What is the recommended duration for prescribing Cheratussin AC (codeine and guaifenesin) for a cough caused by influenza?

Duration of Cheratussin AC for Influenza-Related Cough

Cheratussin AC (codeine-guaifenesin) should be prescribed for 5-7 days maximum for cough from influenza, with reassessment if symptoms persist beyond one week. 1, 2

Recommended Treatment Duration

• Limit codeine-containing cough suppressants to 5-7 days of use, as recommended by clinical guidelines for short-term symptomatic relief 1, 2
• Discontinue as soon as clinically warranted, typically within 24-48 hours after symptoms resolve, to reduce risk of dependence and adverse effects 1, 2
• Reassess the patient if cough persists beyond one week, as this may indicate complications requiring different management 1

Standard Dosing Parameters

According to FDA labeling, the dosing for codeine-containing products is 3:

• Adults and children ≥12 years: 2 teaspoons (10 mL) every 4 hours, maximum 6 doses in 24 hours
• Children 6 to <12 years: 1 teaspoon (5 mL) every 4 hours, maximum 6 doses in 24 hours
• Children <6 years: Consult a physician (not routinely recommended)

The maximum daily dose should not exceed 40 mL (80 mg codeine/800 mg guaifenesin) 1

Important Clinical Context for Influenza

Antiviral medications, not cough suppressants, are the primary treatment for influenza itself 4:

• Oseltamivir or zanamivir should be initiated within 48 hours of symptom onset for influenza treatment
• These antivirals reduce illness duration by approximately one day when started early 4
• The recommended duration for antiviral treatment is 5 days 4

Critical Safety Considerations

Codeine should be used as second-line therapy only after simpler measures have failed 2:

• Consider demulcents (honey, lozenges) or guaifenesin alone first 1
• Codeine carries risks of respiratory depression, constipation, drowsiness, and potential for dependence 1, 2

Absolute contraindication: Do not use codeine in patients with chronic bronchitis or bronchiectasis, as cough suppressants cause dangerous sputum retention 1, 2

Common Pitfall to Avoid

Do not prescribe codeine-containing products for prolonged periods beyond 5-7 days, as:

• Evidence for codeine's effectiveness in viral cough is limited 5
• Risk of adverse effects and dependence increases with duration 1, 2
• Persistent cough beyond one week suggests either complications requiring different treatment or resolution of the acute illness 1