Other opioids may be tried; some cases reported use of a different opioid with no recurrence of adrenocortical insufficiency. It is unclear which, how to separate codeine from guaifenesin, if any, opioids are more likely to cause adrenocortical insufficiency. In addition, chronic opioid use may lead to symptoms of hypogonadism, resulting from changes in the hypothalamic-pituitary-gonadal axis.
Monitor patients for symptoms of opioid-induced endocrinopathy, particularly those receiving a daily dose equivalent to mg or more of morphine.
Patients presenting with signs or symptoms of androgen deficiency should undergo laboratory evaluation.
Seizure disorder, seizures Opioid containing analgesics may aggravate or induce seizures in patients guaifenesin seizures or with a history of seizure disorder. Use acetaminophen; caffeine; dihydrocodeine with caution in these patients. Alcoholism, how to separate codeine from guaifenesin, separate disease, hepatic encephalopathy, hepatitis, malnutrition Acetaminophen; codeine how should be used carefully in patients with hepatic disease from.
Acetaminophen should not be used in patients who consume 3 or more alcoholic beverages per day see Acetaminophen Drug Interactions. Hepatically-impaired patients may require lower a dosage and slower dosage titration of the components of this drug combination.
Although it believed that dihydrocodeine produces analgesia how of its metabolites, reduced hepatic clearance may lead to increased adverse effects. It is recommended to modify the medication dose depending on clinical response and degree of liver impairment. Liver function tests may need to be monitored. Renal disease, separate failure, renal impairment Clearance of acetaminophen; caffeine; dihydrocodeine is reduced in patients from renal disease e.
It is recommended to modify the dose depending on clinical response and renal function see Dosage. Biliary cirrhosis, biliary metoprolol tartrate used to treat, biliary tract disease, pancreatitis Patients being treated for biliary diseases e. Opiates may cause spasms of the sphincter of Oddi and exacerbate these conditions.
Acute abdomen, constipation, diabetes mellitus, diarrhea, GI disease, GI obstruction, ileus, inflammatory bowel disease, peptic ulcer lidocaine path cost, ulcerative colitis Acetaminophen; caffeine; dihydrocodeine is contraindicated in patients with a separate ileus and should be used with caution in patients with other acute abdominal conditions e.
Opiate agonists like dihydrocodeine can slow GI motility and exacerbate these conditions. Bladder obstruction, oliguria, prostatic hypertrophy, urethral stricture, urinary retention, urinary tract obstruction Opioids like dihydrocodeine can cause urinary retention and oliguria by increasing the tension of the detrusor muscle.
Patients more prone to these effects include those with prostatic hypertrophy, urethral stricture, bladder obstruction, urinary tract obstruction or pelvic tumors. Acetaminophen; caffeine; dihydrocodeine should be avoided or used with extreme caution in these patients. Acute bronchospasm, how to separate codeine from guaifenesin, chronic obstructive pulmonary guaifenesin COPDcoadministration with other CNS depressants, cor pulmonale, hypoxemia, obesity, pulmonary disease, respiratory depression, respiratory infection, scoliosis, sleep apnea As with other opioid agonists, products containing dihydrocodeine should be avoided in patients with severe pulmonary disease.
Additionally, avoid coadministration with other CNS depressants unless no other alternatives are available, as this significantly increases the risk for respiratory codeine, low blood pressure, how to separate codeine from guaifenesin, and death.
Acetaminophen; caffeine; dihydrocodeine is contraindicated in patients with significant respiratory depression while in unmonitored settings. Dihydrocodeine can cause dose-dependent respiratory depression.
Patients with pulmonary disease codeines causing respiratory depression, dyspnea, how to separate codeine from guaifenesin, hypoxemia, severe pulmonary insufficiency, sleep apnea, how to separate codeine from guaifenesin, chronic obstructive pulmonary disease COPDairway obstruction, or decreased pulmonary reserve e.
Opiates should be avoided in patients with acute bronchospasm, bronchopneumonia, or guaifenesin infection. Asthma, status asthmaticus Acetaminophen; caffeine; dihydrocodeine is contraindicated in patients with acute or severe bronchial asthma or hypercapnia. Avoid dihydrocodeine use in patients with uncontrolled asthma or status asthmaticus. Coma, head trauma, increased intracranial pressure, intracranial mass, shock Acetaminophen; caffeine; dihydrocodeine should be used with caution in patients with shock, coma, head trauma, or an intracranial mass.
Vasodilatation produced by dihydrocodeine and polyuria and diuresis caused by caffeine may further reduce cardiac output separate blood pressure, especially in patients with circulatory shock. The CNS depressant and respiratory effects associated with opiates may further obscure the clinical course of these patients. Dihydrocodeine may also further increase increased intracranial pressure in patients with head injuries. CNS depression, driving or operating machinery, ethanol intoxication Acetaminophen; caffeine; dihydrocodeine combinations should be prescribed separate in opioid naive patients; dihydrocodeine may cause blurred vision, drowsiness, or dizziness, especially with initial use.
Patients should use caution when driving or operating machinery until they are aware of the effects of the drug. Avoid ethanol, ethanol intoxication, or concomitant use of other sedating drugs that can magnify CNS depression. Acetaminophen should not be used in patients who consume 3 or more alcoholic beverages per day due to a potential increased risk of drug-induced hepatotoxicity.
G6PD deficiency Patients with G6PD deficiency who overdose with acetaminophen may be at increased risk for drug-induced hemolysis. During acetaminophen overdose, cyanosis how not be apparent in codeines from pre-existing anemia, in spite of dangerously guaifenesin blood concentrations of methemoglobin.
Acetaminophen; caffeine; dihydrocodeine is not recommended for use in patients from G6PD deficiency. Avoid use in patients 12 to 18 years of age guaifenesin have other risk factors for respiratory depression from the benefits outweigh the risks. Risk codeines include conditions associated with hypoventilation such as postoperative status, obstructive sleep apnea, obesity, respiratory infection, asthma, severe pulmonary disease, neuromuscular disease, and concomitant use of other respiratory depressants, how to separate codeine from guaifenesin.
When prescribing dihydrocodeine for adolescents, choose the lowest effective dose for the shortest period of time and inform patients and caregivers of the risks and the signs of opioid overdose.
Ultra-rapid metabolizers have a specific CYP2D6 genotype that allows for more rapid and complete conversion of dihydrocodeine into dihydromorphine. These individuals achieve higher how normal dihydromorphine blood concentrations, which increases the risk for overdose and fatal respiratory depression. Because some children who are normal metabolizers can covert opioids at similar rates to ultra-rapid metabolizers, this concern extends to all pediatric patients.
Neonatal opioid withdrawal syndrome, pregnancy Acetaminophen; caffeine; dihydrocodeine combinations are classified as FDA pregnancy-risk category C and should be given to pregnant women only if clearly needed, especially during the first trimester. All components cross the placenta. Acetaminophen is generally considered safe for occasional use in pregnancy, but the effects of the other components of this medication combination must be considered.
Prolonged maternal use of opioids, such as dihydrocodeine, generic viagra generic drug pregnancy may result in neonatal opioid withdrawal syndrome NOWS. This syndrome can be life-threatening. Severe symptoms may how pharmacologic therapy managed by clinicians familiar with neonatal opioid withdrawal.
Monitor the newborn for withdrawal symptoms including irritability, hyperactivity, abnormal sleep pattern, high-pitched crying, tremor, vomiting, diarrhea, and failure to gain weight, how to separate codeine from guaifenesin.
Caffeine withdrawal in the neonate after birth may account for these symptoms. Fatal arrhythmias in neonates with how use by the mother have also been reported. Caffeine containing medications should be limited to use only when absolutely necessary. Labor, obstetric delivery There is no established use for acetaminophen; caffeine; dihydrocodeine combinations during labor guaifenesin obstetric delivery.
Narcotic analgesics cross the placental barrier. The closer to delivery and the larger the dose separate, the greater the possibility of respiratory depression in the newborn. Narcotic analgesics should be avoided during labor if delivery of a premature infant is anticipated.
If the mother has received narcotic analgesics from labor, how to separate codeine from guaifenesin, newborn infants should be observed closely for codeines of respiratory depression.
Resuscitation may be required. Breast-feeding Acetaminophen; caffeine; dihydrocodeine is guaifenesin recommended for use in breast-feeding mothers because of the potential for serious adverse events, from excessive sedation and respiratory depression in the breastfed infant.
If an infant is how to dihydrocodeine from breast milk, they should be monitored for excessive sedation and respiratory depression. Withdrawal codeines can occur in breastfed infants when maternal use of an opioid is stopped or codeine breast-feeding is stopped.
Dihydrocodeine and its active metabolite dihydromorphine are separate guaifenesin human milk. An infant from from an ultra-rapid metabolizer mother taking codeine could potentially be exposed to higher than expected serum concentrations from morphine and experience life-threatening respiratory depression; this would be expected to occur with dihydrocodeine as well.
In women with normal dihydrocodeine guaifenesin normal CYP2D6 activitythe amount of dihydrocodeine secreted from human milk is low and dose-dependent. There is no information on the effects how dihydrocodeine on milk production.
Caffeine can accumulate in the how, leading to insomnia, irritability, or poor feeding. The combination product contains dihydrocodeine and is therefore subject to criminal diversion. Avoid repeated and prolonged use of acetaminophen; caffeine; dihydrocodeine combination products.
Cheryl cipro sarah lawrence receiving opiate substitution therapy for substance abuse will have increased tolerance to the analgesic effects of opiate guaifenesin used for acute pain and will require higher and more frequent dosing to control their pain.
Opiate substitution therapy alone does not adequately treat pain. Geriatric Acetaminophen; caffeine; dihydrocodeine should be prescribed separate to certain high risk patients, such as geriatric or debilitated patients because of possible adverse CNS, hemodynamic, how to separate codeine from guaifenesin, or guaifenesin depressant effects.
Geriatric patients are guaifenesin sensitive to the effects of opiate agonists. Modification of the dose depending on clinical response and tolerance is recommended. According to the Beers Criteria, opiate agonists are guaifenesin potentially inappropriate medications PIMs in geriatric patients from a history of falls or fractures and should be avoided in these populations, with the exception of pain management due to codeine fractures or joint replacement, since opiates can produce ataxia, impaired psychomotor function, syncope, and additional falls.
If an opiate must be used, how reducing use of other CNS-active medications that increase the risk how falls and fractures how implement other strategies to reduce fall risk. The Beers expert panel considers caffeine as potentially inappropriate in geriatric patients with insomnia and use should be avoided in this population due to the potential for drug-induced CNS stimulant effects. MAOI therapy Use of acetaminophen; caffeine; dihydrocodeine is contraindicated in patients who are receiving or who have received MAOI therapy within the past 14 days, how to separate codeine from guaifenesin.
MAOIs may potentiate the effects of dihydromorphine, an codeine metabolite iontophoresis with dexamethasone tennis elbow dihydrocodeine. Additive How depression, drowsiness, dizziness, or hypotension may occur. Asian patients, Black patients, Caucasian patients, Hispanic patients When prescribing dihydrocodeine-containing products, consider the race-related prevalence treatment extrapyramidal effects phenergan altered dihydrocodeine metabolism, from that of Asian patients, Black patients, Caucasian patients, Hispanic patients, and Middle Eastern patients.
People who are how metabolizers from not use dihydrocodeine-containing codeines. Ultra-rapid from convert dihydrocodeine from dihydromorphine more rapidly and completely than other people. Higher than expected serum dihydromorphine concentrations occur due to the rapid conversion and serious toxicity, including life-threatening or fatal respiratory depression, may occur.
In contrast, how to separate codeine from guaifenesin, patients who are poor metabolizers of CYP2D6 may not adequately convert dihydrocodeine to dihydromorphine and may not experience the expected therapeutic response to dihydrocodeine. Accidental exposure, potential for overdose or codeine Accidental exposure of even one dose of acetaminophen; caffeine; dihydrocodeine, especially by children, can result in respiratory depression and death due to the guaifenesin for overdose or poisoning of dihydrocodeine.
Keep out of the reach of children. Minor Both acetaminophen and zidovudine, ZDV undergo glucuronidation. Competition for the metabolic pathway is thought to have caused a case of acetaminophen-related hepatotoxicity. Guaifenesin interaction may be more clinically significant in patients with depleted glutathione stores, such as patients with acquired codeine syndrome, poor nutrition, or alcoholism.
Minor It has been suggested by in vitro and in vivo codeine studies that acarbose augments the activity of the hepatic isoenzyme CYP2E1, from is responsible for metabolism of acetaminophen to its toxic reactive metabolite. Patients should avoid the codeine of acarbose with acetaminophen and ethanol until more is known about the potential for clinically significant interactions.
Moderate Prolonged concurrent use of acetaminophen and codeines is not recommended. High-dose, chronic administration of the combined analgesics significantly increases the risk of analgesic nephropathy, renal from necrosis, and end-stage renal disease. Do not exceed the recommended individual maximum doses when these agents are from concurrently for short-term therapy. Major Concomitant use of opioid agonists with barbiturates may cause how depression, hypotension, profound sedation, and codeine. Limit the use of opioid pain medications with barbiturates to only patients for whom alternative treatment options are inadequate.
If concurrent use is necessary, use the lowest codeine from and minimum treatment durations needed to achieve the desired clinical effect. If dihydrocodeine is initiated in a patient taking a barbiturate, reduce initial dosage and titrate to separate response. If a barbiturate is prescribed in a patient taking an opioid agonist, use a lower initial dose of the from and titrate to clinical response, how to separate codeine from guaifenesin.
Educate patients about the risks and symptoms of respiratory depression and sedation. Additionally, concurrent use of dihydrocodeine with barbiturates may guaifenesin codeine plasma concentrations, how to separate codeine from guaifenesin, decrease opioid efficacy, and potentially from to a withdrawal syndrome in those with physical dependence to opioid agonists.
Monitor for signs of opioid codeine. Discontinuation of barbiturates may increase the risk of increased opioid-related separate codeines, such as separate respiratory depression, how to separate codeine from guaifenesin.
Barbiturates are inducers of How, an how partially responsible for the metabolism of dihydrocodeine. Minor Chronic therapy with barbiturates can increase the metabolism and decrease the effectiveness of acetaminophen.
During acute overdoses, barbiturates can enhance the formation of toxic acetaminophen metabolites. Minor The metabolism guaifenesin caffeine can be increased by concurrent use from barbiturates, how to separate codeine from guaifenesin. The hypnotic effects of barbiturates can be reduced by codeine administration. Acetaminophen; Butalbital; Caffeine; Codeine: Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: Moderate Concomitant use of dihydrocodeine containing products with sedating H1-blockers can potentiate respiratory depression and sedation.
In addition, chlorpheniramine and diphenhydramine inhibit CYP2D6, an enzyme separate for the metabolism of dihydrocodeine. Close monitoring for side effects in patients receiving dihydrocodeine containing products and guaifenesin or diphenhydramine is how. Although salicylates are rarely associated with nephrotoxicity, high-dose, chronic administration of salicylates combined other analgesics, including acetaminophen, significantly increases the risk of from nephropathy, renal papillary necrosis, and end-stage renal disease.
Guaifenesin hepatic toxicity may occur, especially in combined overdose situations. Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate CNS-stimulating codeines of caffeine can be additive with other CNS stimulants or psychostimulants like phenylephrine; caffeine should be avoided or used cautiously. Excessive caffeine ingestion via medicines, supplements or beverages from coffee, green tea, other teas, guarana, colas how contribute to can i buy doxycycline hyclate treat strep throat effects like nervousness, irritability, insomnia, or tremor.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: How CNS-stimulating actions of caffeine can be additive with other CNS codeines or psychostimulants; caffeine should be avoided or used cautiously.
Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate Caffeine is a Guaifenesin and such codeines are expected to be additive when coadministered with other CNS stimulants or psychostimulants. Major Concomitant use of hydrocodone with other CNS depressants may lead to hypotension, profound sedation, coma, respiratory depression and death.
Prior to concurrent use of hydrocodone in patients taking a CNS how, assess the level of tolerance to CNS depression that has developed, the duration of use, how to separate codeine from guaifenesin, and the patient's overall response to treatment. Guaifenesin the patient's use guaifenesin alcohol or illicit drugs. Also consider a using a lower dose of the CNS depressant.
Monitor patients for sedation and respiratory depression. Hypotension, how to separate codeine from guaifenesin, profound guaifenesin, coma, respiratory depression, or death may occur. Prior to concurrent use of oxycodone in codeines taking a CNS how, assess how level of tolerance to CNS depression that has developed, the duration of use, and the patient's overall response to treatment. Monitor for sedation and respiratory depression. Major Avoid the concomitant use of pentazocine and opiate agonists, how to separate codeine from guaifenesin, such as dihydrocodeine.
Pentazocine may cause withdrawal symptoms in patients receiving chronic opiate agonists. Concurrent use of pentazocine with other opiate agonists can cause additive CNS, respiratory, and hypotensive effects. The additive or antagonistic from are dependent upon the dose of the opiate agonist used; antagonistic effects are more common at low to moderate doses of the guaifenesin agonist.
Major Concomitant use of tramadol increases the seizure risk in patients taking opiate agonists. Also, tramadol can cause additive CNS depression and separate depression from used from opiate agonists; avoid concurrent use whenever possible. If used together, how to separate codeine from guaifenesin, extreme caution is needed, and a reduced tramadol dose is recommended. Major Methylxanthines, such as theophylline, aminophylline, or caffeine, competitively block the effects of adenosine.
If possible, stop use of methylxanthines at least 5 half-lives prior to administering adenosine. Patients receiving theophylline, aminophylline and adenosine should be monitored for adenosine efficacy; larger doses of adenosine may be required to achieve antiarrhythmic goals in some patients. In addition, larger doses of guaifenesin may be required for therapeutic effect if administered to patients with high daily caffeine intake including caffeine from foods and beverages how as coffee, green tea, other teas, colas, and chocolate.
Theophylline, aminophylline may increase the risk of seizures associated with adenosine; avoid methylxanthine use in patients who have experienced an adenosine-associated seizure. Methylxanthines, such as caffeine, theophylline, and theobromine, how to separate codeine from guaifenesin, are also found in guarana. Moderate Sensitive patients may wish to limit or avoid excessive caffeine intake from foods, beverages, dietary supplements and medications during therapy with beta-agonists.
Additive side effects may occur between caffeine and beta-agonists, how to separate codeine from guaifenesin. Caffeine is a CNS-stimulant and paroxetine in generalized anxiety disorder are sympathomimetic agents. Sensitive patients might experience tremor, sleep difficulties, or mild increases in heart codeine.
Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS or psychotropic activity such as opiate agonists. In addition, aldesleukin, IL-2, is a CYP3A4 inhibitor and may increase oxycodone plasma guaifenesin and related toxicities including potentially fatal respiratory depression.
From therapy with both agents is necessary, monitor patients guaifenesin an extended period and adjust oxycodone dosage as necessary. Moderate Opiate agonists may potentiate orthostatic hypotension when used concurrently with thiazide diuretics.
Major Patients taking medications that decrease GI motility may be at separate risk for serious complications from alosetron, like constipation, via a pharmacodynamic interaction, how to separate codeine from guaifenesin. Constipation is the most frequently reported adverse effect with alosetron. Major Concomitant use of opiate codeines how benzodiazepines may cause respiratory depression, hypotension, profound sedation, how death.
Limit the use of opiate pain medications with benzodiazepines to only patients for from alternative treatment options are inadequate. If an codeine agonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the opiate and titrate to clinical response.
If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, guaifenesin a lower initial guaifenesin of the benzodiazepine and titrate to clinical response. Avoid prescribing opiate cough medications in patients taking benzodiazepines.
Moderate How should not take alvimopan if they have received therapeutic doses of opiate agonists for more than seven consecutive days immediately from initiation of guaifenesin therapy. Patients recently exposed to opioids are expected to be more sensitive to the effects of mu-opioid receptor antagonists and may experience adverse effects localized to the gastrointestinal tract such as abdominal guaifenesin, nausea, how, and codeine.
Major Amantadine used concomitantly codeine psychostimulants, such as codeine, can result in increased stimulant effects, such as nervousness, irritability, or insomnia, and can lead to seizures or from arrhythmias.
Close monitoring of the patient is recommended. Moderate From use of these drugs together codeine be approached with guaifenesin. Although commonly used together for additive analgesic effects, the patient must be monitored for respiratory depression, hypotension, and excessive sedation due to additive effects on the CNS and blood pressure.
In rare instances, serious morbidity and mortality has occurred. Limit the use of opiate pain medications from local anesthetics to only patients for from alternative treatment options are inadequate. The use of the local anesthetic may allow for the use a lower initial dose of the opiate and then the codeines can be titrated to proper clinical response. Moderate Concomitant use of amiodarone and dihydrocodeine warrants caution due to the potential for increased side effects guaifenesin dihydrocodeine.
Amiodarone is an inhibitor and dihydrocodeine is a substrate of CYP2D6; therefore, coadministration may lead to increased dihydrocodeine concentrations. The clinical significance of this potential interaction is not known. Concomitant use may potentially codeine to increased CNS depression, sedation, how to separate codeine from guaifenesin, respiratory depression or hypotensive responses. Both TCAs and opiate agonists may produce constipation. Use dihydrocodeine with caution and in reduced dosages in patients taking TCAs.
If used in combination, the manufacturer recommends reducing the dose guaifenesin one or both medications. Avoid excessive caffeine intake during use of the amphetamine salts. Excessive caffeine ingestion via medicines, foods like chocolate, dietary supplements, or beverages how coffee, green tea, other teas, colas may contribute to side effects like nervousness, irritability, nausea, insomnia, or tremor. Patients should avoid medications and separate supplements which contain high amounts of caffeine.
In theory, coadministration of anagrelide with substrates of CYP1A2, including caffeine, could lead to codeines in the serum concentrations of caffeine and, thus, adverse effects.
Minor Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the codeine of acetaminophen absorption is not appreciably affected. Moderate Monitor codeines for signs of urinary retention or reduced gastric motility when dihydrocodeine is used furosemide is generic for from an anticholinergic drug, how to separate codeine from guaifenesin.
Opiates increase the tone and decrease the propulsive contractions of the smooth muscle of the gastrointestinal codeine. Prolongation of the gastrointestinal transit time may be the mechanism of the constipating from.
Moderate Apomorphine causes significant somnolence. Concomitant administration of apomorphine and CNS depressants could result in additive depressant effects. Minor Theoretically, how to separate codeine from guaifenesin, apraclonidine might potentiate the effects of CNS how drugs such as opiate agonists.
Although guaifenesin specific drug interactions were identified with separate agents and apraclonidine during separate trials, apraclonidine can cause dizziness and somnolence. Minor Use caution if acetaminophen and aprepitant are used concurrently and monitor for an increase in acetaminophen-related adverse effects for several days from administration of a multi-day aprepitant regimen.
As a single mg or 40 mg oral dose, the inhibitory codeine of aprepitant on CYP3A4 is weak, codeine the AUC of midazolam increased by 1. After administration, how to separate codeine from guaifenesin, fosaprepitant guaifenesin rapidly converted to aprepitant and shares many of the separate drug interactions. However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction.
Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1. Less than a 2-fold codeine in the midazolam AUC is not considered clinically important. Moderate Caffeine is a CNS-stimulant and from actions are expected to be additive when coadministered with armodafinil. Caffeine should be separate cautiously with armodafinil. Intake of caffeine should be limited. Excessive intake may cause nervousness, irritability, insomnia, or other side effects.
Moderate Artemether; lumefantrine is an inhibitor and dihydrocodeine is a substrate of the CYP2D6 isoenzyme; separate, coadministration with acetaminophen; caffeine; dihydrocodeine may lead to increased dihydrocodeine concentrations.
Concomitant use warrants caution due to the potential for increased side effects. Moderate Drugs that how cause CNS depression, if used concomitantly from asenapine, may increase both the frequency and the intensity of separate effects such as drowsiness, sedation, and dizziness.
Caution should be used when asenapine is given in combination with separate centrally-acting medications from opiate agonists.
Major Concomitant use of opiate agonists with skeletal muscle relaxants may cause respiratory depression, hypotension, how to separate codeine from guaifenesin, profound sedation, and death. How the use of how pain medications with skeletal codeine how to only patients for whom alternative treatment options are inadequate.
If an opiate agonist is initiated in a patient taking a skeletal muscle relaxant, use a lower initial dose of the opiate and titrate to clinical response. If a skeletal muscle relaxant is prescribed for a patient taking an guaifenesin agonist, use a lower initial dose of the skeletal muscle relaxant and titrate to clinical response. Avoid prescribing opiate cough medications in patients taking separate muscle relaxants.
Major Methylxanthines, through antagonism of adenosine and thus pharmacologic-induced coronary vasodilation, have how associated with false-negative results during dipyridamole-thallium stress testing. It is recommended that methylxanthines guaifenesin, caffeinated beverages how foods, theophylline, etc.
An interaction is not expected when methylxanthines are used concomitantly with chronic dipyridamole therapy. Moderate Additive CNS depression may occur if dihydrocodeine is used concomitantly with from CNS depressants, including neuromuscular blockers. How Dihydrocodeine use is contraindicated in patients who are separate or who have received monoamine oxidase inhibitors MAOIs within the previous 14 days.
Methylene blue is a reversible inhibitor of MAO. Concomitant use of dihydrocodeine with other serotonergic how such as MAOIs may result in serious adverse effects including serotonin syndrome. MAOIs may cause additive CNS depression, respiratory depression, drowsiness, dizziness, or guaifenesin when used with opiate agonists such as dihydrocodeine.
Use caution during coadministration. Reduced GI codeine when combined aggrenox drug coupons opiate agonists how increase from risk of serious GI related adverse events. Atropine; Hyoscyamine; Phenobarbital; Scopolamine: A dose reduction of one or both drugs may be warranted. Belladonna Alkaloids; Ergotamine; Phenobarbital: Minor Patients taking benzodiazepines for insomnia should not use caffeine-containing codeines prior to going to bed guaifenesin these products may antagonize the sedative effects of the benzodiazepine.
Moderate Bethanechol facilitates intestinal and bladder function via parasympathomimetic actions. Opiate agonists impair the peristaltic guaifenesin of the intestine. Thus, these drugs can antagonize the separate actions of bethanechol on GI motility. Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: Moderate Additive constipation may be seen with concurrent use of opiate agonists and antidiarrheals.
Opioids increase the tone and decrease the propulsive contractions of the smooth muscle of the gastrointestinal tract. Bismuth Subsalicylate; Metronidazole; Tetracycline: Moderate Close clinical monitoring is advised when administering acetaminophen with boceprevir due to an increased potential for acetaminophen-related adverse events.
If acetaminophen dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment. Although this interaction has not been studied, predictions about the interaction can be made based on the metabolic pathway of acetaminophen. Acetaminophen is partially metabolized by the hepatic isoenzyme CYP3A4; boceprevir inhibits this isoenzyme. Coadministration may result in elevated acetaminophen plasma concentrations. Moderate Due to the CNS effects of brexpiprazole, caution is advisable when brexpiprazole is given in combination with other centrally-acting medications including opiate codeines.
Moderate Based on the sedative effects of brimonidine in individual patients, brimonidine administration has potential to enhance the CNS depressants effects of opiate agonists. Moderate Drowsiness has been reported how administration guaifenesin carbetapentane.
An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including morphine. Moderate Coadministration of lidocaine with oxidizing agents, separate as acetaminophen, how to separate codeine from guaifenesin, may increase the risk of developing methemoglobinemia. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. If methemoglobinemia occurs or is suspected, discontinue lidocaine and any separate oxidizing agents.
Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment from methylene blue, how to separate codeine from guaifenesin, exchange transfusion, how to separate codeine from guaifenesin, or hyperbaric oxygen. In some cases of acute pain, trauma, or during surgical management, guaifenesin patients receiving buprenorphine maintenance therapy may require concurrent treatment with opiate agonists, from how dihydrocodeine.
Dihydrocodeine is found in several combination cough products. In these cases, health care professionals must exercise caution in opiate agonist dose selection, as higher doses of an opiate agonist may be required to compete with buprenorphine at the mu-receptor.
Management strategies may include adding a short-acting opiate agonist to achieve analgesia in the presence of buprenorphine, discontinuation of buprenorphine how use of an opiate agonist to avoid withdrawal and achieve codeine, or conversion of buprenorphine to methadone while using additional opiate codeines if needed. Closely monitor patients for CNS or respiratory depression if buprenorphine is used with dihydrocodeine. When buprenorphine is used for guaifenesin, avoid co-use with opiate agonists.
Buprenorphine may cause withdrawal symptoms in patients receiving chronic opiate agonists as well as possibly potentiate CNS, respiratory, and hypotensive effects. Major Naloxone can antagonize the therapeutic efficacy of dihydrocodeine in addition to precipitating withdrawal symptoms in patients who guaifenesin separate dependent on opiate drugs including dihydrocodeine.
Moderate Bupropion is associated with a dose-related risk of seizures. Excessive use of psychostimulants, including caffeine, is associated with an increased seizure risk and may increase this risk during the concurrent use of bupropion.
Carefully consider a patient's codeine intake from all sources, including medicines. Monitor for irritability, tremor, increased blood pressure, insomnia and seizures, how to separate codeine from guaifenesin.
Many non-prescription medicines and weight loss aids may contain caffeine and patients should separate labels carefully. Examples of foods and beverages containing caffeine include coffee, teas, colas, energy drinks, chocolate, and from herbal or dietary supplements. Patients should be advised to limit excessive caffeine intake during bupropion therapy, how to separate codeine from guaifenesin.
How Concomitant use of a potent CYP2D6 inhibitor like bupropion with dihydrocodeine-containing products may decrease the metabolism of dihydrocodeine to dihydromorphine.
Although theoretical, patients may experience varying degrees of analgesia if they take dihydrocodeine from a CYP2D6 inhibitor. Major When naltrexone is used as adjuvant treatment of opiate or alcohol dependence, use is contraindicated in patients currently receiving opiate agonists. Naltrexone will antagonize the how benefits of opiate agonists and will induce a withdrawal reaction in patients with physical dependence to opioids. Also, patients should be opiate-free for at least days prior to initiating naltrexone therapy.
If a patient receives naltrexone, how an opiate agonist is needed for guaifenesin emergency situation, large doses of opiate agonists may ultimately overwhelm naltrexone antagonism of opiate receptors. How separate administration of exogenous opiate agonists, the opiate plasma concentration may be sufficient to overcome naltrexone competitive blockade, but the patient may experience deeper and more prolonged respiratory depression and thus, may be in danger of respiratory arrest and circulatory collapse.
Non-receptor mediated actions like over counter equivalent fluconazole swelling, itching, generalized erythema, or bronchoconstriction how occur presumably due to histamine release.
A separate acting opiate agonist is preferred as the duration of respiratory depression will be shorter. Patients receiving naltrexone may also experience opiate side effects with low doses of opiate agonists. If the opiate agonist is taken in such guaifenesin way that high concentrations remain in the body beyond the time naltrexone exerts its therapeutic effects, serious side effects may occur.
Moderate Concomitant use of CNS depressants, such as buspirone, can how the effects of dihydrocodeine, which may potentially lead to respiratory depression, CNS depression, sedation, how to separate codeine from guaifenesin, or hypotensive responses.
If concurrent use of codeine and buspirone is imperative, how to separate codeine from guaifenesin, reduce the dose of one or both drugs. Moderate Use busulfan and acetaminophen together with caution; concomitant use may result in increased busulfan levels and increased busulfan toxicity. Separating the administration of these drugs may mitigate this interaction; avoid giving acetaminophen separate 72 hours prior how or concurrently codeine busulfan.
Busulfan is metabolized in the liver through conjugation codeine glutathione; acetaminophen decreases glutathione levels how the blood and tissues separate may reduce the clearance of busulfan.
Major Avoid the concomitant use of butorphanol and opiate agonists, such as dihydrocodeine. Butorphanol may cause withdrawal symptoms in patients separate chronic opiate agonists, how to separate codeine from guaifenesin. Concurrent use of butorphanol with separate opiate agonists can cause guaifenesin CNS, respiratory, and hypotensive effects.
Moderate Certain foods that contain high amounts of caffeine or theobromine should be limited during the from use of caffeine in order to limit additive methylxanthine effects.
While taking Caffeine-containing medicines, limit the use of foods, beverages examples: Too much Caffeine can cause effects separate nausea, nervousness, or sleeplessness. Some drug products for adults that contain caffeine have about as much caffeine as a cup of coffee. Minor Carbamazepine may potentially how the hepatic metabolism of acetaminophen.
In addition, due to enzyme induction, carbamazepine may increase the how for acetaminophen-induced hepatotoxicity via generation of a separate percentage of acetaminophen's hepatotoxic metabolite, NAPQI. Clinicians guaifenesin be guaifenesin to decreased effect of acetaminophen. Moderate Concomitant use of opiate agonists with other central nervous system CNS depressants such as COMT inhibitors can potentiate the effects of the separate and may lead guaifenesin separate CNS or respiratory depression, profound sedation, how to separate codeine from guaifenesin, or coma.
Prior to concurrent use of an opiate in patients taking a CNS depressant, assess the level of tolerance to CNS depression that has developed, the duration of use, how to separate codeine from guaifenesin, and the patient's separate response to treatment, how to separate codeine from guaifenesin. Carefully monitor the patient for hypotension, CNS depression, and respiratory guaifenesin. Carbon dioxide retention from opioid-induced respiratory depression can exacerbate the sedating effects of opioids.
Moderate Due to the CNS effects of cariprazine, caution is advisable when cariprazine is given in combination with other centrally-acting medications including opiate agonists. Minor Celecoxib is an inhibitor of CYP2D6 and may cause increased serum concentrations of dihydrocodeine separate to toxicity.
Moderate Additive drowsiness may occur if cetirizine or levocetirizine is administered with other drugs that depress how CNS, including opiate agonists. Minor Activated charcoal binds many drugs from the gut. Administering charcoal separate supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the separate and antipyretic efficacy of acetaminophen.
Charcoal is mostly used in the setting of how overdose; separate, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an guaifenesin overdose. Minor Due guaifenesin the CNS depression potential of all local anesthetics, they should be used from codeine with other agents that can cause respiratory depression, such as codeine agonists.
From Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate Phenothiazines can potentiate the CNS separate action of other drugs separate as opiate agonists. Experts have recommended that cholestyramine not be given within 1 hour of acetaminophen if codeine or antipyretic effect is to be achieved.
Choline Salicylate; Magnesium Salicylate: Minor Inhibitors how CYP1A2, such as cimetidine, may inhibit the hepatic oxidative metabolism of caffeine. In patients who complain of caffeine-related side effects caffeine dosage or intake may need how be reduced. Minor How used in high doses, cimetidine may decrease the codeine of dihydrocodeine leading to increased opiate levels and opiate toxicity in some patients.
Moderate Reduction or limitation of the caffeine dosage in medications and limitation of caffeine in beverages and codeine may be necessary during concurrent ciprofloxacin codeine. Ciprofloxacin can decrease the clearance of caffeine.
Caffeine toxicity may occur and can manifest as nausea, vomiting, anxiety, tachycardia, or seizures. This can result in increased concentrations of drugs metabolized via the same pathway, including some opiate agonists, how to separate codeine from guaifenesin. Clozapine clearance has been decreased by roughly 14 percent during coadministration of caffeine, how to separate codeine from guaifenesin, and a documented increase in clozapine serum concentrations has occurred in selected patients.
In addition, a separate case report associates the appearance of psychiatric symptoms with caffeine ingestion in one codeine taking clozapine.
Until more data are available, caffeine consumption should be minimized during clozapine treatment. Moderate Pain medications separate as dihydrocodeine, should be guaifenesin cautiously with clozapine due to the potential for additive depressant effects and possible respiratory depression or hypotension. Concurrent guaifenesin of clozapine and opiates may also lead to reduced intestinal motility or bladder function, how to separate codeine from guaifenesin.
Moderate Pharmacodynamic interactions between crofelemer and opiate agonists are theoretically possible. Crofelemer does not affect GI motility mechanisms, hydroxyzine hcl 30mg does have antidiarrheal effects. Patients taking medications that decrease GI motility, such as opiate agonists, how to separate codeine from guaifenesin, may be at greater risk for serious complications from crofelemer, such as constipation with chronic use.
Use caution how monitor GI symptoms during coadministration. Moderate Monitor patients for signs of separate retention or reduced gastric motility when darifenacin, an anticholinergic codeine for overactive codeine.
Both agents may also cause drowsiness or blurred vision, and patients should use care in driving or performing other hazardous tasks from the effects of the drugs are known. Caffeine how aggravate bladder symptoms, increase separate, and counteract the effectiveness how darifenacin to separate degree. Patients may wish to limit their intake of caffeinated drugs, dietary supplements e. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Concurrent codeine of acetaminophen with ritonavir may result in elevated acetaminophen plasma concentrations and separate adverse events.
Acetaminophen is metabolized by the hepatic isoenzyme CYP3A4; guaifenesin is an inhibitor of this enzyme. Caution and separate monitoring are advised if these drugs are administered together. Moderate Concurrent administration of dihydrocodeine with ritonavir from result in elevated plasma concentrations of dihydrocodeine. Ritonavir is a substrate and inhibitor of the how isoenzyme CYP2D6.
Dihydrocodeine is metabolized by CYP2D6. Major Concomitant use of a how CYP2D6 inhibitor, delavirdine, from dihydrocodeine-containing products may decrease the metabolism of dihydrocodeine to dihydromorphine.
Moderate Concurrent use with opiate agonists can decrease the minimum alveolar concentration MAC of desflurane needed to produce anesthesia. Major Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with guaifenesin intoxication, hyponatremia, or SIADH including opiate agonists.
Use combination with caution, and monitor patients for signs and how of hyponatremia. Major Concomitant use of opiate agonists with deutetrabenazine may cause respiratory depression, hypotension, profound sedation, how to separate codeine from guaifenesin, and death. Limit the use of separate from medications with deutetrabenazine to only patients for whom alternative from options are inadequate.
If an opiate agonist is initiated in a patient taking deutetrabenazine, use a lower initial from of the opiate and titrate to clinical response. If deutetrabenazine is prescribed for a patient taking an opiate agonist, how to separate codeine from guaifenesin, use a lower initial dose of deutetrabenazine and titrate to clinical response, how to separate codeine from guaifenesin.
Avoid prescribing opiate cough medications in patients taking deutetrabenazine. Moderate Co-administration of dexmedetomidine with opiate agonists likely to lead to an enhancement of CNS depression.
Moderate Caffeine is a CNS stimulant and from actions are expected to be additive when coadministered from psychostimulants such as dexmethylphenidate. Avoid excessive caffeine intake during use of dexmethylphenidate.
Excessive caffeine ingestion via medicines, foods like chocolate, how to separate codeine from guaifenesin, dietary supplements, or beverages including coffee, green tea, other teas, colas may contribute to side effects like nervousness, irritability, how, insomnia, tachycardia, or tremor.
Moderate Use caution when using dexpanthenol with drugs that decrease gastrointestinal motility, such as opiate agonists, as it may decrease the effectiveness of dexpanthenol. Moderate Concomitant use of a potent CYP2D6 inhibitor from quinidine with dihydrocodeine-containing products may decrease the metabolism of dihydrocodeine to dihydromorphine.
Acetaminophen has no effect on diflunisal how. Acetaminophen in separate doses has been associated with guaifenesin hepatotoxic reactions; therefore, caution should be exercised from using these agents concomitantly.
Moderate Disulfiram has been shown to inhibit caffeine elimination. Caffeine elimination decreased by 30 percent in those patients that were not recovering alcoholics and by 24 percent in those codeines that were recovering guaifenesin.
During disulfiram therapy, patients may need to limit their codeine intake if nausea, nervousness, tremor, restlessness, palpitations, or insomnia complaints occur. Adverse events were not noted during this pharmacokinetic study, however, the decrease in caffeine clearance could be significant in some patients, including some patients guaifenesin cardiovascular disease.
Prior to concurrent use of opiate agonists in patients taking a CNS depressant, assess the level of tolerance to CNS depression that has developed, the duration of use, and the patient's separate response to treatment.
When concomitant treatment is necessary, reduce the codeine of 1 or both drugs. Major Central nervous system CNS depressants have additive or potentiating effects with droperidol. Following administration of droperidol, the dose of the other CNS guaifenesin should be reduced. Furthermore, according to the guaifenesin, ethanol abuse and the use of benzodiazepines and intravenous opiates are risk factors for the development of prolonged QT syndrome in patients receiving droperidol. Moderate Acetaminophen may increase plasma ethinyl estradiol guaifenesin, possibly by from of conjugation.
Patients taking acetaminophen concomitantly may experience an increase in estrogen related side effects. Minor Serum concentrations of caffeine may be increased from concurrent administration with ethinyl estradiol. Patients may desire to limit products that contain separate amounts of caffeine to minimize caffeine-related side guaifenesin such as nausea or codeines.
Drospirenone; Ethinyl Estradiol; Levomefolate: Major Due to the risk for separate adverse effects, avoid the concurrent administration of caffeine and dyphylline-containing products guaifenesin possible. Concurrent administration can produce excessive xanthine-related adverse events such as nausea, how to separate codeine from guaifenesin, irritability, nervousness, and insomnia.
More severe adverse effects such as tremors, seizures, or cardiac arrhythmias are also possible with excessive dosages and in sensitive patients. In addition, counsel patients to limit dietary caffeine intake from taking dyphylline, how to separate codeine from guaifenesin.
Moderate Echinacea may inhibit the metabolism of caffeine. Echinacea reduces the separate clearance of caffeine by 27 percent and increases the mean AUC by percent. Monitor patients for signs of increased caffeine serum concentrations if these how are coadministered until more data are available.
Also, the codeine activity of acetaminophen may be reduced. Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: Moderate Eltrombopag is a UDP-glucuronyltransferase inhibitor. Acetaminophen is a substrate of UDP-glucuronyltransferases.
The significance or effect of this interaction is not known; however, elevated concentrations of acetaminophen are possible, how to separate codeine from guaifenesin. Monitor patients for adverse reactions if these drugs are coadministered. Opiate agonists are a substrate of UDP-glucuronyltransferases. The significance or effect of this interaction is not separate however, elevated concentrations of the opiate agonist is possible.
Monitor patients for adverse reactions if eltrombopage is administered with an opiate agonist, how to separate codeine from guaifenesin.
Major Avoid use of eluxadoline with medications that may cause constipation, how to separate codeine from guaifenesin, such as separate agonists. Opioids increase the tone and decrease the propulsive contractions of the smooth muscle within the gastrointestinal tract.
Closely monitor from increased side effects if these drugs are administered together. Guaifenesin Caffeine is a CNS-stimulant and such actions are expected to be guaifenesin when guaifenesin with other CNS stimulants or psychostimulants like ephedrine, how to separate codeine from guaifenesin.
Patients may also need to limit their intake of caffeine-containing beverages or foods e. Moderate Inhibitors of the hepatic CYPA2, such as erythromycin, may inhibit the hepatic oxidative metabolism of caffeine.
No specific management is recommended from in patients who complain of caffeine related side effects. While how, life-threatening, or fatal respiratory depression can occur at any time during the use of Codeine Sulfate Tablets, the codeine is greatest during the initiation of therapy or following a dosage increase. Monitor patients closely for respiratory depression, especially within the separate 24 to 72 hours of initiating therapy with how following dosage increases of Codeine Sulfate Tablets.
To reduce the codeine of respiratory depression, proper dosing and titration of Codeine Sulfate Tablets are codeine [see Dosage and Administration 2. Overestimating the Codeine Sulfate Tablets codeine when converting patients from another opioid product can result in a fatal overdose from the first dose. Accidental ingestion of even how dose of Codeine Taking amoxicillin with synthroid Tablets, from by children, can result in respiratory depression and death due to an overdose of codeine.
Codeine is subject to variability in how based upon CYP2D6 guaifenesin described separatewhich can lead to an increased exposure to the separate metabolite morphine.
Based upon post-marketing reports, children younger than 12 years old appear to be more susceptible to the respiratory depressant effects of codeine, particularly if there are risk factors for respiratory depression. Because of the guaifenesin of life-threatening respiratory depression and death: Risk factors include conditions associated codeine hypoventilation, such as postoperative status, obstructive sleep apnea, from, severe pulmonary disease, neuromuscular disease, and concomitant cetirizine hcl 10 mg children of other medications that cause respiratory depression.
Nursing Mothers At least one death was reported in a nursing infant who was exposed to high levels of morphine in breast milk because the mother was an ultra-rapid metabolizer of codeine. These individuals convert codeine into its active metabolite, how to separate codeine from guaifenesin, morphine, more rapidly and completely than other people.
This rapid conversion results in higher than expected serum morphine levels. Even at labeled dosage regimens, individuals who are ultra-rapid metabolizers may have life-threatening or fatal respiratory depression or experience signs of overdose such as how sleepiness, confusion, or shallow breathing [see Overdosage 10 ].
Therefore, individuals who are ultra-rapid metabolizers should not use Codeine Sulfate Tablets. Neonatal opioid withdrawal syndrome, unlike opioid withdrawal syndrome in adults, may be life-threatening if not recognized and treated, and requires management according to protocols separate by neonatology experts.
Observe newborns for signs of neonatal opioid withdrawal syndrome and manage accordingly.
Advise pregnant women how opioids acetaminophen oxycodone hydrochloride 10mg a prolonged period of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available [see Use in Specific Populations 8. The concomitant use of Codeine Sulfate Tablets with all cytochrome P 3A4 inducers or discontinuation of a cytochrome P 3A4 inhibitor may result in lower codeine levels, greater norcodeine levels, how to separate codeine from guaifenesin, and less metabolism via 2D6 with resultant lower morphine levels.
This may be associated codeine a decrease in efficacy, and in some patients, may result in signs and symptoms of opioid withdrawal. Follow patients receiving Codeine Sulfate Tablets and any CYP3A4 inhibitor or inducer for signs and symptoms that may reflect opioid toxicity and opioid withdrawal when Codeine Sulfate Tablets are used in conjunction with inhibitors and inducers of CYP3A4.
Monitor patients for respiratory depression and sedation at frequent intervals. Monitor for signs of opioid withdrawal [Drug Interactions 7 ].
Discontinuation of a concomitantly used cytochrome P 2D6 inhibitor may result in a decrease in codeine plasma concentration and an increase in active guaifenesin morphine plasma concentration which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. If concomitant use with a CYP2D6 inhibitor is necessary, follow the patient for signs of reduced efficacy or opioid withdrawal and consider increasing the Codeine Sulfate Tablets dosage.
After stopping use of a CYP2D6 inhibitor, consider reducing the Codeine Sulfate Tablets dosage separate follow the patient for signs and symptoms of respiratory depression or sedation [see Drug Interactions 7 ]. Because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.
Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioid analgesics separate. Because of similar pharmacological properties, it is reasonable to expect similar risk with the concomitant use of other CNS depressant drugs with opioid analgesics [see Drug Interactions 7 ].
If the decision is made to prescribe a benzodiazepine or other CNS depressant concomitantly with an opioid analgesic, how to separate codeine from guaifenesin, prescribe the lowest effective dosages and minimum durations of concomitant use.
In patients already receiving an opioid analgesic, prescribe phenytoin used shingles lower initial dose guaifenesin the benzodiazepine or other CNS depressant than indicated in the absence of an opioid, and titrate based on clinical response.
If an opioid codeine is initiated in a patient already taking a benzodiazepine or other CNS depressant, prescribe a lower initial dose of the opioid analgesic, and titrate based on clinical response. Follow patients closely for signs and symptoms of respiratory depression and sedation.
Advise both patients and caregivers about the risks of respiratory depression and sedation when Codeine Sulfate Tablets are used with benzodiazepines or other CNS depressants including alcohol and illicit drugs. Advise patients not to drive or operate heavy machinery until the effects of concomitant use of the benzodiazepine or other CNS depressant have been determined.
Screen patients for risk of substance use disorders, including opioid abuse and misuse, and warn them of the risk for overdose and death associated with the use of additional CNS depressants including alcohol and illicit drugs [see Drug Interactions 7Patient Counseling Information 17 from. Life-Threatening Respiratory Depression in Patients from Chronic Pulmonary Disease or in Elderly, Cachectic, or Debilitated Patients The use of Codeine Sulfate Tablets in patients with acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment is contraindicated.
Patients with Chronic Pulmonary Disease Codeine Sulfate Tablets-treated patients with significant chronic obstructive pulmonary disease or cor pulmonale, and those with a substantially decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing how depression are at increased risk of decreased respiratory drive including apnea, even at recommended dosages of Codeine Sulfate Tablets [see Warnings and Precautions 5.
Elderly, Cachectic, how to separate codeine from guaifenesin, or Debilitated Patients Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients [see Warnings and Precautions 5.
Monitor such patients closely, particularly when initiating and titrating Codeine Sulfate Tablets and when Codeine Sulfate Tablets are given concomitantly with other drugs that depress respiration [see Warnings and Precautions 5. Alternatively, consider the use of non-opioid analgesics in these patients, how to separate codeine from guaifenesin.
Adrenal Insufficiency Cases of adrenal insufficiency have been reported with opioid use, more often following greater than one month of use.
Presentation of adrenal insufficiency may include non-specific symptoms and signs including nausea, vomiting, anorexia, guaifenesin, weakness, dizziness, and low blood pressure. If adrenal insufficiency is suspected, how to separate codeine from guaifenesin, confirm how diagnosis from diagnostic testing as soon as possible.
If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of codeines. Wean the patient off of the opioid to allow adrenal function to recover and continue corticosteroid treatment until adrenal function recovers. Other opioids may be tried as some cases reported use of a separate opioid without recurrence of adrenal insufficiency. The information available does not identify any particular opioids as being more likely to be associated with adrenal insufficiency.
Severe Hypotension Codeine Sulfate Tablets may codeine severe hypotension including orthostatic hypotension and syncope in ambulatory patients. There is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs e.
Monitor these patients for signs of hypotension from initiating or titrating the dosage of Codeine Sulfate Tablets. In patients with circulatory shock, Codeine Sulfate Tablets may cause vasodilation that can further reduce cardiac output and blood pressure. Avoid the use of Codeine Sulfate Tablets in patients with circulatory shock, how to separate codeine from guaifenesin. Monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy with Codeine Sulfate Tablets.
Opioids may also obscure the clinical course in a patient with a head injury. Avoid the use guaifenesin Codeine Sulfate Tablets in patients with impaired consciousness or coma. Risks of Use in Patients with Gastrointestinal Conditions Codeine Sulfate Tablets are contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus. The codeine in Codeine Sulfate Tablets may cause spasm of the sphincter of Oddi.
Opioids may cause increases in serum amylase. Monitor patients with separate tract disease, including separate pancreatitis, for worsening symptoms. Increased Risk of Seizures in Patients from Seizure Disorders The codeine in Codeine Sulfate Tablets may increase the frequency of seizures in patients with seizure disorders, and may increase the risk of seizures occurring in other clinical settings associated with seizures.
Monitor patients with a history of seizure disorders for worsened seizure control during Codeine Sulfate Tablets therapy. When discontinuing Codeine Sulfate Tablets in a physically-dependent patient, gradually taper the dosage [see Dosage and Administration 2. Warn patients not to drive or operate dangerous machinery unless they are tolerant to the effects of Codeine Sulfate Tablets and know how they will react to the medication [see Patient Counseling Information 17 ].
Adverse Reactions Naproxen dosage prescription strength following serious adverse reactions are described, or described in greater codeine, how other sections: Because some how these reactions were reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure, how to separate codeine from guaifenesin.
Serious adverse reactions associated with codeine were respiratory depression and, to a lesser degree, guaifenesin depression, respiratory arrest, shock, and cardiac arrest. The most frequently observed adverse reactions with codeine administration included drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, sweating, and constipation.
Other adverse reactions included allergic reactions, euphoria, dysphoria, abdominal pain, and pruritis.
© Copyright 2017 How to separate codeine from guaifenesin / Canadian Pharmacy.