Side Effects of Promethazine-COD

Promethazine with codeine, sometimes abbreviated promethazine-cod, is also marketed in the United States under the trade name Phenergan with codeine. It is a prescription syrup used to suppress dry or non-productive cough associated with allergies, cold or flu. Because it contains codeine, a substance of potential abuse, promethazine-cod is regulated by state and federal controlled substance laws. Therapeutic effects and side effects of promethazine with codeine are the same as those of its individual ingredients.

Mechanism of Action

• Promethazine is an antihistamine used alone or in combination with other drugs to treat of a variety of conditions, including nausea, cough, congestion and as an adjunct to pain relief.

  Codeine, a narcotic, is available as a single ingredient product, but is used most often in combination with other medications--acetaminophen for example--in the treatment of pain, or with other agents used to treat cold and congestion symptoms.

  Promethazine and codeine work together to suppress cough via codeine's direct effect on the cough center in the brain and promethazine's drying effects on mucus and nasal drainage.

Side Effects

• The most-common side effects of promethazine-cod are drowsiness and dizziness. Patients taking promethazine-cod should not drive or operate machinery during treatment. Alcohol, other narcotics, some anti-anxiety medications, certain seizure drugs and some antidepressants may increase these effects. Patients should consult a physician or pharmacist before taking promethazine-cod with other medications.

  Other side effects include rash, headache, dry mouth, urinary difficulty, nausea and vomiting. Constipation is common with codeine use, and patients taking this product for several days may wish to supplement with an over-the-counter stool softener.

  Less commonly, promethazine can cause involuntary abnormal muscle movement, such as tics or spasms, blood chemistry changes, vision changes or seizures. Patients experiencing muscle abnormalities or muscle restlessness should notify their physician.

  Codeine may induce a feeling of euphoria and can depress respiratory function. Mixing codeine with alcohol, anti-anxiety medications or barbiturates, such as phenobarbital, can further respiratory depression. Children under 16 are especially susceptible to the respiratory effects of promethazine-cod, and its use should be avoided in this age group.

Hypersensitivity

• Allergic reaction is a possibility with promethazine-cod. Symptoms of allergic response include difficulty breathing or swallowing, itching, rash and swelling. Codeine may routinely cause itching not associated with allergy, but patients experiencing any of these symptoms should seek immediate medical care. Patients with a known sensitivity to promethazine, its relatives, codeine or other narcotics should not take promethazine with codeine.

Considerations

• Promethazine may cause sun sensitivity. Patients using products containing promethazine with codeine should avoid prolonged sun exposure and use additional sunscreen.

Legalities

• Under federal law, promethazine with codeine is a Schedule V medication and is subject to state and federal statutes concerning the regulation of controlled substances. Federal and state laws may limit quantities, duration of therapy or number of refills of promethazine with codeine. Transfer of promethazine with codeine to individuals for whom it was not prescribed is prohibited by federal law.