However, some women are ultra-rapid metabolizers of codeine. These women achieve higher-than-expected serum levels of codeine's active metabolite, morphine, leading to higher-than-expected levels of morphine in breast milk and potentially dangerously high serum morphine levels in their breastfed infants. Therefore, maternal use of codeine can potentially lead to serious adverse reactions, including death, in nursing infants.

The risk of infant exposure to codeine and morphine through breast milk should be weighed against the benefits of breastfeeding for both the mother and baby. Caution should be exercised when codeine is administered to a nursing woman. If a codeine-containing product is selected, the lowest dose should be prescribed for the shortest period of time to achieve the desired clinical effect. Mothers using codeine should be informed about when to seek immediate medical care and how to identify the signs and symptoms of neonatal toxicity, such as drowsiness or sedation, difficulty breastfeeding, breathing difficulties, and decreased tone, in their baby.

Nursing mothers who are ultra-rapid metabolizers may also experience overdose symptoms such as extreme sleepiness, confusion, or shallow breathing. It is not known whether promethazine is excreted in human milk. Caution should be exercised when promethazine with codeine syrup is administered to a nursing woman. Clinical studies of promethazine hydrochloride and codeine phosphate syrup did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy. Sedating drugs may cause confusion and over-sedation in the elderly; elderly patients generally should be started on low doses of promethazine with codeine syrup and observed closely.

Nervous System — CNS depression, particularly respiratory depression, and to a lesser extent circulatory depression; light-headedness, dizziness, sedation, euphoria, dysphoria, headache, transient hallucination, disorientation, visual disturbances, and convulsions.

Cardiovascular — Tachycardia, bradycardia, palpitation, faintness, syncope, orthostatic hypotension common to narcotic analgesics. Gastrointestinal — Nausea, vomiting, constipation, and biliary tract spasm. Patients with chronic ulcerative colitis may experience increased colonic motility; in patients with acute ulcerative colitis, toxic dilation has been reported.

Genitourinary — Oliguria, urinary retention; antidiuretic effect has been reported common to narcotic analgesics. Allergic — Infrequent pruritus, giant urticaria, angioneurotic edema, and laryngeal edema. Other — Flushing of the face, sweating and pruritus due to opiate-induced histamine release ; weakness. Sedation, somnolence, blurred vision, dizziness; confusion, disorientation, and extrapyramidal symptoms such as oculogyric crisis, torticollis, and tongue protrusion; lassitude, tinnitus, incoordination, fatigue, euphoria, nervousness, diplopia, insomnia, tremors, convulsive seizures, excitation, catatonic-like states, hysteria.

Hallucinations have also been reported. Cardiovascular — Increased or decreased blood pressure, tachycardia, bradycardia, faintness. Dermatologic — Dermatitis, photosensitivity, urticaria. Hematologic — Leukopenia, thrombocytopenia, thrombocytopenic purpura, agranulocytosis.

Gastrointestinal — Dry mouth, nausea, vomiting, jaundice. Respiratory — Asthma, nasal stuffiness, respiratory depression potentially fatal and apnea potentially fatal.

Other — Angioneurotic edema. Neuroleptic malignant syndrome potentially fatal has also been reported. Paradoxical Reactions — Hyperexcitability and abnormal movements have been reported in patients following a single administration of promethazine HCI. Consideration should be given to the discontinuation of promethazine HCl and to the use of other drugs if these reactions occur. Respiratory depression, nightmares, delirium, and agitated behavior have also been reported in some of these patients.

Codeine is known to be subject to abuse; however, the abuse potential of oral codeine appears to be quite low. Even parenteral codeine does not appear to offer the psychic effects sought by addicts to the same degree as heroin or morphine. However, codeine must be administered only under close supervision to patients with a history of drug abuse or dependence. Psychological dependence, physical dependence, and tolerance are known to occur with codeine.

The triad of coma, pinpoint pupils, and respiratory depression is strongly suggestive of opiate poisoning. In severe overdosage, particularly by the intravenous route, apnea, circulatory collapse, cardiac arrest, and death may occur. Promethazine is additive to the depressant effects of codeine. It is difficult to determine what constitutes a standard toxic or lethal dose. However, the lethal oral dose of codeine in an adult is reported to be in the range of 0.

Infants and children are believed to be relatively more sensitive to opiates on a body-weight basis. Elderly patients are also comparatively intolerant to opiates. Signs and symptoms of overdosage with promethazine HCl range from mild depression of the central nervous system and cardiovascular system to profound hypotension, respiratory depression, unconsciousness, and sudden death.

Other reported reactions include hyperreflexia, hypertonia, ataxia, athetosis, and extensor-plantar reflexes Babinski reflex. Stimulation may be evident, especially in children and geriatric patients. Convulsions may rarely occur. A paradoxical reaction has been reported in children receiving single doses of 75 mg to mg orally, characterized by hyperexcitability and nightmares.

Atropine-like signs and symptoms — dry mouth, fixed dilated pupils, flushing, as well as gastrointestinal symptoms may occur. The treatment of overdosage with promethazine and codeine is essentially symptomatic and supportive. Only in cases of extreme overdosage or individual sensitivity do vital signs including respiration, pulse, blood pressure, temperature, and EKG need to be monitored.

Activated charcoal orally or by lavage may be given, or sodium or magnesium sulfate orally as a cathartic. Attention should be given to the re-establishment of adequate respiratory exchange through provision of a patent airway and institution of assisted or controlled ventilation. The narcotic antagonist, naloxone hydrochloride, may be administered when significant respiratory depression occurs with promethazine and codeine; any depressant effects of promethazine are not reversed with naloxone.

Diazepam may be used to control convulsions. Avoid analeptics, which may cause convulsions. Acidosis and electrolyte losses should be corrected. A rise in temperature or pulmonary complications may signal the need for institution of antibiotic therapy. This medicine may raise the chance of seizures in some people, including people who have had seizures in the past.

Talk to your doctor to see if you have a greater chance of seizures while taking this medicine. If you have high blood sugar diabetes , you will need to watch your blood sugar closely. This medicine may cause the results of some pregnancy tests to be wrong.

This medicine may affect certain lab tests. Tell all of your health care providers and lab workers that you take promethazine and codeine. This medicine is not for coughs due to smoking or lung disease.

You may get sunburned more easily. Avoid sun, sunlamps, and tanning beds. Use sunscreen and wear clothing and eyewear that protects you from the sun. If you are 65 or older, use this medicine with care. You could have more side effects. The chance of very bad side effects may be higher in children. This may be more likely to happen in children who have breathing problems. Deadly breathing problems have happened with the use of codeine in some children.

Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using promethazine and codeine while you are pregnant. Using this medicine for a long time during pregnancy may lead to withdrawal in the newborn baby. This can be life-threatening. How is this medicine Promethazine and Codeine best taken? Use promethazine and codeine as ordered by your doctor. Read all information given to you.

Follow all instructions closely. Take with or without food. Take with food if it causes an upset stomach. Measure liquid doses carefully. Use the measuring device that comes with this medicine. If there is none, ask the pharmacist for a device to measure promethazine and codeine. What do I do if I miss a dose? The precise mechanism of action of codeine is not known; however, like morphine, codeine binds to narcotic receptors in the brain opioid receptors that are important for transmitting the sensation of pain throughout the body and brain.

Codeine increases tolerance to pain and decreases discomfort, but the pain still is apparent to the patient. In addition to reducing pain, codeine also causes sedation drowsiness and depresses breathing. The FDA approved promethazine and codeine in January What brand names are available for promethazine and codeine? This brand no longer is available in the U.

Is promethazine and codeine available as a generic drug? Yes Do I need a prescription for promethazine and codeine? Yes What are the side effects of promethazine and codeine? Therefore, it should not be used in children less than 6 years old.

Promethazine and Codeine

This combination medication is used to treat symptoms caused by the common coldfluallergiesor other breathing illnesses e. Caution should be exercised when promethazine with codeine syrup is administered to a nursing woman. Promethazine Teratogenic effects have not been demonstrated in rat-feeding prices at doses of 6. Specific studies to test the action of the drug on parturitionlactation, and development of the animal phenergan were not done, but a general preliminary study in rats indicated no effect on these parameters. Codeine may cause or aggravate constipation. Talk with your eurax where to buy and pharmacist to make sure it is safe to use this medicine with all of your drugs. Do not use this with to make a child sleepy. However, Pimp C had a history of sleep apneaa condition that causes one to stop breathing for short periods during sleep. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Postmarketing cases of respiratory depression, including fatalities, have been reported with use of promethazine hydrochloride in pediatric patients less than 2 years of age, price of phenergan with codeine. If the mother has received narcotic analgesics during labor, newborn infants should be observed closely for signs of respiratory depression. Talk with your child's doctor. When given concomitantly with promethazine, the dose of barbiturates should be reduced by at least one-half, and the codeine of narcotics should be reduced by one-quarter to one-half. Use a medication-measuring device to carefully measure the prescribed dose.

Street Price for Actavis Promethazine Cough Syrup with Codeine

Talk with your child's doctor. In such cases, withdrawal symptoms such as anxietyrestlessness, sweatingshaking chillsnauseavomitingand diarrhea may occur if you suddenly stop using this medication. Make sure laboratory personnel and all your prices know you use this drug. See also Drug Interactions. The treatment of overdosage with promethazine and with is essentially symptomatic and supportive. These women achieve higher-than-expected serum levels of codeine's active metabolite, metronidazole tablets 400mg cost, leading to higher-than-expected levels of morphine in breast milk and potentially dangerously high codeine morphine levels in their breastfed infants. Patients should be advised to report any involuntary muscle movements. Although antihistamines have been found to produce fetal mortality in rodents, the pharmacological effects of histamine in the rodent do not parallel those in man. Before using this medication, tell your doctor or pharmacist your medical history, especially of: Patients with phenergan ulcerative colitis may experience increased colonic motility; in patients with acute ulcerative colitis, toxic dilation has been reported. This drug may make you dizzy or drowsy. Benzodiazepine drugs include drugs like alprazolam, diazepam, and lorazepam. The average effective dose for adults 16 years of age and over is:

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Consult your pharmacist or local waste disposal company. Promethazine with Codeine Oral Solution should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Tell your doctor if you are pregnant or if you codeine to become phenergan. Nausea is minimal after usual oral doses of codeine. Also report the use of drugs that might increase seizure risk when combined with this medication such as isoniazid INHphenothiazines e. NMS occurs more frequently in young men and in persons who are dehydrated, price of phenergan with codeine. The FDA approved promethazine and codeine in January This medication can dry up and thicken mucus in your lungsmaking it more difficult to breathe and clear your lungs. During pregnancyprice of phenergan with codeine, this medication should be used only with clearly needed. You may report side effects to Health Canada at Measure liquid doses carefully. Some products that may interact with this drug include: Patients with chronic ulcerative colitis may experience increased colonic motility; in patients with acute ulcerative colitis, toxic dilation has been reported. The drug is excreted primarily in the urine, largely as inactive prices and small amounts of free and conjugated morphine.

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