What is the recommended dosing for Codeine and Guaifenesin in adults and children?

Codeine with Guaifenesin Dosing

For adults, the standard dose is 10 mL (containing codeine 10-20 mg and guaifenesin 200-400 mg) every 4 hours, not exceeding 6 doses in 24 hours; however, codeine-containing products are not recommended as first-line therapy due to their adverse effect profile without superior efficacy compared to safer alternatives. 1, 2, 3

Adult Dosing

Standard Formulation:

• Adults and children ≥12 years: 10 mL (2 teaspoons) every 4 hours 3
• Maximum: 6 doses in 24 hours (60 mL total) 3
• Codeine component: Typically 10-20 mg per dose, maximum 240 mg daily 2
• Guaifenesin component: 200-400 mg per dose, maximum 2400 mg daily 4

Pediatric Dosing

Children 6 to <12 years:

• Dose: 5 mL (1 teaspoon) every 4 hours 3
• Maximum: 6 doses in 24 hours 3

Children <6 years:

• Contraindicated - consult physician; codeine should not be used in young children due to risk of respiratory depression 3

Critical Prescribing Considerations

Duration of Use:

• Short-term only: 5-7 days maximum 2
• Reassess if symptoms persist beyond 1 week - do not continue antitussive therapy without re-evaluation 2
• If cough persists >3 weeks: Mandatory reassessment for underlying causes rather than continued antitussive use 1

Why Codeine Is Not Recommended:

• No superior efficacy: Codeine has no greater effectiveness than dextromethorphan for cough suppression 1, 5
• Significant adverse effects: Drowsiness, nausea, constipation, respiratory depression, and risk of physical dependence 1, 2
• Better alternatives exist: Dextromethorphan at 60 mg provides equivalent or superior cough suppression with fewer side effects 1, 5

Contraindications and Warnings

Avoid in:

• Chronic bronchitis and bronchiectasis: Cough suppressants cause sputum retention 2
• Patients taking CNS depressants: Risk of additive respiratory depression 2
• Children <6 years: Increased risk of respiratory depression 3

Common Side Effects:

• Drowsiness, constipation, nausea 2
• Respiratory depression at higher doses 2
• Risk of dependence with prolonged use 1

Preferred Alternative Approach

First-line recommendations instead of codeine:

• Dextromethorphan 60 mg every 4-6 hours for maximum cough suppression (not the subtherapeutic 15-30 mg OTC doses) 1, 5
• Guaifenesin alone 200-400 mg every 4 hours for productive cough 4, 6
• Simple home remedies like honey and lemon for benign viral cough 1, 5

For nocturnal cough specifically:

• First-generation sedating antihistamines may be more appropriate than codeine 1, 5

Common Pitfalls to Avoid

• Do not prescribe for extended periods without reassessing the underlying cause 1, 2
• Do not use standard OTC doses of individual components - they are often subtherapeutic 1
• Do not combine with other CNS depressants without careful monitoring 2
• Do not use as substitute for proper diagnosis when cough becomes chronic (>8 weeks) 1