Codeine-Guaifenesin

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Apr 10, 2023

Warnings

Codeine-Guaifenesin Risks, Warnings, and Complications

Codeine-guaifenesin can cause or worsen certain health problems in some people. Talk to your doctor or pharmacist about other treatment options for cough if you are at increased risk of complications from this drug combination.

POTENTIAL FOR MISUSE, ADDICTION, AND ABUSE: Codeine is a narcotic and habit-forming medicine that has the potential for abuse. Narcotic medicines carry the risk of addiction if you use the medicine improperly or even at the prescribed dose as recommended. These drugs can result in dangerously slow breathing and a fatal overdose. Taking other narcotic medications or consuming alcohol can have additive effects and increase the risk of this happening. Use codeine and guaifenesin at the lowest possible dose for the shortest possible time. Do not use this medicine for more than 7 days without your doctor’s approval. Tell your doctor if you have a history of drug or alcohol addiction or a mental illness such as depression.
NOT FOR LONG-LASTING COUGHS: Codeine-guaifenesin is not for the treatment of chronic cough caused by lung conditions such as asthma, chronic bronchitis, emphysema, or smoking. Do not take this medicine for more than 7 days unless your doctor tells you to. Talk to your doctor about other treatment options if you have a chronic cough. Also, tell your doctor if you develop fever, rash, headache, or other symptoms along with a cough. You may have a health condition that this medicine cannot treat. Do not take this medicine without a prescription.
RISK IN PEOPLE WITH CERTAIN MEDICAL CONDITIONS: Before starting codeine-guaifenesin, tell your healthcare provider if you have a history of asthma, chronic obstructive pulmonary disease, neuromuscular disease, sleep apnea, obesity, or scoliosis. In people with these health conditions, taking this combination medicine (codeine-guaifenesin) with other narcotic medications or CNS depressants can increase the risk of profound sedation, slow breathing, coma, and death.
DANGEROUS FOR CHILDREN UNDER 12 YEARS OLD: The FDA has issued a warning that codeine-containing medications should not be used to treat cough in children 12 years of age or younger. This medication can cause serious breathing problems in children. Talk to your child's healthcare provider or pharmacist for alternative treatments if your child has a cough.
RISK WHILE DRIVING OR OPERATING MACHINERY: Codeine-guaifenesin can cause severe dizziness and drowsiness and impaired mental abilities. Be careful when driving, operating machinery, or doing other hazardous tasks until you know how this medicine affects you. Avoid taking this cough medicine with other drugs or alcohol that can also cause central nervous system depression.
LIFE-THREATENING WITHDRAWAL SYMPTOMS: Codeine-guaifenesin is not intended for long-term use to treat chronic cough. If your doctor has prescribed it for long-term use, do not abruptly discontinue this medicine after prolonged use, as it can result in life-threatening withdrawal symptoms. Licensed healthcare practitioners can tell you how to gradually reduce the dose to prevent symptoms of withdrawal.
ORTHOSTATIC HYPOTENSION: Codeine-guaifenesin may cause orthostatic hypotension (low blood pressure when standing from a sitting or lying position). The risk of this occurring is higher in people who are dehydrated or are taking other drugs that also cause this side effect. Get out of bed slowly when on this medicine. Tell your doctor if you experience severe dizziness when standing from a sitting or lying position.
SEVERE CONSTIPATION: Codeine-guaifenesin can cause severe constipation. People with certain conditions, such as known or suspected gastrointestinal obstruction, including paralytic ileus, should not take this medicine. People with inflammatory bowel diseases such as ulcerative colitis should take this prescription cough medicine with caution as they may be more sensitive to developing constipation caused by narcotic medications. Do not take this narcotic cough suppressant if you have infectious diarrhea or food poisoning as it can obscure the diagnosis and clinical course.
RISK DURING PREGNANCY AND BREASTFEEDING: Codeine-guaifenesin is not safe for use by pregnant women. Use of this narcotic cough suppressant during pregnancy can lead to an increased risk of respiratory depression in the newborn. Also, prolonged use of opioids such as codeine during pregnancy can lead to a life-threatening condition called neonatal opioid withdrawal syndrome in the baby. Do not breastfeed while taking codeine-guaifenesin as it can lead to serious adverse reactions, including excessive sedation and respiratory depression in a breastfed infant.

Precautions Before Starting Codeine-Guaifenesin

Tell your healthcare provider if you have ever had an allergic reaction to codeine, guaifenesin, or any other drugs. Your pharmacy can give you a list of active and inactive ingredients in this combination medicine.

Give your doctor and pharmacist a complete list of all your current medicines, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products. This will help avoid possible drug interactions between your medications.

Give your doctor a complete medical history. Codeine-guaifenesin may not be right for people with certain medical conditions such as liver disease, gallbladder disease, pancreatitis, renal impairment, kidney failure, bladder obstruction, prostatic hypertrophy, urinary retention, seizures, hypothyroidism, and adrenal insufficiency.

Codeine can cause constipation. Talk to your healthcare provider about making changes to your diet to prevent this side effect.

Tell your doctor if you are pregnant, could be pregnant, planning a pregnancy, or are breastfeeding.

Precautions During Use of Codeine-Guaifenesin

Keep all your medical and lab appointments while on codeine-guaifenesin.

Check the label of any cough or cold medicine you take. Codeine is present in many combination medicines. Make sure you don’t exceed the maximum recommended dose of this narcotic medicine.

Taking codeine can affect fertility in men and women. Discuss this risk with your doctor if you are planning to have children in the future.

Codeine can make you drowsy and dizzy. Do not drive or do any hazardous activity that requires your full concentration until you know how it affects you. Avoid drinking alcohol as this can make these side effects worse and increase your risk of injuries and accidents.

Codeine may cause lightheadedness, dizziness, or fainting if you get up too quickly from a lying position. This is more likely to happen when you first start taking the medicine. To avoid this problem, get out of bed slowly and rest your feet on the ground for several minutes before you stand up.

Tell all your doctors you are on this medicine before any laboratory tests or medical procedures, including dental procedures.

Call your healthcare professional if you become pregnant while taking this medicine.

Codeine-Guaifenesin Drug Interactions

Certain other drugs can affect how codeine and guaifenesin work. Possible interactions between drugs can increase the risk of severe adverse effects.

Tell your doctor or pharmacist if you are taking or have taken in the past 2 weeks medications called monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl, Emsam, Zelapar), linezolid (Zyvox), isocarboxazid (Marplan), or methylene blue. You should not take codeine if you are currently taking or have taken these medicines within the last 14 days.

The following medications can have possible drug interactions with codeine and guaifenesin:

Antidepressants such as bupropion (Aplenzin, Wellbutrin, Zyban), mirtazapine (Remeron), and trazodone (Oleptro)
Selective serotonin-reuptake inhibitors (SSRIs) such as sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), fluoxetine (Prozac, Sarafem, in Symbyax), and paroxetine (Brisdelle, Prozac, Pexeva)
Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor)
Tricyclic antidepressants such as amitriptyline, imipramine (Tofranil), desipramine (Norpramin), clomipramine (Anafranil), doxepin (Silenor), nortriptyline (Pamelor), trimipramine (Surmontil), and protriptyline (Vivactil)
Skeletal muscle relaxants like cyclobenzaprine (Amrix)
Medications used to treat cough, cold, or allergies
Diuretics or water pills
Psychiatric medications such as lithium (Lithobid)
Anti-anxiety and anti-seizure medications
Triptan medications used to treat migraine headaches such as eletriptan (Relpax), almotriptan (Axert), frovatriptan (Frova), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), and sumatriptan (Imitrex, in Treximet)
5HT3 serotonin blockers (medications used to treat and prevent nausea and vomiting) such as ondansetron (Zofran, Zuplenz), alosetron (Lotronex), granisetron (Kytril), dolasetron (Anzemet), or palonosetron (Aloxi)
Other narcotic medications like tramadol (Conzip)

Give your doctor and pharmacist a list of all your current medicines, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal products. Also, tell your healthcare professionals if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription medications.

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