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Codeine/ diphenhydramine/ phenylephrine solution

Generic Name: codeine/diphenhydramine/phenylephrine (KOE-deen/DYE-fen-HYE-dra-meen/FEN-il-EF-rin)
Brand Name: Examples include Airacof and Endal CD

Some children have had serious and sometimes fatal breathing problems when using codeine after surgery to remove tonsils or adenoids. Talk with your doctor for more information.

Codeine/ diphenhydramine/ phenylephrine solution is used for:

Relieving symptoms of sinus congestion, runny nose, sneezing, and cough caused by colds, upper respiratory infections, and allergies. It may also be used for other conditions as determined by your doctor.

Codeine/diphenhydramine/phenylephrine solution is a decongestant, antihistamine, and cough suppressant combination. It works by constricting blood vessels and reducing swelling in the nasal passages. The antihistamine works by blocking the action of histamine, which helps reduce symptoms such as watery eyes and sneezing. The cough suppressant works in the brain to help decrease the cough reflex to reduce a dry cough.

Do NOT use codeine/ diphenhydramine/ phenylephrine solution if:

  • you are allergic to any ingredient in codeine/diphenhydramine/phenylephrine solution
  • you have severe high blood pressure, severe heart blood vessel disease, rapid heartbeat, severe heart problems, stomach ulcer, narrow-angle glaucoma, or difficulty urinating, or you are having an asthma attack
  • you take sodium oxybate (GHB) or you have taken furazolidone or a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) within the last 14 days
  • the patient is a child and has just had surgery to remove tonsils or adenoids

Contact your doctor or health care provider right away if any of these apply to you.

Before using codeine/ diphenhydramine/ phenylephrine solution:

Some medical conditions may interact with codeine/diphenhydramine/phenylephrine solution. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have a recent head injury, severe drowsiness, brain tumor or lesion, or increased pressure in the brain
  • if you have a history of adrenal gland problems (eg, adrenal gland tumor); heart problems (eg, heart disease); fast, slow, or irregular heartbeat; high or low blood pressure; liver problems; low blood volume; diabetes; blood vessel problems; stroke; glaucoma or increased pressure in the eye; a blockage of your stomach, bladder, or intestines; recent stomach or bowel surgery or other stomach or bowel problems (eg, constipation, diarrhea caused by antibiotic use, inflammation, ulcers); trouble urinating; an enlarged prostate or other prostate problems; seizures; mental or mood problems (eg, depression); pancreas problems (eg, pancreatitis); or an overactive thyroid
  • if you have a history of asthma, sleep apnea, or other breathing problems (eg, slow or irregular breathing), chronic cough, lung problems (eg, chronic bronchitis, emphysema), or chronic obstructive pulmonary disease (COPD), or if your cough occurs with large amounts of mucus
  • if you have a history of alcohol abuse, drug abuse, or suicidal thoughts or behavior; or if you are in poor health or are very overweight

Some MEDICINES MAY INTERACT with codeine/diphenhydramine/phenylephrine solution. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Anticholinergics (eg, scopolamine) because a serious bowel problem (paralytic ileus) may occur
  • Digoxin or droxidopa because the risk of irregular heartbeat or heart attack may be increased
  • Beta-blockers (eg, propranolol), catechol-O-methyltransferase (COMT) inhibitors (eg, tolcapone), cimetidine, furazolidone, HIV protease inhibitors (eg, ritonavir), MAOIs (eg, phenelzine), muscle relaxants (eg, cyclobenzaprine), opioid analgesics (eg, hydrocodone), phenothiazines (eg, chlorpromazine), sodium oxybate (GHB), or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of codeine/diphenhydramine/phenylephrine solution's side effects
  • Naltrexone, quinidine, or rifamycins (eg, rifampin) because they may decrease codeine/diphenhydramine/phenylephrine solution's effectiveness
  • Bromocriptine or hydantoins (eg, phenytoin) because the risk of their side effects may be increased by codeine/diphenhydramine/phenylephrine solution
  • Guanadrel, guanethidine, mecamylamine, methyldopa, or reserpine because their effectiveness may be decreased by codeine/diphenhydramine/phenylephrine solution

This may not be a complete list of all interactions that may occur. Ask your health care provider if codeine/diphenhydramine/phenylephrine solution may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use codeine/ diphenhydramine/ phenylephrine solution:

Use codeine/diphenhydramine/phenylephrine solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Take codeine/diphenhydramine/phenylephrine solution by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
  • Take codeine/diphenhydramine/phenylephrine solution with a full glass of water (8 oz/240 mL).
  • Drink plenty of water while taking codeine/diphenhydramine/phenylephrine solution.
  • Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.
  • If you miss a dose of codeine/diphenhydramine/phenylephrine solution, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use codeine/diphenhydramine/phenylephrine solution.

Important safety information:

  • Codeine/diphenhydramine/phenylephrine solution may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use codeine/diphenhydramine/phenylephrine solution with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
  • Codeine/diphenhydramine/phenylephrine solution may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
  • Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using codeine/diphenhydramine/phenylephrine solution; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
  • Do not take diet or appetite control medicines while you take codeine/diphenhydramine/phenylephrine solution without checking with your doctor.
  • Codeine/diphenhydramine/phenylephrine solution has codeine, phenylephrine, and diphenhydramine in it. Before you start any new medicine, check the label to see if it has codeine, phenylephrine, or diphenhydramine in it too. If it does or if you are not sure, check with your doctor or pharmacist.
  • Do not use codeine/diphenhydramine/phenylephrine solution for a cough with a lot of mucus. Do not use it for a long-term cough (eg, caused by asthma, emphysema, smoking). However, you may use it for these conditions if your doctor tells you to.
  • Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.
  • If your symptoms do not get better within 5 to 7 days or if they get worse, check with your doctor.
  • Codeine/diphenhydramine/phenylephrine solution may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to codeine/diphenhydramine/phenylephrine solution. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
  • Codeine/diphenhydramine/phenylephrine solution may interfere with skin allergy tests. If you are scheduled for a skin test, talk to your doctor. You may need to stop taking codeine/diphenhydramine/phenylephrine solution for a few days before the tests.
  • Tell your doctor or dentist that you take codeine/diphenhydramine/phenylephrine solution before you receive any medical or dental care, emergency care, or surgery.
  • Use codeine/diphenhydramine/phenylephrine solution with caution in the ELDERLY; they may be more sensitive to its effects.
  • Caution is advised when using codeine/diphenhydramine/phenylephrine solution in CHILDREN; they may be more sensitive to its effects, especially excitability.
  • Codeine/diphenhydramine/phenylephrine solution should not be used in CHILDREN younger than 6 years old; safety and effectiveness in these children have not been confirmed.
  • PREGNANCY and BREAST-FEEDING: It is not known if codeine/diphenhydramine/phenylephrine solution can cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using codeine/diphenhydramine/phenylephrine solution while you are pregnant. It is not known if this medicine is found in breast milk. Do not breast-feed while taking codeine/diphenhydramine/phenylephrine solution.

Some people who use codeine/diphenhydramine/phenylephrine solution for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction.

If you stop taking codeine/diphenhydramine/phenylephrine solution suddenly, you may have WITHDRAWAL symptoms. These may include anxiety, irregular heartbeat, irritability, restlessness, trouble sleeping, and unusual sweating.

Possible side effects of codeine/ diphenhydramine/ phenylephrine solution:

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:

Constipation; diarrhea; dizziness; drowsiness; dry mouth, nose, or throat; excitability; headache; loss of appetite; nausea; nervousness or anxiety; trouble sleeping; upset stomach; vomiting; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); confusion; difficulty urinating or inability to urinate; fast or irregular heartbeat; hallucinations; mental or mood changes (eg, irritability); persistent trouble sleeping; restlessness; seizures; severe dizziness, lightheadedness, or headache; severe drowsiness; tremor; vision changes or blurred vision.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include blurred vision; cold and clammy skin; coma; confusion; hallucinations; seizures; severe dizziness, lightheadedness, or headache; severe drowsiness; unusually fast, slow, or irregular heartbeat; vomiting.

Proper storage of codeine/diphenhydramine/phenylephrine solution:

Store codeine/diphenhydramine/phenylephrine solution at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep codeine/diphenhydramine/phenylephrine solution out of the reach of children and away from pets.

General information:

  • If you have any questions about codeine/diphenhydramine/phenylephrine solution, please talk with your doctor, pharmacist, or other health care provider.
  • Codeine/diphenhydramine/phenylephrine solution is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take codeine/diphenhydramine/phenylephrine solution or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about codeine/diphenhydramine/phenylephrine solution. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to codeine/diphenhydramine/phenylephrine solution. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using codeine/diphenhydramine/phenylephrine solution.

Issue Date: June 3, 2015

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.