthcare advice.

The drug combinations that react so significantly that they should never be taken together are classed as major drug interactions. Of the 1,208 drugs that have been found to have some level of reaction with Codeine, Phenylephrine, and Promethazine, 393 of them are classified as major interactions. Before taking Codeine, Phenylephrine, and Promethazine, go through the list below carefully and thoroughly, to check whether you have been prescribed these majorly interactive drugs:

  • acetaminophen
  • acetaminophen, caffeine, chlorpheniramine, hydrocodone, phenylephrine, caffeine
  • acetaminophen, isometheptene mucate
  • acetaminophen, hydrocodone
  • acetaminophen, oxycodone
  • acetaminophen, pentazocine
  • acetaminophen, propoxyphene
  • acetaminophen, tramadol
  • acetylcarbromal
  • alprazolam
  • alvimopan
  • amiodarone
  • amobarbital
  • amobarbital, secobarbital
  • amoxapine
  • anagrelide
  • aripiprazole
  • arsenic trioxide
  • artemether, lumefantrine
  • asenapine
  • aspirin, caffeine, dihydrocodeine
  • aspirin, caffeine, orphenadrine
  •  aspirin, caffeine, propoxyphene
  • aspirin, carisoprodol
  • aspirin, carisoprodol, codeine
  • aspirin, hydrocodone
  • aspirin, meprobamate
  • aspirin, methocarbamol
  • aspirin, oxycodone
  • aspirin, pentazocine
  • atropine, hyoscyamine, scopolamine
  • baclofen
  • baclofen, flurbiprofen, lidocaine topical
  • bedaquiline
  • belladonna, butabarbital
  • belladonna, caffeine, ergotamine, pentobarbital
  • belladonna, ergotamine
  • benzoic acid, hyoscyamine, methenamine, methylene blue, phenyl salicylate
  • bepridil
  • bisacodyl, polyethylene glycol 3350, potassium chloride, sodium bicarbonate, sodium chloride
  • brexpiprazole
  • brompheniramine, dihydrocodeine, phenylephrine
  • brompheniramine, dihydrocodeine, pseudoephedrine
  • brompheniramine, hydrocodone, phenylephrine
  • brompheniramine, hydrocodone, pseudoephedrine
  • bupivacaine, fentanyl
  • bupivacaine, hydromorphone
  • buprenorphine
  • buprenorphine, naloxone
  • bupropion
  • bupropion, naltrexone
  • buspirone
  • butabarbital
  • butabarbital, hyoscyamine, phenazopyridine
  • butalbital
  • butorphanol
  • caffeine, ergotamine
  • cannabis
  • carbinoxamine, hydrocodone, phenylephrine
  • carbinoxamine, hydrocodone, pseudoephedrine
  • cariprazine
  • carisoprodol
  • ceritinib
  • chloral hydrate
  • chlordiazepoxide
  • chlordiazepoxide, clidinium
  • chlordiazepoxide, methscopolamine
  • chlormezanone
  • chlorphenesin
  • chlorpheniramine, dihydrocodeine, phenylephrine
  • chlorpheniramine, dihydrocodeine, phenylephrine, phenylpropanolamine
  • chlorpheniramine, dihydrocodeine, pseudoephedrine
  • chlorpheniramine, guaifenesin, hydrocodone, pseudoephedrine
  • chlorpheniramine, hydrocodone
  • chlorpheniramine, hydrocodone, phenylephrine
  • chlorpheniramine, hydrocodone, pseudoephedrine
  • chlorpromazine
  • chlorzoxazone
  • cisapride
  • citalopram
  • citric acid, potassium citrate
  • citric acid, potassium citrate, sodium citrate
  • clobazam
  • clomipramine
  • clonazepam
  • clorazepate
  • clozapine
  • conjugated estrogens, meprobamate
  • crizotinib
  • cyclobenzaprine
  •  dantrolene
  • desipramine
  • deutetrabenazine
  • dexbrompheniramine, hydrocodone, phenylephrine
  • dexchlorpheniramine, hydrocodone, phenylephrine
  • dextromethorphan, quinidine
  • dezocine
  • diazepam
  • dihydrocodeine, guaifenesin
  • dihydrocodeine, guaifenesin, phenylephrine
  • dihydrocodeine, guaifenesin, pseudoephedrine
  • dihydrocodeine, phenylephrine
  • dihydrocodeine, phenylephrine, pyrilamine
  • dihydroergotamine
  • diphenhydramine, hydrocodone, phenylephrine
  • disopyramide
  • dofetilide
  •  dolasetron
  • doxepin
  • dronedarone
  • droperidol
  • droperidol, fentanyl
  • dyphylline, ephedrine, guaifenesin,
  • efavirenz
  • efavirenz, emtricitabine, tenofovir
  • ephedrine, hydroxyzine, theophylline
  • ephedrine, potassium iodide, theophylline
  • ephedrine, theophylline
  • ergonovine
  • ergotamine
  • escitalopram
  • estazolam
  • eszopiclone
  • ethchlorvynol
  • fentanyl
  • fentanyl, ropivacaine
  • fingolimod
  • fluoxetine, olanzapine
  • fluphenazine
  • flurazepam
  • furazolidone
  • gatifloxacin
  • grepafloxacin
  • guaifenesin, hydrocodone
  • guaifenesin, hydrocodone, pheniramine, phenylephrine, phenylpropanolamine
  • guaifenesin, hydrocodone, pheniramine, phenylpropanolamine, pyrilamine
  • guaifenesin, hydrocodone, phenylephrine
  • guaifenesin, hydrocodone, pseudoephedrine
  • guaifenesin, hydromorphone
  • halazepam
  • halofantrine
  • haloperidol
  • halothane
  • heroin
  • homatropine, hydrocodone
  • hydrocodone
  • hydrocodone, ibuprofen
  • hydrocodone, pheniramine, phenylephrine, phenylpropanolamine, pyrilamine
  • hydrocodone, phenylephrine
  • hydrocodone, phenylephrine, pyrilamine
  • hydrocodone, phenylpropanolamine
  • hydrocodone, potassium guaiacolsulfonate
  • hydrocodone, potassium guaiacolsulfonate, pseudoephedrine
  • hydrocodone, pseudoephedrine
  • hydrocodone, pseudoephedrine, triprolidine
  • hydromorphone
  • hydromorphone, ropivacaine
  • hydroxyzine
  • hyoscyamine, methenamine, methylene blue, phenyl salicylate
  • hyoscyamine, methenamine, methylene blue, phenyl salicylate, sodium biphosphate
  • hyoscyamine, methenamine, methylene blue, sodium biphosphate
  • hyoscyamine, phenobarbital
  • ibuprofen, oxycodone
  • ibutilide
  • iloperidone
  • imipramine
  • iohexol
  • iopamidol
  • isocarboxazid
  • ivabradine
  • letrozole, ribociclib
  • levomethadyl acetate
  • levorphanol
  • lidocaine, potassium chloride
  • linezolid
  • lorazepam
  • loxapine
  • lurasidone
  • meperidine
  • meperidine, promethazine
  • mephobarbital
  • meprobamate
  • mesoridazine
  • metaxalone
  • methadone
  • methocarbamol
  • methylene blue
  • methylergonovine
  • methysergide maleate
  • metoclopramide
  • metrizamide
  • mifepristone
  • molindone
  • morphine
  • morphine liposomal
  • morphine, naltrexone
  • moxifloxacin
  • nalbuphine
  • naloxone, oxycodone
  • naloxone, pentazocine
  • naltrexone
  • naltrexone, oxycodone
  • nilotinib
  • nortriptyline
  • olanzapine
  • orphenadrine
  • osimertinib
  • oxazepam
  • oxycodone
  • oxymorphone
  • paliperidone
  • panobinostat
  • paraldehyde
  • pasireotide
  • pentazocine
  • pentobarbital
  • phenelzine
  • phenobarbital
  • phentermine, topiramate
  • pimavanserin
  • pimozide
  • potassium acetate, potassium bicarbonate, potassium citrate
  • potassium bicarbonate, potassium chloride
  • potassium bicarbonate, potassium citrate
  • potassium chloride
  • potassium chloride, sodium chloride
  • potassium citrate
  • potassium citrate, sodium citrate
  • primidone
  • procainamide
  • procarbazine
  • promazine
  • propiomazine
  • propoxyphene
  • protriptyline
  • quazepam
  • quetiapine
  • quinidine
  • ramelteon
  • ribociclib
  • risperidone
  • saquinavir
  • secobarbital
  • selegiline
  • sodium oxybate
  • sotalol
  • sparfloxacin
  • suvorexant
  • tapentadol
  • tasimelteon
  • temazepam
  • tetrabenazine
  • thioridazine
  • thiothixene
  • tizanidine
  • topiramate
  • toremifene
  • tramadol
  • tranylcypromine
  • triazolam
  • trifluoperazine
  • triflupromazine
  • trimipramine
  • vandetanib
  • vemurafenib
  • zaleplon
  • ziprasidone
  • zolpidem
  • zonisamide

Warnings

Codeine and dependency

Patients should not take any medication containing codeine for long periods of time. This is because the drug can cause the body to become dependent, and it may become more difficult to stop using it. Those patients that have experienced some form of dependency in the past - such as to alcohol, drugs, medications or other substances - should not be prescribed codeine unless there is no other suitable alternative. A doctor will be able to make that judgment.

Other diseases or conditions

It is particularly important when you are taking a combination drug that you tell your doctor about any other conditions or diseases that you may be suffering from. Likewise, be sure to include any conditions that you have had in the past, or any that you know you may be vulnerable to developing. There are some diseases or conditions that could have an interaction with this medication; if you suffer from any of the below, your doctor may recommend that you do not take this drug combination. Taking the medicine while suffering from any of these conditions could make that condition worse.

  • Impaired Gi Motility
  • Liver Disease
  • Prematurity
  • Drug Dependence
  • Hypotension
  • Intracranial Pressure
  • Anticholinergic Effects
  • Infectious Diarrhea
  • Asthma/Copd
  • Acute Alcohol Intoxication
  • Respiratory Depression
  • Acute Alcohol Intoxication
  • Cardiovascular Disease
  • Renal Dysfunction
  • Arrhythmias
  • Breast Cancer
  • Dystonic Reactions
  • Hematologic Toxicity
  • Depression
  • Head Injury
  • Biliary Spasm
  • Hypothyroidism
  • Antidopaminergic Effects 1
  • Antidopaminergic Effects 2
  • Cardiovascular Disease
  • Nms
  • Parkinsonism
  • Renal Dysfunction
  • Seizure Disorders
  • Urinary Retention
  • Liver Disease
  • Tardive Dyskinesia
  • Bph
  • Diabetes
  • Asthma
  • Glaucoma
  • Adrenal Insufficiency

Children

This medication must not be prescribed to treat children. Medical studies have found that there are serious risks in using this medicine for children under the age of six; respiratory depression could occur in young children, with the risk of death. Cases of life-threatening side effects and even death is a possibility in children under the age of two years old after they have taken promethazine with respiratory depressants.

For children that are suffering from persistent infections or pain, there are other drug combinations that are more suitable for consumption. If you are worried about your child's symptoms, you should contact your doctor or medical care provider for advice - do not administer over the counter codeine products to children.

Elderly patients

There have been studies that have shown the impact of Codeine, Phenylephrine, and Promethazine to be more severe in elderly patients. This could result in more severe side effects for the patient, or an increased risk of developing side effects. It may be advised by a doctor that a lower dosage is prescribed for a geriatric patient. This group of patients should also be monitored when administering Codeine, Phenylephrine, and Promethazine to help spot any emerging health complications.

There may be some instances where it is unsuitable for an elderly patient to take this medication, such as when the patient has been considered to be more vulnerable to developing health complications.

Alcohol

Codeine is part of a group of drugs called opioids – and these should not be used with alcohol. Patients are therefore strongly advised to refrain from consuming alcohol while undergoing this treatment. Using CNS depressants or opioids with alcohol can lead to serious side effects, including respiratory depression, coma, extreme sedation or even death. Furthermore, patients that mix these substances are more likely to experience side effects such as nausea, vomiting, headaches, confusion, stomach pains, rapid or irregular heartbeat, faintness and lack of judgment.

Driving

You should refrain from operating machinery or driving a vehicle when you have just started to take Codeine, Phenylephrine, and Promethazine. Instead, wait until the drug combination has been fully absorbed into your system before you drive. Codeine, Phenylephrine, and Promethazine can impair judgment, cause blurry vision and bring on drowsiness and tiredness in the first instance, which would make driving dangerous.

Monitoring

It is important to monitor patients that are taking this medication due to the breadth of side effects and possible interactions. Healthcare professionals and patients alike should be aware of signs of hypotension (low blood pressure), respiratory problems (particularly respiratory depression) and gastrointestinal issues (such as constipation or decreased bowel movements).

Patients should also be mindful of the development of abuse, addiction or drug misuse – a risk that arises through taking codeine longer than recommended. Patients that have a history of addiction to alcohol, or a dependency on any type of drug, should be advised and monitored throughout their treatment course. It may be that your doctor advises against you using this medication if you have a history of addiction.

Storage

There are certain instructions for storing Codeine, Phenylephrine, and Promethazine. Keep the medication away from direct sunlight and other sources of heat. Do not keep the medicine in an area where moisture is present, such as the bathroom. Always keep the medicine at room temperature and do not refrigerate or freeze.

Keep out of the reach of children and keep the lid tightly shut when not in use. The consumption of household medications is a serious problem in the United States. More than 60,000 children have to be admitted to hospital because they have taken medication that was not properly stored in their households. Do your bit to help reduce that figure by keeping a lockable cabinet for medications – whether they are prescription-only drugs or everyday over the counter medicines. If you do not have a lockable cupboard in your home, store them at the back of a high shelf or cupboard. Also, remember to keep your medication in the container with which it was supplied; this will prevent it becoming mixed up with other medications and being mistakenly consumed by others in your household.

Disposal

Do not use your Codeine, Phenylephrine, and Promethazine combination if it has exceeded its expiry date. Expiry dates have been set for the safety of patients; therefore, the medicine may not be safe to use if it has become out of date. You should instead dispose of it in a safe and responsible way. Visit the FDA’s website for advice on disposing of medications; it is very often insufficient to simply throw medicines away into your regular trash and you should take precautions to minimize the risk of it getting into the wrong hands.

The best way to get rid of unwanted or unused medicine is to book a collection via one of the FDA’s medicine take-back schemes. These are available throughout the country in most locations and are the most convenient and safest way to empty your drugs cabinet. Visit the FDA’s website for further information about take-back schemes for residents of the United States, or ask your doctor for further information.

Do not attempt to flush your medication down the toilet or a drain, unless your doctor has advised you to do so.

Summary

Codeine, Phenylephrine, and Promethazine is a widely-used drug combination that has been found to effectively remedy the effects of allergies or persistent common colds. It is available as a prescription or upon the advice of a qualified pharmacist, and is designed only as a short-term treatment for viral conditions or allergies.

Due to the addictive nature of codeine, it is highly recommended that this drug combination is not used for long periods of time, and patients must not exceed the stated dose. Patients that take this medication should be fully educated on the risk of addiction and dependency when using codeine, and it is not generally recommended for those that have a history of substance or alcohol abuse.

As this is a combination medication, there are many other drugs that can interact with one of the three active ingredients. Therefore, it is essential that the patient makes a note of any other medications they may be taking and discusses this with a pharmacist or doctor before taking the treatment. This treatment also has interactions with a number of conditions and diseases, so it may not be safe to take for some people. The drug is a particularly strong treatment for allergies and the common cold, and therefore is not recommended for light instances of discomfort – rather for persistent or particularly unpleasant cases. It is also not suitable for consumption by children under the age of 12, and dosages may need to be reduced for elderly patients.

Provided the instructions for taking Codeine, Phenylephrine, and Promethazine are followed, and the dosage is not exceeded or abused, this treatment can be very fast-acting and effective at reliving uncomfortable symptoms and pain. It is not, however, a cure for allergies and will not prevent further viral infections. The patient will need to take extra precautions to prevent repeat bouts of the conditions, including lifestyle changes and staying away from the cause of allergies.