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Codeine / Guaifenesin / Pseudoephedrine Dosage

Applies to the following strength(s): 10 mg-100 mg-30 mg/5 mL ; 20 mg-200 mg-60 mg/5 mL ; 10 mg-100 mg-22.5 mg/5 mL ; 9 mg-200 mg-30 mg/5 mL ; 10 mg-400 mg-60 mg ; 20 mg-400 mg-60 mg ; 10 mg-400 mg-40 mg ; 20 mg-400 mg-40 mg ; 10 mg-400 mg-20 mg ; 20 mg-400 mg-20 mg ; 10 mg-400 mg-30 mg ; 20 mg-400 mg-30 mg ; 8 mg-200 mg-30 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 Cold Symptoms

1 dose orally every 4 to 6 hours as needed
-Codeine: Single dose: up to 20 mg; Maximum daily dose: 120 mg in 24 hours
-Guaifenesin: Single dose: up to 400 mg; Maximum daily dose: 2400 mg in 24 hours
-Pseudoephedrine: Single dose: up to 60 mg; Maximum daily dose: 240 mg in 24 hours

Comments:
-Maximum dose should not exceed maximum dose of any of the single ingredient doses.
-Oral liquid should be measured with an accurate milliliter measuring device.

Uses: Temporary relief of coughs due to the common cold, allergic rhinitis or other upper respiratory allergies; reduces swelling of nasal passages to relieve nasal congestion and helps loosen mucus and thin bronchial secretions to make cough more productive.

Usual Pediatric Dose for Cold Symptoms

Age: Less than 2 years:
-Not recommended

Age: 2 to less than 6 years:
Under physician supervision
1 dose orally every 4 to 6 hours as needed
-Codeine: 1 mg/kg/day in equally divided doses
-Guaifenesin: Single dose: up to 100 mg; Maximum dose: 600 mg in 24 hours
-Pseudoephedrine: Single dose: up to 15 mg; Maximum dose: 60 mg in 24 hours

Age: 6 to less than 12 years:
1 dose orally every 4 to 6 hours as needed
-Codeine: Single dose: up to 10 mg; Maximum dose: 60 mg in 24 hours
-Guaifenesin: Single dose: up to 200 mg; Maximum dose: 1200 mg in 24 hours
-Pseudoephedrine: Single dose: up to 30 mg; Maximum dose: 120 mg in 24 hours

Age: 12 years or older:
1 dose orally every 4 to 6 hours as needed
-Codeine: Single dose: up to 20 mg; Maximum dose: 120 mg in 24 hours
-Guaifenesin: Single dose: up to 400 mg; Maximum dose: 2400 mg in 24 hours
-Pseudoephedrine: Single dose: up to 60 mg; Maximum dose: 240 mg in 24 hours

Comments:
- Maximum doses should not exceed any of the single or maximum daily doses.
-Oral liquid should be measured with an accurate milliliter measuring device, especially in children under 6 years old.
-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, or those taking other medications unless directed by a physician.

Uses: Temporary relief of coughs due to the common cold, allergic rhinitis or other upper respiratory allergies; reduces swelling of nasal passages to relieve nasal congestion and helps loosen mucus and thin bronchial secretions to make cough more productive.

Renal Dose Adjustments

Dose adjustments not recommended

Liver Dose Adjustments

Dose adjustments not recommended

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 have not been established in patients younger than 2 years.
-Consumer Healthcare Products Association (CHPA) has recommended all combination cough and cold products be labeled "Do not use in children under 4 years of age".

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 provided to ensure accuracy in dosing; a household teaspoon should not be considered an accurate measuring device

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; recommended doses should not be exceeded.
-Patients should be understand that this product is for temporary relief of cough; if cough persists for longer than 1 week, recurs, or is accompanied by fever, rash, or persistent headache, a health care professional should be consulted.
-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.
-Patients should be instructed to discontinue use if they experience nervousness, dizziness, or sleeplessness.

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