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Chlorpheniramine / Codeine Dosage

Applies to the following strength(s): 2 mg-10 mg/5 mL ; 1 mg-3 mg/3 mL ; 1 mg-3.5 mg/3.5 mL ; 1 mg-4 mg/4 mL ; 1 mg-4.5 mg/4.5 mL ; 2 mg-5 mg/5 mL ; 2 mg-7.5 mg/7.5 mL ; 2 mg-10 mg/10 mL ; 4 mg-15 mg/15 mL ; 2 mg-9 mg/5 mL ; 4 mg-10 mg ; 4 mg-20 mg ; 2 mg-8 mg/5 mL ; 4 mg-20 mg/5 mL

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Allergic Rhinitis

Immediate-release (suspension, liquid, tablets):
1 dose orally every 4 to 6 hours as needed
-Chlorpheniramine: Single dose: up to 4 mg; Maximum dose: 24 mg/24 hours
-Codeine: Single dose: up to 20 mg; Maximum dose: 120 mg/24 hours
Maximum doses should not exceed maximum dose of either of the single ingredient doses

Extended-release suspension: chlorpheniramine polistirex 2.8 mg/codeine polistirex 14.7 mg per 5 mL (equivalent to chlorpheniramine maleate 4 mg/codeine phosphate 20 mg per 5 mL)
5 mL orally every 12 hours
Maximum dose: 10 mL/24 hours

Comments:
-Liquid preparations should be measured with an accurate milliliter measuring device.
-Shake oral suspensions well before measuring dose.

Uses: For the temporary relief of cough due to minor throat and bronchial irritations as may occur with the common cold or inhaled irritants; temporarily decreases runny nose and reduces sneezing, itching of the nose or throat, and itchy, watery eyes due to hay fever or other upper respiratory allergies.

Usual Adult Dose for Cough and Nasal Congestion

Immediate-release (suspension, liquid, tablets):
1 dose orally every 4 to 6 hours as needed
-Chlorpheniramine: Single dose: up to 4 mg; Maximum dose: 24 mg/24 hours
-Codeine: Single dose: up to 20 mg; Maximum dose: 120 mg/24 hours
Maximum doses should not exceed maximum dose of either of the single ingredient doses

Extended-release suspension: chlorpheniramine polistirex 2.8 mg/codeine polistirex 14.7 mg per 5 mL (equivalent to chlorpheniramine maleate 4 mg/codeine phosphate 20 mg per 5 mL)
5 mL orally every 12 hours
Maximum dose: 10 mL/24 hours

Comments:
-Liquid preparations should be measured with an accurate milliliter measuring device.
-Shake oral suspensions well before measuring dose.

Uses: For the temporary relief of cough due to minor throat and bronchial irritations as may occur with the common cold or inhaled irritants; temporarily decreases runny nose and reduces sneezing, itching of the nose or throat, and itchy, watery eyes due to hay fever or other upper respiratory allergies.

Usual Pediatric Dose for Allergic Rhinitis

Under 2 years: Not recommended

2 to 6 years: Under physician supervision
-Chlorpheniramine: up to 1 mg every 4 to 6 hours not to exceed 6 mg/24 hours
-Codeine: 1 mg/kg/day in equally divided doses every 4 to 6 hours

6 to 12 years:
Take 1 dose orally every 4 to 6 hours
-Chlorpheniramine: Single dose: up to 2 mg; Maximum dose: 12 mg/24 hours
-Codeine: Single dose up to 10 mg; Maximum dose: 60 mg/24 hours

12 years or older:
1 dose orally every 4 to 6 hours as needed
-Chlorpheniramine: Single dose: up to 4 mg; Maximum dose: 24 mg/24 hours
-Codeine: Single dose: up to 20 mg; Maximum dose: 120 mg/24 hours

Comments:
-Maximum doses should not exceed maximum dose of either of the single ingredient doses.
-The FDA supports action by the Consumer Healthcare Products Association (CHPA) and many drug manufacturers to place "do not use in children under 4 years of age" on the label of all over the counter (OTC) cough and cold medicines.
- The America Academy of Pediatrics (AAP) warns against use of combination cough and cold products in children due to lack of well-controlled efficacy studies and the potential for adverse effects and overdose.
-This product should not be administered to children who have a chronic respiratory disease or shortness of breath, persistent or chronic cough such as occurs with asthma or if cough is accompanied by excessive phlegm (mucus).
-Extended-release products are not indicated for use in patients less than 18 years of age.

Uses: For the temporary relief of cough due to minor throat and bronchial irritations as may occur with the common cold or inhaled irritants; temporarily decreases runny nose and reduces sneezing, itching of the nose or throat, and itchy, watery eyes due to hay fever or other upper respiratory allergies.

Usual Pediatric Dose for Cough and Nasal Congestion

Under 2 years: Not recommended

2 to 6 years: Under physician supervision
-Chlorpheniramine: up to 1 mg every 4 to 6 hours not to exceed 6 mg/24 hours
-Codeine: 1 mg/kg/day in equally divided doses every 4 to 6 hours

6 to 12 years:
Take 1 dose orally every 4 to 6 hours
-Chlorpheniramine: Single dose: up to 2 mg; Maximum dose: 12 mg/24 hours
-Codeine: Single dose up to 10 mg; Maximum dose: 60 mg/24 hours

12 years or older:
1 dose orally every 4 to 6 hours as needed
-Chlorpheniramine: Single dose: up to 4 mg; Maximum dose: 24 mg/24 hours
-Codeine: Single dose: up to 20 mg; Maximum dose: 120 mg/24 hours

Comments:
-Maximum doses should not exceed maximum dose of either of the single ingredient doses.
-The FDA supports action by the Consumer Healthcare Products Association (CHPA) and many drug manufacturers to place "do not use in children under 4 years of age" on the label of all over the counter (OTC) cough and cold medicines.
- The America Academy of Pediatrics (AAP) warns against use of combination cough and cold products in children due to lack of well-controlled efficacy studies and the potential for adverse effects and overdose.
-This product should not be administered to children who have a chronic respiratory disease or shortness of breath, persistent or chronic cough such as occurs with asthma or if cough is accompanied by excessive phlegm (mucus).
-Extended-release products are not indicated for use in patients less than 18 years of age.

Uses: For the temporary relief of cough due to minor throat and bronchial irritations as may occur with the common cold or inhaled irritants; temporarily decreases runny nose and reduces sneezing, itching of the nose or throat, and itchy, watery eyes due to hay fever or other upper respiratory allergies.

Renal Dose Adjustments

Use with caution, especially in patients with severe renal impairment

Liver Dose Adjustments

Use with caution, especially in patients with severe hepatic impairment

Dose Adjustments

Elderly: Use with caution generally starting at the lower end of the dosing range.

Precautions

US BOXED WARNING: DEATH RELATED TO ULTRA-RAPID METABOLISM OF CODEINE TO MORPHINE:
-Respiratory depression and death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to CYP450 2D6 polymorphism.

Safety and efficacy of extended-release oral suspension have not been established in patients younger than 18 years.

Safety and efficacy of immediate-release formulations have not been established in patients younger than 2 years.
-Children under 6 years of age should not use this product without physician supervision.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule V

Dialysis

Data not available

Other Comments

Administration advice:
-Take orally with or without food
-Oral measuring devices should be used to ensure accuracy in dosing; a household teaspoon should not be considered an accurate measuring device
-Shake suspension well prior to measuring dose

Storage requirements:
-Protect from moisture and light

General:
-Patients who are ultra-rapid metabolizers of codeine due to a CYP450 2D6 polymorphism, will convert codeine more rapidly and completely to morphine resulting in unexpectedly high morphine levels, which may be life-threatening.
-Codeine use is contraindicated in the postoperative period in children who have undergone tonsillectomy and/or adenoidectomy.
-Professional organizations are concerned with use of all cough and cold medicines in children; prescription and non-prescription alternatives to codeine for cough also have risks.

Monitoring:
-Cardiovascular: Monitor for signs of hypotension, especially in those whose blood pressure is compromised
-Respiratory: Monitor for respiratory depression
-Gastrointestinal: Monitor for constipation and decreased bowel motility in post-operative patients.
-Patients should be monitored for the development of addiction, abuse, or misuse.

Patient advice:
-Patients should understand that codeine use can result in addiction, abuse, and misuse.
-Patients should understand risks of life-threatening respiratory depression and when this risk is greatest; patients should be aware that a genetic mutation may result in greater codeine toxicity in some patients; breastfed infants of women who have this genetic mutation are also at risk.
-Women who are breastfeeding, pregnant, or planning to become pregnant should speak to their healthcare provider before using this product.
-This drug may cause drowsiness, dizziness, or impair thinking or motor skills; patients should avoid driving or operating machinery until adverse effects are determined.
-Concomitant use of alcohol, sedatives, and tranquilizers may increase drowsiness; patients should avoid alcohol and consult with their healthcare provider regarding concomitant use of other CNS depressants.

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