Codeine/Phenylephrine/Promethazine Side Effects

Brand Names: Promethazine VC with Codeine, Phenergan VC with Codeine

Please note - some side effects for Codeine/Phenylephrine/Promethazine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Codeine/Phenylephrine/Promethazine - for the Consumer

Codeine/Phenylephrine/Promethazine Syrup

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Codeine/Phenylephrine/Promethazine Syrup:

Anxiety; blurred vision; constipation; dizziness; drowsiness; dry mouth, throat, or nose; headache; nausea; nervousness; restlessness; tiredness or weakness; vomiting.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); abnormal thoughts; agitation; chest pain; confusion; change in the amount of urine produced; fast, slow, or irregular heartbeat; fainting; hallucinations; loss of coordination; mood or mental changes; muscle pain or stiffness; overexcitement; seizures; severe drowsiness; severe or persistent blurred vision, dizziness, headache, or lightheadedness; slow or irregular breathing; symptoms of infection (eg, fever, chills); tremors; uncontrolled muscle movements (eg, movements of the arms, legs, tongue, eyes); unusual bruising or bleeding; unusual sweating; vision problems; yellowing of the skin or eyes.

Side Effects by Body System

Nervous system

Nervous system side effects of codeine have included mental and respiratory depression, stupor, delirium, somnolence, and dysphoria. An increased risk of falls and hip fractures has been associated with codeine therapy, particularly in the elderly. Nervous system side effects of phenylephrine have included headache, dizziness, nervousness, restlessness, tremor, insomnia, convulsions, and central nervous system depression. Nervous system side effects of promethazine are common and include excessive sedation, drowsiness, fatigue, paradoxical excitation, and decreased motor coordination. Extrapyramidal effects (including oculogyric crises, torticollis and tongue protrusion), encephalitic symptoms, convulsions, and psychosis have been rarely reported.

Opiates may result in psychotic symptoms in some patients.

One retrospective study of elderly patients who sustained a hip fracture suggested that the relative risk of hip fracture was 1.6 in patients using codeine compared to age-matched nonusers.

Other

Fever, altered consciousness, autonomic dysfunction, and muscle rigidity are the hallmarks of the neuroleptic malignant syndrome. The neuroleptic malignant syndrome is associated with a case fatality rate of about 20%. Immediate discontinuation of promethazine and intensive monitoring and supportive care are indicated.

Other side effects of codeine have included withdrawal symptoms after either abrupt cessation or fast tapering of narcotic analgesics, including codeine, and have included agitation, restlessness, anxiety, insomnia, tremor, abdominal cramps, blurred vision, vomiting and sweating. Other side effects of promethazine have rarely included the neuroleptic malignant syndrome.

Cardiovascular

Cardiovascular adverse effects of codeine have included hypotension and dizziness. Cardiovascular side effects of phenylephrine have included palpitations, arrhythmias, and cardiovascular collapse with hypotension. Cardiovascular effects of promethazine have included rarely observed tachycardia, bradycardia, and transient hypotension. Prolongation of the QT interval, heart block, and malignant arrhythmias have been reported in association with other phenothiazines.

Gastrointestinal

Gastrointestinal side effects of codeine have included nausea, vomiting, and constipation. Severe constipation and ileus resulting in colonic perforation have been also reported. Four cases of acute pancreatitis have been reported. Gastrointestinal side effects of phenylephrine have included nausea. Gastrointestinal side effects of promethazine have included nausea and vomiting.

Genitourinary

Genitourinary side effects of codeine have included urinary retention. Genitourinary side effects of phenylephrine have included dysuria.

Dermatologic

Dermatologic side effects of codeine have included rash. Codeine-induced rash may be related to direct stimulation of histamine release. There are also case reports of severe scarlatiniform eruptions.

Renal

Renal side effects of codeine have included acute renal failure (which may respond to naloxone therapy).

Immunologic

Immunologic side effects of codeine have included one study of a patient with exercise-induced anaphylaxis and three control subjects. This study found a correlation between codeine wheal size and recent exercise. Immunologic side effects of promethazine have included rare reports of a systemic lupus erythematosus syndrome.

Hypersensitivity

Hypersensitivity reactions have included rare reports of rash, pruritus, hypotension, photosensitivity, and tachycardia.

Hematologic

Hematologic effects of promethazine have included rare cases of neutropenia.

Psychiatric

Psychiatric side effects of phenylephrine have included hallucinations, fear, and anxiety.

Respiratory

Respiratory side effects of phenylephrine have included respiratory difficulty.

General

General side effects of phenylephrine have included pallor and weakness.

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