- Does Phenergan with Codeine (promethazine and codeine) cause side effects?
- What are the important side effects of Phenergan with Codeine (promethazine and codeine)?
- Phenergan with Codeine (promethazine and codeine) side effects list for healthcare professionals
- Does Phenergan with Codeine (promethazine and codeine) cause addiction or withdrawal symptoms?
- What drugs interact with Phenergan with Codeine (promethazine and codeine)?
Does Phenergan with Codeine (promethazine and codeine) cause side effects?
Phenergan with Codeine (promethazine and codeine) is a combination of an anti-histamine, sedative, antiemetic (anti-nausea), and cough suppressant and a weak narcotic pain-reliever and cough suppressant used to treat common cold symptoms and cough.
Promethazine blocks the action of the neurotransmitter acetylcholine on its receptors (anticholinergic effect), and this may explain its benefit in reducing the nausea of motion sickness. It is used as a sedative because it causes drowsiness as a side effect. The cough suppressant effects may be due to is anticholinergic effects.
Codeine is a weak narcotic pain-reliever and cough suppressant similar to morphine. The precise mechanism of action of codeine is not known; however, like morphine, codeine binds to narcotic receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain throughout the body and brain.
Codeine increases tolerance to pain and decreases discomfort. In addition to reducing pain, codeine also causes sedation (drowsiness) and depresses breathing. The brand name Phenergan with Codeine is no longer is available in the U.S.
Common side effects of Phenergan with Codeine include
- inability to sleep,
- palpitations, and
- extrapyramidal symptoms (changes in muscle tone, sharp, involuntary muscle movements often limited to one muscle or muscle group, restlessness, and Parkinsonism).
Withdrawal symptoms may occur if you suddenly stop taking this drug.
Serious side effects of Phenergan with Codeine include
- depressed respiration and even death in children less than 6 years of age, and
- neuroleptic malignant syndrome (high body temperature, severe extrapyramidal symptoms, changes in consciousness and mental status, and increased heart rate with low or high blood pressure).
Drug interactions of Phenergan with Codeine include other medications that cause sedation (because excessive sedation may occur), such as
- anti-anxiety medications,
- other phenothiazines, and
- narcotic pain medications.
Excessive anti-cholinergic effects can occur when promethazine is used with
There may be an increase in the risk of certain neurologic reactions that affect movement of muscles when promethazine is combined with medicines that also cause EPS such as
- metoclopramide, and
Promethazine should not be used with propylthiouracil (PTU) due to the increased risk of low white blood cell counts and increased risk of infections. Concurrent use of promethazine with dye used for myelography (X-rays of the spinal cord) can lower the threshold for seizures and thus increase the risk of seizures.
Codeine generally is avoided during pregnancy because it may cause
- fetal physical dependence,
- withdrawal and
- growth retardation.
It is unknown if promethazine is excreted in breast milk. Small amounts of codeine are secreted in breast milk, but the risk of adverse events in the infant is small. Consult your doctor before breastfeeding.
What are the important side effects of Phenergan with Codeine (promethazine and codeine)?
- In children less than 6 years of age, promethazine and codeine can depress respiration and lead to death.
- Therefore, it should not be used in children less than 6 years old.
- Death has also been reported in children less than 2 years old due to respiratory depression.
- Although promethazine causes dizziness, it may stimulate activity in patients, particularly children.
- Such stimulation may be manifest by restlessness, inability to sleep, palpitations (rapid heartbeat) or even seizures.
Extrapyramidal symptoms (EPS) may occur. EPS are categorized as
- dystonic reactions (alterations in muscle tone),
- sharp, involuntary muscle movements often limited to one muscle or muscle group,
- akathisia (subjective restlessness), and
Parkinsonian symptoms are more common in older persons whereas children more often develop involuntary muscle movement reactions. Dystonic reactions are most commonly seen during the first week of treatment. Restlessness and Parkinsonian symptoms usually develop days to weeks after starting therapy.
A complex called neuroleptic malignant syndrome (NMS) can occur in patients receiving phenothiazines. NMS consists of
- high body temperature,
- severe EPS,
- changes in consciousness and mental status, and
- increased heart rate with low or high blood pressure.
NMS occurs more frequently in young men and in persons who are dehydrated.
Phenergan with Codeine (promethazine and codeine) side effects list for healthcare professionals
Central Nervous System
CNS depression, particularly respiratory depression, and to a lesser extent circulatory depression; light-headedness, dizziness, sedation, euphoria, dysphoria, headache, transient hallucination, disorientation, visual disturbances, and convulsions.
Nausea, vomiting, constipation, and biliary tract spasm. Patients with chronic ulcerative colitis may experience increased colonic motility; in patients with acute ulcerative colitis, toxic dilation has been reported.
Oliguria, urinary retention, antidiuretic effect has been reported (common to narcotic analgesics).
Central Nervous System
Drowsiness is the most prominent CNS effect of this drug. Sedation, somnolence, blurred vision, dizziness, confusion, disorientation and extrapyramidal symptoms such as oculogyric crisis, torticollis, and tongue protrusion; lassitude, tinnitus, incoordination, fatigue, euphoria, nervousness, diplopia, insomnia, tremors, convulsive seizures, excitation, catatonic-like states, hysteria. Hallucinations have also been reported.
Increased or decreased blood pressure, tachycardia, bradycardia, faintness.
Leukopenia, thrombocytopenia, thrombocytopenic purpura, agranulocytosis.
Asthma, nasal stuffiness, respiratory depression (potentially fatal) and apnea (potentially fatal).
Angioneurotic edema. Neuroleptic malignant syndrome (potentially fatal) has also been reported.
Hyperexcitability and abnormal movements have been reported in patients following a single administration of promethazine HCl. Consideration should be given to the discontinuation of promethazine HCl and to the use of other drugs if these reactions occur.
Does Phenergan with Codeine (promethazine and codeine) cause addiction or withdrawal symptoms?
Drug Abuse And Dependence
Promethazine HCl and Codeine Phosphate Oral Solution is a Schedule V Controlled Substance.
Codeine is known to be subject to abuse; however, the abuse potential of oral codeine appears to be quite low. Even parenteral codeine does not appear to offer the psychic effects sought by addicts to the same degree as heroin or morphine. However, codeine must be administered only under close supervision to patients with a history of drug abuse or dependence.
Psychological dependence, physical dependence, and tolerance are known to occur with codeine.
What drugs interact with Phenergan with Codeine (promethazine and codeine)?
Codeine: In patients receiving MAO inhibitors, an initial small test dose is advisable to allow observation of any excessive narcotic effects or MAOI interaction.
Promethazine may increase, prolong or intensify the sedative action of other central-nervous-system depressants, such as
- sedatives/hypnotics (including barbiturates),
- narcotic analgesics,
- general anesthetics,
- tricyclic antidepressants, and
Therefore, such agents should be avoided or administered in reduced dosage to patients receiving promethazine HCl. When given concomitantly with promethazine, the dose of barbiturates should be reduced by at least one-half, and the dose of narcotics should be reduced by one-quarter to one-half.
Dosage must be individualized. Excessive amounts of promethazine HCl relative to a narcotic may lead to restlessness and motor hyperactivity in the patient with pain; these symptoms usually disappear with adequate control of the pain.
Because of the potential for promethazine to reverse epinephrine's vasopressor effect, epinephrine should NOT be used to treat hypotension associated with promethazine overdose.
Concomitant use of other agents with anticholinergic properties should be undertaken with caution.
Monoamine Oxidase Inhibitors (MAOI)
Drug interactions, including an increased incidence of extrapyramidal effects, have been reported when some MAOI and phenothiazines are used concomitantly.
Drug/Laboratory Test Interactions
Because narcotic analgesics may increase biliary tract pressure, with resultant increase in plasma amylase or lipase levels, determination of these enzyme levels may be unreliable for 24 hours after a narcotic analgesic has been given.
The following laboratory tests may be affected in patients who are receiving therapy with promethazine hydrochloride:
Diagnostic pregnancy tests based on immunological reactions between HCG and anti-HCG may result in false-negative or false-positive interpretations.
Glucose Tolerance Test
An increase in blood glucose has been reported in patients receiving promethazine.
Phenergan with Codeine (promethazine and codeine) is a combination of an anti-histamine, sedative, antiemetic (anti-nausea), and cough suppressant and a weak narcotic pain-reliever and cough suppressant used to treat common cold symptoms and cough. Common side effects of Phenergan with Codeine include dizziness, restlessness, inability to sleep, palpitations, and extrapyramidal symptoms (changes in muscle tone, sharp, involuntary muscle movements often limited to one muscle or muscle group, restlessness, and Parkinsonism). Withdrawal symptoms may occur if you suddenly stop taking this drug. There are no adequate studies of Phenergan with Codeine in pregnant women. Administration of promethazine within two weeks of delivery may affect platelet function in the newborn. It is unknown if promethazine is excreted in breast milk. Small amounts of codeine are secreted in breast milk, but the risk of adverse events in the infant is small.
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Killer Cold Virus (Adenovirus Infection, Ad14)
Second Source article from Government
Cold Agglutinin Disease
Cold agglutinin hemolytic anemia or cold agglutinin hemolytic disease, is rare disorder of the autoimmune system. There are two types of cold agglutinin disease, primary and secondary. Characteristics, symptoms, and signs of in cold agglutinin disease are premature destruction of red blood cells in the body’s natural defense antibodies. The lifespan of red blood cells is approximately 120 before the spleen destroys the antibodies. In cold agglutinin disease, the severity of the condition is determined by how long it takes for the red blood cells to survive, and at the rate that the bone marrow continues to produce more red cells. Immune hemolytic anemias are classified by the optimal temperature when the antibodies try to destroy red blood cells. Cold agglutinin anemia occurs at temperatures between 10 C (50 F) and 37 C (F 98.6) or above while the body warms antibody hemolytic anemia. Usually, cold agglutinin anemia becomes apparent between the ages of 50 to 60. Other symptoms of the disease include fatigue, jaundice (yellowing of the skin and eyes), fingers and/or toes are cold and sweat, an uneven bluish or reddish discoloration of the toes, ankles, and wrists (Raynaud's syndrome), and fingers. Usually, cold agglutinin anemia affects people that are older. The disease is diagnosed by a physical exam, and the Coomb's test. If the red blood cells destruction seem to be slowing on its own, treatment therapies, usually, isn’t needed. Other treatments for cold agglutinin anemia are corticosteroids, and splenectomy (removal of the spleen). There is no cure for cold agglutinin disease.
Diabetes and Safe Medications for Colds and the Flu: OTC Medication Guide
If you have diabetes and catch a cold or the flu, can be more difficult to recover from infections and their complications, for example, pneumonia. Home remedies and over-the-counter (OTC) drugs used for the treatment of the signs and symptoms of colds and the flu may affect blood sugar levels in people with diabetes.Some medications are OK to take if you have diabetes get a cold or the flu include nonsteroidal anti-inflammatory drugs or NSAIDs, like acetaminophen (Tylenol) and ibuprofen (Motrin) to control symptoms of fever and pain. Most cough syrups are safe to take; however, check with your pediatrician to see what medications are safe to give your child if he or she has type 1 or 2 diabetes. If you have diabetes and are sick with a cold or flu, you need to check your blood sugar levels more frequently. Continue taking your regular medications. Eat a diabetic low-glycemic index diet rich in antioxidants. To prevent colds and the flu drink at least eight 8 ounce glasses of water a day. To replenish fluids, drink sports drinks like Gatorade and Pedialyte to replenish electrolytes. Avoid people who are sick, sneezing, coughing, or have other symptoms of a cold or flu.
Cold vs. Flu
Though the common cold and flu share many signs and symptoms, they are caused by different viruses. Signs and symptoms include sneezing, sore throat, runny nose, fatigue, and cough. Treatment options for the cold and flu are similar and focus on reducing symptoms. Doctors may prescribe antivirals/neuraminidase inhibitors for the flu.
Sinus Infection vs. Cold
Viruses cause the common cold and most sinus infections. Bacterial and fungal infections may also cause a sinus infection. Signs and symptoms of colds and sinus infections include nasal irritation or dryness, sore throat, stuffy nose, nasal discharge/congestion, sneezing, and cough. Additional symptoms of sinus infections include sinus pressure behind the cheeks or eyes, facial pain when pressure is applied, bad breath, and thick yellow or green mucus. Treatment focuses on symptom relief.
COVID-19 vs. Flu vs. Cold
When you're feeling sick, it can be difficult to distinguish the symptoms of a COVID-19 infection from the symptoms of the common cold or the flu (influenza). While fever is common with the flu and COVID-19, sneezing is typically only associated with colds. Though sore throats are typical with colds, they are uncommon with COVID-19 infections and the flu.
Emphysema, Chronic Bronchitis, and Colds
If you have a COPD such as emphysema, avoiding chronic bronchitis and colds is important to avoid a more severe respiratory infection such as pneumonia. Avoiding cigarette smoking, practice good hygeine, stay away from crowds, and alerting your healthcare provider if you have a sinus infection or cold or cough that becomes worse. Treatment options depend upon the severity of the emphysema, bronchitis, or cold combination.
Cold Sores (Nongenital Herpes Simplex Infections)
Herpes simplex infections are common and when they appear around the mouth and lips, people often refer to them as "cold sores" and "fever blisters." Canker sores are different than cold sores. Air droplets can spread the virus, as can direct contact with the fluid from the blisters. Cold sore treatment include over-the-counter medication, as well as prescription medications.
The common cold (viral upper respiratory tract infection) is a contagious illness that may be caused by various viruses. Symptoms include a stuffy nose, headache, cough, sore throat, and maybe a fever. Antibiotics have no effect upon the common cold, and there is no evidence that zinc and vitamin C are effective treatments.
How Long Is a Cold or Flu Contagious?
Viruses cause the common cold and the flu. Early symptoms and signs for a cold and the flu are similar, however, flu symptoms are typically more severe than cold symptoms. Cold and flu viruses are transmitted typically via coughing or sneezing.
Cold, Flu, Allergy Treatments
Before treating a cold, the flu, or allergies with over-the-counter (OTC) medications, it's important to know what's causing the symptoms, which symptoms one wishes to relieve, and the active ingredients in the OTC product. Taking products that only contain the medications needed for relieving your symptoms prevents ingestion of unnecessary medications and reduces the chances of side effects.
Pimple vs. Cold Sore
Pimples are areas of skin inflammation with pus in the center. Cold sores are fluid-filled blisters. Pimples are caused by bacterial overgrowth and inflammation. Cold sores are caused by infection with herpes simplex viruses (HSV-1 and HSV-2). Benzoyl peroxide and sometimes antibiotics treat acne. Antiviral medications accelerate the healing process of oral herpes.
Adenovirus 14 (Killer Cold Virus)
Adenovirus infection, particularly Ad14, or the "killer cold virus" has been on the increase in the past two years. Symptoms range from those experienced with colds, sore throat, bronchitis, pneumonia, diarrhea, pinkeye, fever, bladder infection, and neurological conditions. Diagnosis and treatment options need to be discussed with your physician.
Cold and Cough Medicine for Infants and Children
The safety of giving infants and children over-the-counter (OTC) cold and cough medicine is important for caregivers to understand. While there is no "gold standard" recommendation for giving infants and children OTC cold and cough medicine for fever, aches, cough, and runny nose, a few standards have been recommended. The American Academy of Pediatrics recommends that OTC cold and cough medicine only be used in children age four years and older. The American College of Chest Physicians recommend that these medicines only be used in children age 15 years and older. The FDA recommends that OTC cold and cough medicine be used in children 2 years of age and older. However, there is agreement in regard to which OTC medications should not be used in children under the age of four (or the age of two, depending upon which guidelines are used), and they are 1) certain antihistamines like brompheniramine, chlorpheniramine maleate, and diphenhydramine (Benadryl); 2) cough expectorants (guaifenesin); 3) cough suppressants (dextromethorphan, DM); and 4) decongestants (pseudoephedrine and phenylephrine). Aspirin should never be given to infants, children, and adolescents due to the possibility of a rare, but often severe and even fatal illness called Reye's syndrome. REFERENCES:FDA. "Most Young Children with a Cough or Cold Don't Need Medicines." July 18, 2017. FDA. "Use Caution When Giving Cough and Cold Products to Kids." Updated: Nov 04, 2016.
Are Cold Sores (Fever Blisters) Contagious?
About 20% of cases of cold sores are caused by herpes simplex virus type 2 (HSV-2), and approximately 80% of cold sores are caused by herpes simplex virus type 1 (HSV-1). Cold sores are transmitted by sharing utensils and razors, kissing, and oral sex. There is no cure for cold sores.
Treatment & Diagnosis
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Medications & Supplements
- codeine phosphate - injection
- promethazine suppository - rectal, Phenergan, Promethegan
- promethazine - injection, Phenergan
- promethazine - oral, Phenergan
- acetaminophen/antihistamine - oral
- promethazine/codeine syrup - oral, Phenergan w/ codeine
- acetaminophen/codeine - oral, Tylenol-Codeine No.3, Tylenol-
- Antihistamine Shots (Injections)
- promethazine, Phenergan, Phenadoz, Promethegan
- promethazine and codeine, Phenergan with Codeine
- Codeine Side Effects, Warnings, and Interactions
- Ondansetron (Zofran) vs. promethazine (Phenergan)
- Codeine vs. Vicodin
- codeine (for Pain)
- Antihistamines vs. Corticosteroids
- Antihistamines (Oral)
- Side Effects of Phenergan (promethazine)
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Professional side effects, drug interactions, and addiction sections courtesy of the U.S. Food and Drug Administration.