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Promethazine and codeine (Oral route)

Pronunciation:

proe-METH-a-zeen hye-droe-KLOR-ide, KOE-deen FOS-fate

Brand Names:

  • Phenergan w/Codeine

Dosage Forms:

  • Syrup

Warnings:

Oral route(Solution)

Promethazine/codeine use is contraindicated in pediatric patients under 6 years of age. Concomitant use of respiratory depressants has an association with respiratory depression, and sometimes death, in pediatric patients. Postmarketing cases of respiratory depression, including fatalities, have been reported with a wide range of weight-based promethazine doses in pediatric patients younger than 2 years. Respiratory depression and death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultrarapid metabolizers of codeine due to CYP2D6 polymorphism .

Classifications:

Therapeutic—

Antitussive, Opioid/Antihistamine Combination

Pharmacologic—

Promethazine

Chemical—

Promethazine

Uses of This Medicine:

Promethazine and codeine combination is used to relieve cough, runny or stuffy nose, sneezing, or other symptoms caused by allergies or the common cold.

Promethazine is an antihistamine. It works by preventing the effects of a substance called histamine, which is produced by the body. Histamine can cause itching, sneezing, runny nose, and watery eyes. It can sometimes close up the bronchial tubes (air passages of the lungs) and make breathing difficult.

Codeine belongs to the group of medicine called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Use of promethazine and codeine combination is not recommended in children younger than 6 years of age because of the increased risk of respiratory depression.

Promethazine and codeine combination should not be used to relieve pain after surgery to remove tonsils and/or adenoids in any children. Severe breathing problems and deaths have been reported in some children who received codeine after tonsil or adenoid surgery.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of promethazine and codeine combination in the elderly. However, elderly patients are more likely to have unwanted effects (such as confusion, drowsiness) and age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving this medicine.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Cisapride
  • Dronedarone
  • Grepafloxacin
  • Mesoridazine
  • Metoclopramide
  • Naltrexone
  • Pimozide
  • Piperaquine
  • Sparfloxacin
  • Thioridazine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Adinazolam
  • Alfentanil
  • Alfuzosin
  • Alprazolam
  • Amiodarone
  • Amitriptyline
  • Amoxapine
  • Anileridine
  • Apomorphine
  • Arsenic Trioxide
  • Asenapine
  • Astemizole
  • Azithromycin
  • Bromazepam
  • Brotizolam
  • Buprenorphine
  • Bupropion
  • Butalbital
  • Butorphanol
  • Carbinoxamine
  • Carisoprodol
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chloroquine
  • Chlorpromazine
  • Chlorzoxazone
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Codeine
  • Crizotinib
  • Dantrolene
  • Dasatinib
  • Desipramine
  • Dezocine
  • Diazepam
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Domperidone
  • Droperidol
  • Erythromycin
  • Estazolam
  • Ethchlorvynol
  • Fentanyl
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Flunitrazepam
  • Fluoxetine
  • Flurazepam
  • Gatifloxacin
  • Gemifloxacin
  • Granisetron
  • Halazepam
  • Halofantrine
  • Haloperidol
  • Hydrocodone
  • Hydromorphone
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Isradipine
  • Ivabradine
  • Ketazolam
  • Lapatinib
  • Levofloxacin
  • Levorphanol
  • Lithium
  • Lopinavir
  • Lorazepam
  • Lormetazepam
  • Lumefantrine
  • Meclizine
  • Medazepam
  • Mefloquine
  • Meperidine
  • Mephenesin
  • Mephobarbital
  • Meprobamate
  • Meptazinol
  • Metaxalone
  • Methadone
  • Methocarbamol
  • Methohexital
  • Metrizamide
  • Midazolam
  • Mifepristone
  • Morphine
  • Morphine Sulfate Liposome
  • Moxifloxacin
  • Nalbuphine
  • Nilotinib
  • Nitrazepam
  • Nordazepam
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Ondansetron
  • Opium
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Paliperidone
  • Pazopanib
  • Pentamidine
  • Pentazocine
  • Perflutren Lipid Microsphere
  • Posaconazole
  • Prazepam
  • Procainamide
  • Procarbazine
  • Prochlorperazine
  • Propafenone
  • Propoxyphene
  • Protriptyline
  • Quazepam
  • Quetiapine
  • Quinine
  • Ranolazine
  • Remifentanil
  • Salmeterol
  • Saquinavir
  • Sodium Oxybate
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Sufentanil
  • Sunitinib
  • Tapentadol
  • Telavancin
  • Telithromycin
  • Temazepam
  • Terfenadine
  • Tetrabenazine
  • Thiopental
  • Toremifene
  • Tramadol
  • Triazolam
  • Trifluoperazine
  • Trimipramine
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Voriconazole
  • Ziprasidone
  • Zolpidem

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Belladonna
  • Belladonna Alkaloids
  • Betel Nut
  • Evening Primrose
  • Meperidine
  • Midodrine
  • Perampanel
  • Phenylalanine

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Addison's disease (an adrenal problem) or
  • Brain tumors or
  • Breathing problems (eg, respiratory depression, sleep apnea) or
  • Drug abuse or dependence or
  • Enlarged prostate or
  • Glaucoma, narrow-angle or
  • Head injury, history of or
  • Hypothyroidism (underactive thyroid) or
  • Seizures, history of or
  • Stomach or bowel problems (eg, blockage, peptic ulcer, ulcerative colitis) or
  • Surgery (eg, stomach, bowel, urinary tract), recent or
  • Trouble urinating—Use with caution. May increase risk for more serious side effects.
  • Bone marrow problems (eg, agranulocytosis, leukopenia) or
  • Heart or blood vessel disease or
  • Hypotension (low blood pressure) or
  • Kidney disease or
  • Liver disease—Use with caution. May make these conditions worse.
  • Lung disease or breathing problems (eg, asthma) or
  • Surgery in children (eg, nasopharyngeal tonsils, tonsils)—Should not be used in patients with these conditions.

Proper Use of This Medicine:

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. If too much of this medicine is taken for a long time, it may become habit-forming and cause mental or physical dependence.

Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (solution):
    • For relief of symptoms caused by allergies or the common cold:
      • Adults and children 12 years of age and older—5 milliliters (mL) (1 teaspoonful) every 4 to 6 hours. Do not take more than 30 mL in 24 hours.
      • Children 6 to 11 years of age—2.5 to 5 mL (0.5 to 1 teaspoonful) every 4 to 6 hours. Do not take more than 30 mL in 24 hours.
      • Children younger than 6 years of age—Use is not recommended.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is very important that your doctor check your or your child's progress while taking this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.

If your condition does not improve or become worse, check with your doctor.

Codeine is changed to morphine in the body. Some people change codeine to morphine more quickly than others. These individuals are called "ultra-rapid metabolizers of codeine". Contact your doctor immediately if you experience extreme sleepiness, confusion, or shallow breathing. These symptoms may indicate that you are an "ultra-rapid metabolizer of codeine". As a result, there may be too much morphine in the body and more side effects from morphine than usual. Children may be especially sensitive to this effect.

If a nursing mother is an ultra-rapid metabolizer of codeine, it could lead to a morphine overdose in the nursing baby and cause very serious side effects.

For nursing mothers taking this medicine:

  • Talk to your doctor if you have any questions about taking codeine or about how this medicine may affect your baby.
  • Call your doctor if you become extremely tired and have difficulty caring for your baby.
  • Your baby should generally nurse every 2 to 3 hours and should not sleep more than 4 hours at a time.
  • Check with your doctor or hospital emergency room immediately if your baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, difficulty breathing, or limpness. These may be symptoms of an overdose and need immediate medical attention.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. Avoid driving, using machines, or do anything else that could be dangerous if you are not alert. You may also feel lightheaded when getting up suddenly from a lying or sitting position, so stand up slowly.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, medicine for seizures or barbiturates, or anesthetics, including some dental anesthetics. Check with your medical doctor or dentist before taking any of the above while you or your child are taking this medicine.

Check with your doctor right away if you or your child are having convulsions, difficulty in breathing, fast heartbeat, high fever, high or low blood pressure, increased sweating, loss of bladder control, severe muscle stiffness, unusually pale skin, or tiredness. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS).

If you think you or your child may have taken an overdose of this medicine, get emergency help at once. Signs of an overdose include extreme sleepiness, confusion, shallow breathing, hallucinations, nausea or vomiting, pinpoint pupils of the eyes, pale or blue lips, fingernails, or skin, or seizures.

Before you have any medical tests, tell the medical doctor in charge that you or your child are taking this medicine. The results of some tests may be affected by this medicine.

This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

This medicine may cause dryness of the mouth. For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known
Abdominal or stomach pain
bluish lips or skin
chills
clay-colored stools
cold sweats
confusion
convulsions
cough
dark urine
decrease in the frequency of urination
decrease in the urine volume
diarrhea
difficult or troubled breathing
difficulty in passing urine (dribbling)
dizziness
dizziness, faintness, or lightheadedness when getting up from lying or sitting position
fast, pounding, or irregular heartbeat or pulse
feeling of warmth
fever
headache
high fever
hives or welts
increased sweating
irregular, fast or slow, or shallow breathing
itching
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
loss of bladder control
nausea
noisy breathing
not breathing
painful urination
pale or blue lips, fingernails, or skin
rash
rectal bleeding
redness of the face, neck, arms, and occasionally, upper chest
redness of the skin
seeing, hearing, or feeling things that are not there
severe muscle stiffness
shakiness in the legs, arms, or hands
shortness of breath
sweating
tightness in the chest
tiredness
trembling or shaking of the hands or feet
unpleasant breath odor
unusual tiredness or weakness
unusually pale skin
vomiting of blood
yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
Cold, clammy skin
dry mouth
fainting
irregular heartbeat
no blood pressure or pulse
no muscle tone or movement
pinpoint pupils (black part of the eye)
stopping of the heart
unconsciousness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known
Bad dreams
blurred or loss of vision
confusion as to time, place, or person
continuing ringing or buzzing or other unexplained noise in the ears
difficulty having a bowel movement (stool)
disturbed color perception
double vision
drowsiness
false or unusual sense of well-being
halos around lights
hearing loss
holding false beliefs that cannot be changed by fact
increased sensitivity of the skin to sunlight
night blindness
overbright appearance of lights
redness or other discoloration of the skin
relaxed and calm
severe sunburn
sleepiness
trouble sleeping
tunnel vision
unusual excitement, nervousness, or restlessness
vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 4/4/2014

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