What are the teaching instructions for the combination of antitussive (cough suppressant) and codeine (opioid analgesic) medications?

From the Guidelines

Codeine is recommended for short-term symptomatic relief of coughing in patients with chronic bronchitis, with a standard adult dosage of 10-20 mg every 4-6 hours as needed, not exceeding 120 mg in 24 hours, as supported by the American College of Chest Physicians evidence-based clinical practice guidelines 1. When teaching patients about codeine-containing antitussive combinations, emphasize that these are typically prescribed for short-term management of dry, nonproductive coughs.

• Patients should be instructed to take these medications exactly as prescribed and for the shortest duration necessary due to their potential for dependence.
• Important teaching points include: these medications may cause drowsiness and impair driving or operating machinery; they should not be combined with alcohol or other central nervous system depressants; they can cause constipation, so increased fluid and fiber intake is recommended; and they should be stored securely away from children.
• Patients with respiratory conditions like asthma or COPD should use these medications cautiously as they can suppress respiratory drive.
• Codeine-containing antitussives work by acting on opioid receptors in the brain's cough center, reducing the sensitivity of cough receptors and providing relief, but they don't treat the underlying cause of the cough.
• Due to their potential for misuse, many healthcare providers now prefer non-opioid alternatives for cough suppression when possible, as suggested by a study published in Chest in 2017 1.
• However, opioids are the best cough suppressants in patients with lung cancer, with codeine being the most widely used opioid for cough suppression, as stated in a study published in Chest in 2013 1.
• Other options for cough suppression in patients with lung cancer include hydrocodone, dihydrocodeine, levodropropizine, and benzonatate, as discussed in a study published in Chest in 2006 1.

From the FDA Drug Label

Directions do not exceed 6 doses in 24 hours. Adults and children 12 years of age and over: 2 tsp (10 mL) every 4 hours, or as directed by a doctor. Children 6 to under 12 years of age: 1 tsp (5 mL) every 4 hours, or as directed by a doctor. Children under 6 years of age: Consult a doctor. Drug Facts Active Ingredients Purpose (in each teaspoonful (5 mL)) Codeine Phosphate USP 10 mg ................... Antitussive Guaifenesin USP 100 mg ........................... Expectorant When teaching patients about the combination of antitussive and codeine, key points to emphasize include:

• Dosage: Do not exceed 6 doses in 24 hours.
• Administration:
  • Adults and children 12 years and older: 2 tsp (10 mL) every 4 hours.
  • Children 6 to under 12 years: 1 tsp (5 mL) every 4 hours.
• Special considerations: Children under 6 years of age should consult a doctor 2. The combination of codeine (an antitussive) and other ingredients like Guaifenesin (an expectorant) is used to relieve cough symptoms 2.

From the Research

Antitussive and Codeine Combination

• The combination of antitussive drugs, such as codeine and dextromethorphan, is commonly used to treat cough symptoms 3, 4, 5, 6, 7.
• Studies have shown that both codeine and dextromethorphan are effective in reducing cough frequency and intensity, with dextromethorphan being considered a better antitussive by some patients due to its lack of side effects and non-narcotic status 3.
• The combination of codeine and antihistamines, such as chlorpheniramine, is also used to treat dry cough, with sedation being a valuable effect in patients whose sleep is disturbed by coughing 4.
• Currently available cough suppressants include centrally acting opioids like morphine, codeine, and dextromethorphan, as well as peripherally acting antitussives like moguisteine and levodropropizine 5.
• Clinical trials have compared the effectiveness of different cough syrups, including those containing codeine, dextromethorphan, and guaifenesin, with mixed results 6, 7.

Teaching for Combination of Drugs

• When teaching about the combination of antitussive drugs, it is essential to emphasize the importance of understanding the mechanisms of action, potential side effects, and interactions between different medications 3, 4, 5.
• Healthcare professionals should be aware of the various treatment options available for cough symptoms, including the use of codeine, dextromethorphan, and other antitussive agents, as well as the potential benefits and drawbacks of each 4, 5, 6, 7.
• Patients should be educated on the proper use of antitussive medications, including the importance of following dosage instructions and being aware of potential side effects, such as drowsiness and constipation 3, 4, 5.