Pholcodine

Indications

Pholcodine is used to relieve a dry, tickly, non-productive cough (a cough that does not bring up phlegm). It is not meant for a chesty cough with mucus, where coughing helps clear the airways.

How It Works

Pholcodine is an opioid-type cough suppressant. It acts on the cough centre in the brain and raises the trigger point for coughing, so you cough less. Unlike stronger opioids, it has little pain-relieving effect and a low risk of dependence at normal doses.

Dosage and Administration

Adults and children over 12 years: usually 5 to 10 mg three or four times a day, as directed on the label. Do not take more than the label says. Use the measuring cup or spoon provided. It is not recommended for children under 6 years; for children 6 to 12 years use only as advised by a doctor or pharmacist. Do not use for more than a few days without medical advice.

Interactions

• Alcohol, sleeping tablets, Benzodiazepines, sedating antihistamines and other opioids increase drowsiness and may slow breathing.
• MAO inhibitors (such as Selegiline) should not be taken with it or within 14 days before it.
• Pholcodine use in the past 12 months has been linked to a higher risk of severe allergic reactions to muscle relaxants used during general anaesthesia (such as Suxamethonium or Rocuronium). Tell your doctor or anaesthetist before any operation.

Contraindications

• Allergy to Pholcodine or other opioids.
• Breathing problems or reduced breathing, severe asthma attack, chronic lung disease with sputum.
• Severe liver disease.
• Children under 6 years.

Side Effects

Side effects are usually mild: drowsiness, dizziness, nausea, vomiting, constipation, and occasionally confusion or excitement. Skin rash can occur.

Get urgent medical help if you have difficulty breathing, slow or shallow breathing, extreme sleepiness, or swelling of the face, lips or throat with hives.

Pregnancy and Lactation

It is not recommended during pregnancy, especially near delivery, unless a doctor advises it. Small amounts may pass into breast milk; avoid while breastfeeding or use only on medical advice.

Precautions and Warnings

• See a doctor if the cough lasts more than a week, comes with fever, blood, chest pain or breathlessness.
• It may cause drowsiness: avoid driving if affected.
• Use with care in asthma, liver or kidney disease and in older people.
• Tell your anaesthetist if you have taken Pholcodine in the past year.
• Many countries have withdrawn Pholcodine because of the anaesthesia allergy risk; ask your pharmacist about alternatives.

Overdose

Overdose may cause severe drowsiness, unsteadiness, vomiting, slowed breathing and in children fits. Get emergency medical help.

Therapeutic Class

Cough suppressant (antitussive), opioid derivative.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.