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Chlorpheniramine / Codeine Dosage

Medically reviewed on January 15, 2018.

Applies to the following strengths: 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; 2.8 mg-14.7 mg/5 mL

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)
10 mL orally every 12 hours
Maximum dose: 20 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)
10 mL orally every 12 hours
Maximum dose: 20 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.

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 WARNINGS: ULTRA-RAPID METABOLISM OF CODEINE AND OTHER RISK FACTORS FOR LIFE-THREATENING RESPIRATORY DEPRESSION IN CHILDREN; RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS:
-Ultra-Rapid Metabolism of Codeine and Other Risk Factors for Life-Threatening Respiratory Depression in Children: Life-threatening respiratory depression and death have occurred in children who received codeine. Most of the reported cases occurred following tonsillectomy and/or adenoidectomy, and many of the children had evidence of being an ultra-rapid metabolizer of codeine due to a CYP450 2D6 polymorphism. This drug is contraindicated in children younger than 12 years of age and in children younger than 18 years of age following tonsillectomy and/or adenoidectomy. Avoid the use of this drug in adolescents 12 to 18 years of age who have other risk factors that may increase their sensitivity to the respiratory depressant effects of codeine.
-Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Avoid use of opioid cough medications in patients taking benzodiazepines, other CNS depressants, or alcohol.

The US FDA recommends against use of codeine-containing cough and cold medications in patients less than 18 years because it has been determined that the risks outweigh benefits.

Safety and efficacy of extended-release oral suspension have not been established in patients younger than 18 years.
Safety and efficacy of immediate-release oral suspension have not been established in patients younger than 12 years.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule III (extended-release); Schedule V (immediate-release)

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.
-The US FDA recommends against use of codeine-containing cough and cold medications in patients less than 18 years because it has been determined that the risks outweigh benefits.

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.

Further information

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

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