Let's learn about the drug combination Codeine; Guaifenesin; Pseudoephedrine.

When you have a cold, or an allergy , or a fever, you probably have a lot of trouble with things like coughing, sneezing, and a stuffy nose and runny nose, right? One type of medicine that is given at such times is this syrup , which comes as a combination of three drugs: codeine, guaifenesin , and pseudoephedrine. Let's see what happens with this, how to use it, and what things to be careful about.

What is this medicine? Simply put...

This medicine is a combination of several medications that are given to reduce cough, thin out some of the mucus in the chest so it can be easily expelled, and also to reduce runny nose and nasal congestion. Specifically, it contains:

• Codeine: This is an opioid that controls cough and has some pain-relieving properties.
• Guaifenesin: This works by thinning and diluting the mucus in the respiratory tract, making it easier to cough up. We call this an ``Expectorant``.
• Pseudoephedrine : This works by slightly constricting the blood vessels in the nose, reducing nasal congestion and runny nose. This is called a ``decongestant.''

This medicine may sometimes be prescribed by doctors for other reasons. If you have any questions about it, it is best to ask your doctor or the person at the pharmacy. This medicine may come under different brand names.

What should you tell your medical team before taking this medication?

Before you start taking this medicine, it is important to tell your doctor or the pharmacist if you have any of these conditions. This is because they will be able to decide whether this medicine is right for you or not, and how much to give you.

• If you have a brain tumor .
• If you have diabetes (diabetes mellitus) (i.e. high blood sugar levels).
• If there is a drug addiction or similar problem.
• If you have recently had a head injury .
• If you have heart disease .
• High blood pressureIf you have ``(High blood pressure)``.
• If you are a regular drinker .
• If you have kidney disease .
• If you have liver disease .
• If you have a lung disease, asthma, or other breathing difficulties .
• If you have prostate disease (applicable to men).
• If you have a seizure -like condition .
• If you have stomach or intestinal problems (for example, stomach ulcers, intestinal blockages).
• If you have used a medicine in the MAOI class, such as `(Marplan)`, `(Nardil)`, or `(Parnate)`, within the past 14 days.
• If you have thyroid disease .
• If you have previously had an unusual allergic reaction to codeine, guaifenesin, pseudoephedrine, or any other medicine, food, dye, or preservative.
• If you are pregnant or trying to get pregnant .
• If you are a breastfeeding mother .

It is very important for your safety to inform them of these things.

How should I use this medicine?

This medicine is a liquid (syrup) to be taken by mouth. Take it exactly as directed on the label or as directed by your doctor.

• Measuring medication: Use a specially designed syringe, special spoon, or dropper to measure each dose of medication. Ask your pharmacy if you don't have one. Don't use regular teaspoons or tablespoons, as they won't give you an accurate measurement.
• With or without food?: This medicine can be taken with or without food. However, if you experience stomach discomfort after taking the medicine, it is best to take the medicine with some food.
• Do not take more than the prescribed amount: Do not use this medicine more often than the doctor tells you to.

Important: This medicine has been prescribed for you only. Never give this medicine to anyone else, even if they have the same symptoms you have.

Be careful when giving to children.

Although this medicine can be given to children as young as 12 years old in some selected cases, there are some special considerations to be taken into account. Therefore, it is essential to seek medical advice if giving this medicine to children.

People over 65 years of age

People over the age of 65 may have a more severe reaction to this medicine, so they should be given a lower dose than usual.

Overdose

If you think you have taken more of this medicine than you think, go to the nearest hospital emergency department immediately, or call a poison control center.

What to do if you miss a dose of medication?

This is not a medicine that usually needs to be taken at the same time every day. It is used as needed. That is, only when symptoms such as cough and phlegm are present. Therefore, the term "missed time" does not apply to this.

What other things can interact with this medicine? (Interactions)

There are some medications that can cause problems when taken together with this combination of codeine, guaifenesin, and pseudoephedrine. So if you are using any other medications, you should definitely tell your doctor about it.

Never take this medicine together with the following medications:

• Linezolid
• MAOI drugs (e.g. Marplan, Nardil, Parnate)
• Methylene blue `(Methylene blue)`
• Ozanimod

This medicine may also interact with the following:

• Alcohol
• Other types of antihistamines for allergies, coughs, and colds
• Some medications for anxiety or sleep
• Some medications for depression (e.g. Amitriptyline, Fluoxetine, Sertraline)
• Some medications for seizures (e.g., Phenobarbital, Primidone)
• General anesthetics (e.g., Halothane, Isoflurane, Methoxyflurane, Propofol)
• Muscle relaxants used during surgery
• Other opioid (narcotic) pain relievers
• Phenothiazines (e.g. Chlorpromazine, Mesoridazine, Prochlorperazine, Thioridazine)

This list is not complete. Tell your doctor about all the medicines you take (prescribed, over-the-counter, herbal products, even vitamins). Also, tell your doctor if you smoke, drink alcohol, or use illegal drugs. Some things can interact with your medicine.

What are the things to be careful about when using this medicine?

• Visit your doctor: Visit your doctor regularly to see if your symptoms improve. Tell your doctor if your symptoms do not improve or if they get worse . If you need to use this medicine for more than 7 days, talk to your doctor.
• Recommended dosage:Use only the prescribed dose as directed by your doctor. Do not take more than the recommended amount.
• Tolerance: If you use this medicine for a long time, your body may get used to it. Over time, the amount of relief you get from coughing may decrease. Tell your doctor if your symptoms do not improve or if they get worse.
• Stopping the medicine suddenly: If you have been using this medicine for a long time, do not stop it suddenly. Doing so can cause a serious reaction. This is because your body has become accustomed to the medicine. This does not mean that you are addicted to the medicine. Addiction is the behavior of obtaining and using a medicine for a non-medical reason. If your doctor wants you to stop taking the medicine, he or she will gradually reduce the dose to prevent side effects.
• Other medications that make you sleepy: If you are taking other medications that make you sleepy (such as other narcotic pain medications, benzodiazepines, sleeping pills), you may have other side effects. Tell your doctor about all the medications you are taking. He or she will tell you how much to take. Do not take more than the prescribed dose. If you have trouble breathing, or feel unusually tired or sleepy, seek emergency medical attention right away.
• Drowsiness and dizziness: This medicine may make you feel drowsy or dizzy . Therefore, do not drive, operate machinery, or do anything that requires concentration until you know how this medicine affects you. Do not stand or sit up suddenly, especially if you are elderly. This can reduce the risk of dizziness and falls.
• Alcohol: Alcohol can interfere with the effectiveness of this medication. Therefore, avoid drinking alcohol.
• Constipation: This medicine may cause constipation . If you do not have a bowel movement for 3 days, call your doctor.
• Dry mouth: You may have a dry mouth . Chewing sugarless gum, sucking on sugarless hard candy, and drinking plenty of water can help relieve this. If this problem persists or is severe, see your doctor.

Special risks to children

Children may be at higher risk of side effects. If your child has trouble breathing, makes wheezing noises, seems confused, or is unusually sleepy, stop giving this medicine immediately and seek emergency medical attention.

What side effects might I experience from this medicine?

Like all medications, this one can cause side effects in some people. Some are serious, some are common.

Side effects that should be reported to the doctor immediately:

• Allergic reactions: Skin rash, itching, hives, swelling of the face, lips, tongue, or throat.
• Central nervous system depression (CNS depression): Slow or shallow breathing, difficulty breathing, fainting, dizziness, confusion, difficulty staying awake.
• Low adrenal gland function: nausea, vomiting, loss of appetite, unusual weakness or fatigue, dizziness.
• Low blood pressure: Dizziness, fainting or lightheadedness, blurred vision.

Side effects that usually do not require medical treatment, but should be reported to your doctor if they persist or are bothersome:

• Anxiety or restlessness
• Dizziness
• Drowsiness
• Dry mouth
• Headache (Here " Headache " means "Hisaradaya" in Georgian. The correct Sinhala word is "Hisaradaya".) - Headache
• Nausea
• Trouble sleeping
• Vomiting

This list does not describe all possible side effects. Contact your doctor for medical advice about side effects.

How should I store my medicine?

• Keep out of reach of children and pets. This medicine can be misused. Therefore, keep your medicine in a safe place to protect it from theft.
• Do not share this medicine with anyone else. This medicine has been prescribed for you only. Selling or giving this medicine to others is dangerous and against the law.
• Storage: Store at a temperature between 15 and 30 degrees Celsius (59 and 86 degrees Fahrenheit). Throw away any unused medicine after the expiration date.

How to dispose of unused medication

This medicine can be harmful or even fatal if taken by other adults, children, or pets. Therefore, it is very important to properly dispose of this medicine when you no longer need it or when it has expired. There are two ways to do this:

1. Give to a medication take-back program. Check with your pharmacy or law enforcement to see if they have one.

2. If you can't return it, check the label on the medicine bottle or the leaflet that comes with it to see if the medicine should be thrown in the trash or flushed down the toilet. If you're not sure, ask your healthcare team. If it's safe to throw it in the trash, pour the medicine out of the bottle and mix it with cat litter, soil, coffee grounds, or other unwanted material. Put this mixture in a bag or container, seal it well, and throw it in the trash.

The most important things to remember (Take-Home Message)

This medicine helps relieve symptoms such as cough, phlegm, and nasal congestion caused by colds, allergies, and flu. However, you need to be very careful when using it.

• Use only as directed by your doctor. Take only the prescribed dose and frequency.
• Be sure to tell your doctor about any other medical conditions you have and any other medications you are taking.
• Be aware that this medicine may cause drowsiness and dizziness . Be careful when driving or doing other activities that require alertness.
• Do not take this medicine with alcohol.
• Be especially careful when giving to children and follow medical advice.
• Be aware of side effects. If you notice any serious side effects, see a doctor immediately.
• Keep medicines safe and properly dispose of unused medicines.

This information sheet is a summary only. It does not cover all the details. If you have any further questions about this medicine, please talk to your doctor, pharmacist, or healthcare provider.

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