Phenergan VC with Codeine Disease Interactions
There are 33 disease interactions with Phenergan VC with Codeine (codeine / phenylephrine / promethazine).
- Impaired GI motility
- Infectious diarrhea
- Prematurity
- Acute alcohol intoxication
- Drug dependence
- Hypotension
- Intracranial pressure
- Respiratory depression
- Gastrointestinal obstruction
- Acute alcohol intoxication
- CNS depression
- Hematologic toxicity
- Hypotension
- Liver disease
- Antidopaminergic effects 1
- Asthma
- Cardiovascular disease
- Anticholinergic effects
- Asthma/COPD
- Adrenal insufficiency
- Liver disease
- Renal dysfunction
- Seizure disorders
- Urinary retention
- Arrhythmias
- Biliary tract disease
- Breast cancer
- NMS
- Seizure disorders
- Antidopaminergic effects 2
- BPH
- Diabetes
- Glaucoma
Narcotic analgesics (applies to Phenergan VC with Codeine) impaired GI motility
Major Potential Hazard, Moderate plausibility. Applicable conditions: Constipation, Gastrointestinal Obstruction, Inflammatory Bowel Disease, Intestinal Anastomoses
Narcotic (opioid) analgesic agents increase smooth muscle tone in the gastrointestinal tract and decrease peristalsis, which can lead to elevated intraluminal pressure, spasm, and constipation following prolonged use. In patients with severe or acute inflammatory bowel disease, the decrease in colonic motility may induce toxic megacolon. Therapy with opioids should be administered cautiously in patients with gastrointestinal obstruction, constipation, inflammatory bowel disease, or recent gastrointestinal tract surgery. Gastrointestinal effects appear to be the most pronounced with morphine.
Narcotic analgesics (applies to Phenergan VC with Codeine) infectious diarrhea
Major Potential Hazard, Moderate plausibility. Applicable conditions: Infectious Diarrhea/Enterocolitis/Gastroenteritis
Narcotic (opioid) analgesic agents may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic Escherichia coli, Salmonella, Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. These agents decrease gastrointestinal motility, which may delay the excretion of infective gastroenteric organisms and/or their toxins. Other symptoms and complications such as fever, shedding of organisms, and extraintestinal illness may also be increased or prolonged. Therapy with opioids should be avoided or administered cautiously in patients with infectious diarrhea, particularly that due to pseudomembranous enterocolitis or enterotoxin-producing bacteria or if accompanied by high fever, pus, or blood in the stool.
Narcotic analgesics (applies to Phenergan VC with Codeine) prematurity
Major Potential Hazard, Moderate plausibility. Applicable conditions: Prematurity/Underweight in Infancy
The use of narcotic (opioid) analgesic agents is contraindicated in premature infants. These agents may cross the immature blood-brain barrier to a greater extent than in adults, resulting in disproportionate respiratory depression.
Opiate agonists (applies to Phenergan VC with Codeine) acute alcohol intoxication
Major Potential Hazard, High plausibility.
The use of opiate agonists is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of opiate agonists may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with opiate agonists should be administered cautiously in patients who might be prone to acute alcohol intake.
Opiate agonists (applies to Phenergan VC with Codeine) drug dependence
Major Potential Hazard, High plausibility. Applicable conditions: Alcoholism, Drug Abuse/Dependence
Opiate agonists have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop after prolonged use. Abrupt cessation, reduction in dosage, or administration of an opiate antagonist such as naloxone may precipitate withdrawal symptoms. In patients who have developed tolerance to an opiate agonist, overdosage can still produce respiratory depression and death, and cross-tolerance usually will occur with other agents in the class. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance or medical supervision when treated with opiate agonists. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of opiate therapy should be undertaken gradually using a dosage-tapering schedule.
Opiate agonists (applies to Phenergan VC with Codeine) hypotension
Major Potential Hazard, Moderate plausibility. Applicable conditions: Shock, Dehydration
Opiate agonists can induce vasodilation and significant hypotension, particularly when given in high dosages and/or by rapid intravenous administration. Opiate analgesics cause vasodilatation that may exacerbate hypotension and hypoperfusion and, therefore, are contraindicated in circulatory shock. At therapeutic analgesic dosages, ambulatory patients are more likely to experience dizziness and hypotension than patients who are confined to bed. However, orthostatic hypotension may occur in supine patients upon rising. Therapy with opiate agonists should be administered cautiously and initiated at reduced dosages in patients with hypovolemia, or a predisposition to hypotension. When given by intramuscular or subcutaneous administration, clinicians should also be aware that impaired perfusion in these patients may prevent complete absorption of the drug. With repeated injections, an excessive amount may be absorbed suddenly if normal circulation is reestablished.
Opiate agonists (applies to Phenergan VC with Codeine) intracranial pressure
Major Potential Hazard, Moderate plausibility. Applicable conditions: Head Injury, Brain/Intracranial Tumor, Cerebral Vascular Disorder
The hypoventilation associated with administration of opiate agonists, particularly by the intravenous route, can induce cerebral hypoxia and vasodilatation with resultant increase in intracranial pressure. Opiate agonists should not be used in patients with suspected or known head injury or increased intracranial pressure. Also, clinicians treating such patients should be aware that opiate agonists may interfere with the evaluation of CNS function, especially with respect to consciousness levels, respiratory status, and pupillary changes.
Opiate agonists (applies to Phenergan VC with Codeine) respiratory depression
Major Potential Hazard, High plausibility. Applicable conditions: Altered Consciousness, Asphyxia, Brain/Intracranial Tumor, Cerebral Vascular Disorder, Head Injury, Pulmonary Impairment, Respiratory Arrest
Opiate agonists may produce significant central nervous system and respiratory depression of varying duration, particularly when given in high dosages and/or by rapid intravenous administration. Apnea may result from decreased respiratory drive as well as increased airway resistance, and rigidity of respiratory muscles may occur during rapid IV administration or when these agents are used in the induction of anesthesia. At therapeutic analgesic dosages, the respiratory effects are usually not clinically important except in patients with preexisting pulmonary impairment. Therapy with opiate agonists should be avoided or administered with extreme caution and initiated at reduced dosages in patients with severe CNS depression; sleep apnea; hypoxia, anoxia, or hypercapnia; upper airway obstruction; chronic pulmonary insufficiency; a limited ventilatory reserve; or other respiratory disorders. In the presence of excessive respiratory secretions, the use of opiate agonists may also be problematic because they decrease ciliary activity and reduce the cough reflex. Caution is also advised in patients who may be at increased risk for respiratory depression, such as comatose patients or those with head injury, intracranial lesions, or intracranial hypertension. Clinical monitoring of pulmonary function is recommended, and equipment for resuscitation should be immediately available if parenteral or neuraxial routes are used. Naloxone may be administered to reverse clinically significant respiratory depression, which may be prolonged depending on the opioid agent, cumulative dose, and route of administration.
Opioid agonists (applies to Phenergan VC with Codeine) gastrointestinal obstruction
Major Potential Hazard, Moderate plausibility.
Opioid analgesics are contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus.
Phenothiazines (applies to Phenergan VC with Codeine) acute alcohol intoxication
Major Potential Hazard, High plausibility. Applicable conditions: Alcoholism
Phenothiazines are contraindicated in the presence of large amounts of central nervous system depressants such as alcohol. The risk of suicide and the danger of overdose may be increased in patients who use alcohol excessively. Phenothiazines should be used with caution in patients experiencing alcohol withdrawal.
Phenothiazines (applies to Phenergan VC with Codeine) CNS depression
Major Potential Hazard, High plausibility. Applicable conditions: Altered Consciousness, Respiratory Arrest
The use of phenothiazines is contraindicated in comatose patients and patients with severe central nervous system depression. Phenothiazines may potentiate the CNS and respiratory depression in these patients.
Phenothiazines (applies to Phenergan VC with Codeine) hematologic toxicity
Major Potential Hazard, Moderate plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts
Phenothiazines may cause hematologic toxicity. In patients with preexisting blood dyscrasias, bone marrow suppression, or a history of drug-induced leukopenia or neutropenia, phenothiazines should not be used or are contraindicated. Complete blood counts should be regularly monitored in patients with risk factors for blood dyscrasias. If white blood cell counts indicate cellular depression, discontinue treatment and institute appropriate therapy.
Phenothiazines (applies to Phenergan VC with Codeine) hypotension
Major Potential Hazard, Moderate plausibility. Applicable conditions: Cardiovascular Disease, Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Pheochromocytoma, Arrhythmias, Valvular Heart Disease, Hypertension
Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.
Phenothiazines (applies to Phenergan VC with Codeine) liver disease
Major Potential Hazard, Moderate plausibility.
Therapy with phenothiazines should be administered cautiously or are contraindicated in patients with preexisting liver disease or with a history of jaundice due to phenothiazine hypersensitivity. Patients with a history of hepatic encephalopathy due to cirrhosis may have increased sensitivity to the central nervous system effects of some phenothiazines (e.g., chlorpromazine). Treatment should be discontinued if jaundice occurs.
Promethazine (applies to Phenergan VC with Codeine) antidopaminergic effects 1
Major Potential Hazard, Moderate plausibility. Applicable conditions: Dehydration, Hypocalcemia, Tardive Dyskinesia, Neuroleptic Malignant Syndrome
Promethazine has weak central antidopaminergic activity. While its use is rarely associated with adverse effects secondary to dopaminergic blockade, large doses have produced extrapyramidal reactions. During chronic administration and/or high-dose therapy, the usual contraindications, warnings and precautions applicable to phenothiazines should be observed with promethazine.
Promethazine (applies to Phenergan VC with Codeine) asthma
Major Potential Hazard, High plausibility. Applicable conditions: Pulmonary Impairment
Promethazine is contraindicated for use in the treatment of lower respiratory tract symptoms including asthma. Furthermore, promethazine tablets may lead to potentially fatal respiratory depression, and its use should be avoided in patients with compromised respiratory function such as patients with COPD, and sleep apnea.
Sympathomimetics (applies to Phenergan VC with Codeine) cardiovascular disease
Major Potential Hazard, High plausibility. Applicable conditions: Cerebrovascular Insufficiency, Hyperthyroidism, Pheochromocytoma
Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.
Antihistamines (applies to Phenergan VC with Codeine) anticholinergic effects
Moderate Potential Hazard, High plausibility. Applicable conditions: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary Retention
Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.
Antihistamines (applies to Phenergan VC with Codeine) asthma/COPD
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Chronic Obstructive Pulmonary Disease
It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.
Narcotic analgesics (applies to Phenergan VC with Codeine) adrenal insufficiency
Moderate Potential Hazard, Moderate plausibility.
Patients with Addison's disease may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. Conversely, these agents may cause or potentiate adrenal insufficiency. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with adrenocortical insufficiency. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.
Narcotic analgesics (applies to Phenergan VC with Codeine) liver disease
Moderate Potential Hazard, Moderate plausibility.
Narcotic (opioid) analgesic agents are extensively metabolized by the liver, and several of them (e.g., codeine, hydrocodone, meperidine, methadone, morphine, propoxyphene) have active metabolites that are further converted to inactive substances. The serum concentrations of these agents and their metabolites may be increased and the half-lives prolonged in patients with impaired hepatic function. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with liver disease. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.
Narcotic analgesics (applies to Phenergan VC with Codeine) renal dysfunction
Moderate Potential Hazard, Moderate plausibility.
Although narcotic (opioid) analgesic agents are generally metabolized by the liver, renal impairment can alter the elimination of these agents and their metabolites (some of which are pharmacologically active), resulting in drug accumulation and increased risk of toxicity. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with significantly impaired renal function. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.
Narcotic analgesics (applies to Phenergan VC with Codeine) seizure disorders
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Seizures
Narcotic (opioid) analgesic agents may increase the frequency of seizures in patients with seizure disorders, may increase the risk of seizures occurring in other clinical settings associated with seizures, and, at higher dosages, have been reported to induce seizures in patients without history of seizures. Patients with history of seizure disorders should be regularly evaluated for worsened seizure control during therapy. Prolonged meperidine use may increase the risk of toxicity (e.g., seizures) from the accumulation of the active metabolite (normeperidine).
Narcotic analgesics (applies to Phenergan VC with Codeine) urinary retention
Moderate Potential Hazard, Moderate plausibility.
Narcotic (opioid) analgesic agents may inhibit the urinary voiding reflex and increase the tone of the vesical sphincter in the bladder. Acute urinary retention requiring catheterization may occur, particularly in patients with prostatic hypertrophy or urethral stricture and in older adult patients. These agents may also decrease urine production via direct effects on the kidney and central stimulation of the release of vasopressin. Therapy with opioids should be administered cautiously in patients with or predisposed to urinary retention and/or oliguria. The effects on smooth muscle tone appear to be the most pronounced with morphine.
Opiate agonists (applies to Phenergan VC with Codeine) arrhythmias
Moderate Potential Hazard, Moderate plausibility.
Opiate agonists have cholinergic activity. Large doses and/or rapid intravenous administration may produce bradycardia and arrhythmias via stimulation of medullary vagal nuclei. Therapy with opiate agonists should be administered cautiously in patients with a history of arrhythmias. Clinical monitoring of cardiovascular status is recommended during therapy.
Opioid agonists (applies to Phenergan VC with Codeine) biliary tract disease
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Biliary Obstruction, Gallbladder Disease, Pancreatitis
Opioid agonists may cause spasm of the sphincter of Oddi, which may increase biliary tract pressure. Other opioid-induced effects may include a reduction in biliary and pancreatic secretions and transient elevations in serum amylase. Patients with biliary tract disease (including acute pancreatitis) should be regularly evaluated for worsening symptoms. Therapy with opioids should be administered cautiously in patients with biliary tract disease, gallbladder disease, or acute pancreatitis.
Phenothiazines (applies to Phenergan VC with Codeine) breast cancer
Moderate Potential Hazard, Moderate plausibility.
The chronic use of phenothiazines is associated with persistent elevations in prolactin levels. The clinical significance in patients with a history of breast cancer is unknown and should be considered prior to therapy; approximately one-third of human breast cancers are thought to be prolactin-dependent. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in animal studies; however, evidence is inconclusive in humans.
Phenothiazines (applies to Phenergan VC with Codeine) NMS
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Neuroleptic Malignant Syndrome
Therapy with phenothiazines may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). Treatment should not be initiated in patients with active NMS, and should be immediately discontinued if currently administered in such patients. In patients with a history of NMS, introduction or reintroduction of phenothiazines should be carefully considered, since NMS may recur.
Phenothiazines (applies to Phenergan VC with Codeine) seizure disorders
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: CNS Disorder, Seizures
Phenothiazines can lower the seizure threshold. Caution is recommended during administration in patients with a history of convulsive disorders or EEG abnormalities. Anticonvulsant therapy should be maintained or adequately adjusted during phenothiazine treatment.
Promethazine (applies to Phenergan VC with Codeine) antidopaminergic effects 2
Moderate Potential Hazard, Low plausibility. Applicable conditions: Parkinsonism
Promethazine has weak central antidopaminergic activity. While its use is rarely associated with adverse effects secondary to dopaminergic blockade, large doses have produced extrapyramidal reactions. During chronic administration and/or high-dose therapy, the usual contraindications, warnings and precautions applicable to phenothiazines should be observed with promethazine.
Sympathomimetics (applies to Phenergan VC with Codeine) BPH
Moderate Potential Hazard, High plausibility. Applicable conditions: Benign Prostatic Hyperplasia, Prostate Tumor
Sympathomimetic agents may cause or worsen urinary difficulty in patients with prostate enlargement due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate.
Sympathomimetics (applies to Phenergan VC with Codeine) diabetes
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus
Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.
Sympathomimetics (applies to Phenergan VC with Codeine) glaucoma
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension
Sympathomimetic agents can induce transient mydriasis via stimulation of alpha-1 adrenergic receptors. In patients with anatomically narrow angles or narrow-angle glaucoma, pupillary dilation can provoke an acute attack. In patients with other forms of glaucoma, mydriasis may occasionally increase intraocular pressure. Therapy with sympathomimetic agents should be administered cautiously in patients with or predisposed to glaucoma, particularly narrow-angle glaucoma.
Switch to professional interaction data
Phenergan VC with Codeine drug interactions
There are 818 drug interactions with Phenergan VC with Codeine (codeine / phenylephrine / promethazine).
Phenergan VC with Codeine alcohol/food interactions
There are 3 alcohol/food interactions with Phenergan VC with Codeine (codeine / phenylephrine / promethazine).
More about Phenergan VC with Codeine (codeine / phenylephrine / promethazine)
- Check interactions
- Compare alternatives
- Side effects
- Dosage information
- During pregnancy
- Drug class: upper respiratory combinations
Related treatment guides
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.