How does this medication work? What will it do for me?
This combination product contains four medications: brompheniramine, phenylephrine, guaifenesin, and hydrocodone.
Hydrocodone belongs to the group of medications called narcotic analgesics and cough suppressants. It works by blocking pain signals that are sent out by the brain to various areas of the body and reduces coughing by acting in the brain to dull the cough reflex.
Brompheniramine belongs to the group of medications called antihistamines and helps to relieve sneezing and runny nose.
Phenylephrine belongs to the group of medications called nasal decongestants and is used to decrease nasal stuffiness.
Guaifenesin belongs to the group of medications called expectorants. This medication helps to loosen mucus so it can be coughed up.
This medication is used for the temporary relief of coughing and stuffy or runny nose that is associated with allergies, the common cold, or chest infections.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each 5 mL of cherry-red liquid, with menthol and raspberry taste and odour, contains hydrocodone bitartrate 1.8 mg, brompheniramine maleate 2 mg, phenylephrine HCl 5 mg, and guaifenesin 100 mg. Nonmedicinal ingredients: alcohol, citric acid, D&C Red No. 33, FD&C Red No. 40, flavours, glycerin, invert sugar, sodium benzoate, and water.
How should I use this medication?
The usual adult dose is 10 mL (2 teaspoons) every 6 hours as needed. It may be taken with or without food, and with a glass of water.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
Use an oral syringe to measure each dose of the liquid, as it gives a more accurate measurement than household teaspoons.
It is important to take this medication exactly as prescribed by your doctor. If your doctor has told you to take this medication on a regular basis and you miss a dose, take it as soon as you remember and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Note: A cough is a symptom. Before taking a cough suppressant, it is important to assess the underlying cause of the cough.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not use this medication if you:
- are allergic to brompheniramine, phenylephrine, guaifenesin hydrocodone, or any of the ingredients of the medication
- are allergic to hydrocodone-like narcotics or other similar antihistamines, or decongestants
- are experiencing slowed, shallow breathing (respiratory depression)
- are pregnant or breast-feeding
- are taking an MAO inhibitor (e.g., phenelzine, tranylcypromine) or have taken one in the past 2 weeks
- have a blockage of the intestines or a condition that slows down passage of material through the digestive tract
- have a decreased level of consciousness
- have a head injury or increased pressure inside the brain
- have active alcoholism or are experiencing alcohol withdrawal
- have acute asthma or other obstructive airway diseases (e.g., chronic bronchitis, emphysema), or a chronic cough
- have diabetes, high blood pressure, heart disease, thyroid disease, glaucoma, enlarged prostate or bladder neck obstruction
- have or may have appendicitis or pancreatitis
- have seizures
Do not give this medication to children less than 6 years of age.
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- decreased appetite
- decreased sexual ability or interest in sexual activity
- difficulty sleeping
- dry mouth
Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- decreased coordination
- difficulty urinating
- fast, slow, or irregular heartbeat
- itchy skin
- symptoms of a bowel blockage (e.g., stomach pain, severe constipation, nausea)
- symptoms of low blood pressure (e.g., dizziness, fainting, lightheadedness, particularly when rising from a lying or sitting position)
- vision problems
Stop taking the medication and seek immediate medical attention if any of the following occur:
- hallucinations (seeing or hearing things that are not there)
- signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
- slow, shallow, or weak breathing
- symptoms of serotonin syndrome (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)
- symptoms of overdose of hydrocodone, such as:
- abnormally slow or weak breathing
- cold, clammy skin
- hallucinations (seeing or hearing things that are not there)
- severe dizziness
- slow heartbeat
- extreme drowsiness
- withdrawal symptoms (e.g., nausea, vomiting, diarrhea, anxiety, shivering, cold and clammy skin, body aches, loss of appetite, sweating)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
HEALTH CANADA ADVISORY
August 24, 2020
Health Canada has issued new restrictions concerning the use of brompheniramine maleate - phenylephrine HCl - guaifenesin - hydrocodone bitartrate. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.
Accidental use: When this medication is used by anyone other than the person for whom it was prescribed, the effects of the medication may be fatal. Children are particularly at risk. Keep this medication out of sight and reach of children.
Adrenal gland problems: Adrenal glands produce chemical messengers that are responsible for the normal function of the body's organs, including how your body responds to injury or stress. When opioids are taken for a month or longer, the medication may cause your adrenal gland to function improperly. Your doctor may monitor your adrenal gland condition, especially if you have experienced stress such as surgery, injury, or severe infection.
Alcohol and other medications that cause drowsiness: People taking this medication should not combine it with alcohol and should avoid combining it with other medications, such as narcotic pain relievers, sedatives or anxiety medications, that cause drowsiness. Doing so can cause additive drowsiness and reduced breathing, as well as other side effects, which can be dangerous and possibly fatal.
Breathing: Hydrocodone can suppress breathing. If you are at risk for breathing difficulties, such as asthma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Constipation: Hydrocodone can be very constipating. Eating a high-fibre diet and following good bowel habits will help to minimize this effect. If you develop constipation easily, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Dependence and withdrawal: This medication contains hydrocodone. Physical dependence, psychological dependence, and abuse have occurred with the use of hydrocodone. People with a history of past or current substance use problems may be at greater risk of developing abuse or addiction while taking this medication. Abuse is not a problem with people who require this medication for pain relief.
If you suddenly stop taking this medication, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shaking, pain, nausea, tremors, diarrhea, and hallucinations. If you have been taking this medication for a while, it should be stopped gradually as directed by your doctor.
Diabetes: The phenylephrine in this medication may cause blood sugar to become less controlled for people with diabetes. It may become necessary to test your blood glucose levels more often when taking brompheniramine - phenylephrine - guaifenesin - hydrocodone.
If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Drowsiness/reduced alertness: Hydrocodone may cause drowsiness. Do not drive, operate machinery, or perform any potentially hazardous tasks until you have made sure that this medication does not make you drowsy.
Glaucoma: Brompheniramine - phenylephrine - guaifenesin - hydrocodone may worsen glaucoma symptoms. If you have narrow-angle glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Head injury: If you have a head injury or increased pressure in the head, you may have a higher risk of experiencing side effects (breathing problems) or worsening of their condition while taking this medication. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Heart disease: This medication may make symptoms of certain heart conditions worse. If you have an irregular heart rhythm, ischemic heart disease, high blood pressure or other heart condition, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Kidney disease: If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver disease: If you have liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Other medical conditions: If you are about to undergo surgery of the biliary tract, approach taking hydrocodone with caution, as it may worsen your condition. Hydrocodone will worsen the effects of acute alcohol intoxication and delirium tremens.
As well, if you have low thyroid (hypothyroidism), Addison's disease, benign prostatic hypertrophy (enlarged prostate), gallbladder disease, urethral stricture, decreased function of the adrenal glands, or porphyria, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Seizures: People with seizure disorders may be more likely to experience seizures when taking this medication. If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Serotonin Syndrome: Although rare, severe reactions are possible when hydrocodone is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors, medications used to treat depression. These combinations should be avoided if possible. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. Infants born to mothers who have been taking this medication for long periods of time may experience serious breathing difficulties and withdrawal symptoms.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking brompheniramine - phenylephrine - guaifenesin - hydrocodone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children. Because children and adolescents are more likely to experience severe side effects of cough and cold medications, this medication should not be given to children under 18 years of age.
Seniors: This medication is more likely to cause side effects for those 65 years of age and older. Lower doses may be necessary.
What other drugs could interact with this medication?
There may be an interaction between brompheniramine - phenylephrine - guaifenesin - hydrocodone and any of the following:
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
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