What are examples of cough medications containing codeine?

Examples of Cough Medications Containing Codeine

Codeine is commonly found in prescription cough medications, typically formulated as codeine phosphate (10-30 mg per dose) combined with other ingredients such as guaifenesin (100 mg) in liquid formulations. 1

Common Codeine-Containing Cough Preparations

Prescription Formulations:

• Codeine phosphate syrup/linctus (15 mg/5 mL) 2
• Codeine phosphate tablets (15 mg, 30 mg) 2
• Codeine-guaifenesin combinations (codeine as antitussive, guaifenesin as expectorant) 1
• Pholcodine linctus (10 mL four times daily) 2

Typical Dosages:

• Codeine: 30-60 mg four times daily (maximum 240 mg/day) 2
• Initial dosing often starts at 15-30 mg every 4 hours as needed 2
• For palliative care in cancer patients, doses may range from 10-30 mg three times daily 2

Clinical Considerations When Using Codeine for Cough

Efficacy:

• Opioids like codeine appear to be the most effective cough suppressants for intractable cough, particularly in patients with lung cancer 2
• Codeine works centrally on the cough center in the brain, providing suppression of the cough reflex 3

Appropriate Use:

• Most appropriate for dry, non-productive cough that is bothersome and disruptive 3
• Particularly useful for nighttime cough that interferes with sleep 3
• Often used in palliative care settings for patients with advanced cancer 2

Contraindications and Cautions:

• Should be avoided in productive cough where sputum clearance is needed 3
• Not recommended for long-term use due to potential for physical dependence 3
• Should be limited to short-term use (3-7 days) 3
• Use with caution in elderly patients (lower doses recommended) 3
• Contraindicated in children due to safety concerns 3

Side Effects:

• Common side effects include drowsiness, constipation, and nausea 4
• Somnolence is reported in approximately 22% of patients using dihydrocodeine 2
• Risk of physical dependence with prolonged use 3

Alternative Codeine-Related Antitussives

Some related opioid derivatives also used for cough suppression include:

• Dihydrocodeine (10 mg three times daily) 2
• Hydrocodone (5 mg twice daily) 2
• Morphine sulfate oral solution (2.5-5 mg every 4 hours) for severe cases 2

Practical Prescribing Notes

• Initial treatment should start with the lowest effective dose
• For adults with distressing cough, codeine linctus 15-30 mg every 4 hours (up to four doses in 24 hours) is recommended 2
• If necessary, the dose can be increased to 30-60 mg four times daily 2
• Treatment response should be assessed after 2-4 days 3
• Discontinue if no improvement is seen 3

When prescribing codeine-containing cough medications, it's important to recognize that while these medications have been widely used for decades, recent evidence suggests their efficacy may be more limited than previously thought 5, and they should be reserved for short-term use in appropriate clinical scenarios.