Nurses Compass
Drug Guide
Bromodiphenhydramine Hydrochloride and Codeine Phosphate
Classification
Therapeutic: Antitussive and Antihistamine
Pharmacological: Antihistamine and Opioid
FDA Approved Indications
- Temporary relief of coughs and colds associated with allergies or respiratory infections
Mechanism of Action
Bromodiphenhydramine acts as an antihistamine, blocking H1 receptors to reduce allergy symptoms; codeine is an opioid that suppresses cough reflex in the brain's cough center.
Dosage and Administration
Adult: As prescribed, typically 15-30 mg bromodiphenhydramine and 10-20 mg codeine every 4-6 hours as needed, not exceeding 120 mg bromodiphenhydramine and 120 mg codeine per day.
Pediatric: Use is generally not recommended for children under 12 years due to safety concerns. Consult specific age-related dosing guidelines.
Geriatric: Caution due to increased sensitivity, start at lower doses and monitor closely.
Renal Impairment: Adjust dosage based on severity of impairment; consult specific guidelines.
Hepatic Impairment: Use with caution; dosage adjustments may be necessary.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed, crossing the blood-brain barrier.
Metabolism: Liver metabolism via CYP2D6 and other pathways.
Excretion: Primarily renal.
Half Life: Approximately 3-4 hours for bromodiphenhydramine; codeine half-life around 3 hours.
Contraindications
- History of hypersensitivity to antihistamines, codeine, or components of the formulation.
- Respiratory depression, asthma, multi-system failure.
- Children under 12 years.
- Pregnancy Category C/D depending on trimester.
Precautions
- Use with caution in elderly, those with respiratory compromise, or head injuries. Monitor for signs of sedation or respiratory depression. Risk of dependency and abuse with opioids.
Adverse Reactions - Common
- Drowsiness (Common)
- Dizziness (Common)
- Nausea (Common)
Adverse Reactions - Serious
- Respiratory depression (Rare)
- Allergic reactions including rash, hives (Rare)
- Dependence and abuse potential (Caution in opioid-tolerant individuals)
Drug-Drug Interactions
- CNS depressants, alcohol, other sedatives, monoamine oxidase inhibitors (MAOIs)
Drug-Food Interactions
- Alcohol may enhance sedative effects.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for signs of respiratory depression, sedation, and allergic reactions. Assess pain and cough severity.
Diagnoses:
- Risk for respiratory depression
- Ineffective airway clearance
- Risk for dependency.
Implementation: Administer with caution, especially in vulnerable groups. Educate patient on risk of sedation and respiratory depression.
Evaluation: Effectiveness in cough suppression, relief of allergy symptoms, and monitoring adverse effects.
Patient/Family Teaching
- Do not operate machinery or drive until effects are known.
- Avoid alcohol and other CNS depressants.
- Report signs of respiratory difficulty, allergic reactions, or excessive sedation.
- Use exactly as prescribed; do not increase dose.
Special Considerations
Black Box Warnings:
- Potential for opioid addiction, abuse, and misuse.
- Risks of respiratory depression, especially in children and with overdose.
Genetic Factors: CYP2D6 polymorphisms may alter metabolism of codeine, affecting efficacy and safety.
Lab Test Interference: May cause false-positive urinary tests for opioids.
Overdose Management
Signs/Symptoms: Severe drowsiness, respiratory depression, hypotension, coma.
Treatment: Supportive care, respiratory support, naloxone for opioid overdose, gastrointestinal decontamination if early.
Storage and Handling
Storage: Store at room temperature, away from light and moisture.
Stability: Stable under recommended storage conditions.