What is the name of the cough medicine with codeine (opioid) and how is it prescribed?

Codeine-Containing Cough Medications: Prescription Guidelines

Codeine phosphate with guaifenesin is the primary codeine-containing cough medication, dosed at 10mg codeine/100mg guaifenesin per 5mL, and should be prescribed only for short-term relief of dry cough due to minor throat and bronchial irritation when non-opioid options have failed. 1

First-Line Approaches Before Codeine

Before prescribing codeine-containing products, consider these evidence-based alternatives:

1. Non-pharmacological approaches:

   • Simple home remedies like honey and lemon 2
   • Demulcents and simple linctus syrups 2

2. Non-opioid medications:

   • Dextromethorphan (10-15mg three to four times daily) 2
   • Ipratropium bromide inhaler for cough due to URI or bronchitis 3
   • Peripheral cough suppressants like levodropropizine (75mg three times daily) for chronic bronchitis 3, 2

When to Consider Codeine

Codeine should be reserved for:

• Persistent dry cough not responding to first-line treatments
• Cough due to chronic bronchitis (where it has demonstrated 40-60% reduction in cough counts) 3
• Nocturnal cough disrupting sleep 3

Prescription Details for Codeine-Containing Products

When prescribing codeine for cough:

• Standard formulation: Codeine phosphate 10mg with guaifenesin 100mg per 5mL 1
• Dosing: Typically 5-10mL every 4-6 hours as needed
• Duration: Limited to short-term use (3-7 days)
• Schedule: Classified as a controlled substance requiring appropriate prescription protocols
• Maximum daily dose: Generally not to exceed 120mg of codeine per day

Important Prescribing Considerations

Efficacy Considerations

• Codeine is effective for cough due to chronic bronchitis but has limited efficacy for cough due to upper respiratory infections 3
• Consider that codeine must be metabolized to morphine by CYP2D6 to be effective, and efficacy varies based on patient metabolism 4

Safety Precautions

• Contraindications: Avoid in patients with respiratory depression, MAOI use, head injury
• Drug interactions: Caution with CNS depressants, antihistamines, and CYP2D6 inhibitors
• Side effects: Monitor for drowsiness, constipation, nausea, and respiratory depression 4
• Dependency risk: Limit duration of use due to potential for physical dependence 4

Special Populations

• Elderly: Use lower doses due to increased sensitivity to side effects
• Pregnancy: Avoid if possible, especially in third trimester 2
• Children: Not recommended due to safety concerns and limited evidence of efficacy

Alternative Opioid Antitussives

If codeine is not suitable, consider:

• Hydrocodone (5mg twice daily) 2
• Dihydrocodeine (10mg three times daily) 2
• Pholcodine (where available) 3

Monitoring and Follow-up

• Assess response after 2-4 days 2
• Discontinue if no improvement is observed
• Ensure adequate expectoration despite cough suppression 2
• Watch for red flags requiring immediate attention (hemoptysis, increasing breathlessness, fever)

Common Pitfalls to Avoid

1. Prescribing codeine for viral URI cough where efficacy is limited 3
2. Extended use beyond 7-10 days, increasing dependency risk
3. Failure to consider CYP2D6 metabolism variations affecting efficacy
4. Not recognizing that combination products may contain other active ingredients with their own side effects
5. Overlooking non-opioid alternatives that may be equally effective with fewer side effects 5