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MAR-COF BP (BROMPHENIRAMINE MALEATE/PSEUDOEPHEDRINE HCL/CODEINE)
- Cold symptoms
- Cough
- Rhinorrhea
- Allergic rhinitis
- Nasal congestion
2 mg-30 mg-7.5 mg/5 mL oral liquid
- 10 milliliters by oral route every 4-6 hours as needed
Allergic rhinitis
- 10 milliliters by oral route every 4 hours as needed
- 10 milliliters by oral route every 6 hours as needed
- 10 milliliters by oral route every 6 hours
- 10 milliliters by oral route every 4-6 hours as needed
- 10 milliliters by oral route every 4 hours
Cold symptoms
- 10 milliliters by oral route every 4 hours as needed
- 10 milliliters by oral route every 6 hours as needed
- 10 milliliters by oral route every 6 hours
- 10 milliliters by oral route every 4-6 hours as needed
- 10 milliliters by oral route every 4 hours
Cough
- 10 milliliters by oral route every 4 hours as needed
- 10 milliliters by oral route every 6 hours as needed
- 10 milliliters by oral route every 6 hours
- 10 milliliters by oral route every 4-6 hours as needed
- 10 milliliters by oral route every 4 hours
Nasal congestion
- 10 milliliters by oral route every 4 hours as needed
- 10 milliliters by oral route every 6 hours as needed
- 10 milliliters by oral route every 6 hours
- 10 milliliters by oral route every 4-6 hours as needed
- 10 milliliters by oral route every 4 hours
Rhinorrhea
- 10 milliliters by oral route every 4 hours as needed
- 10 milliliters by oral route every 6 hours as needed
- 10 milliliters by oral route every 6 hours
- 10 milliliters by oral route every 4-6 hours as needed
- 10 milliliters by oral route every 4 hours
- Depade
- isocarboxazid
- Marplan
- Matulane
- methylene blue (antidote)
- naltrexone
- naltrexone microspheres
- Nardil
- Parnate
- phenelzine
- procarbazine
- Revia
- tranylcypromine
- Vivitrol
Contraindicated
- Azilect
- bromocriptine
- cabergoline
- Cafergot
- Cycloset
- D.h.e.45
- dihydroergotamine
- Eldepryl
- ergoloid
- Ergomar
- ergotamine tartrate
- ergotamine-caffeine
- linezolid
- methylergonovine
- Migergot
- Migranal
- Parlodel
- rasagiline
- selegiline HCl
- Zelapar
- Zyvox
Severe
Moderate
- Aplenzin
- Brisdelle
- Buprenex
- buprenorphine
- buprenorphine-naloxone
- Buproban
- bupropion HBr
- bupropion HCl
- butorphanol tartrate
- Butrans
- dextromethorphan-quinidine
- Fanatrex
- fluoxetine
- Forfivo Xl
- gabapentin
- gabapentin enacarbil
- Gralise
- Gralise 30-day Starter Pack
- Horizant
- methyldopa
- methyldopa-hydrochlorothiazide
- methyldopate
- nalbuphine
- Neurontin
- Nuedexta
- olanzapine-fluoxetine
- paroxetine HCl
- paroxetine mesylate
- Paxil
- Paxil Cr
- Pexeva
- Prozac
- Prozac Weekly
- quinidine gluconate
- quinidine sulfate
- reserpine
- Sarafem
- Suboxone
- Symbyax
- Wellbutrin
- Wellbutrin Sr
- Wellbutrin Xl
- Zubsolv
- Zyban
- Adenoidectomy in pediatric patient
- Angle-closure glaucoma
- Lactating mother
- Respiratory depression
- Severe coronary artery disease
- Severe uncontrolled hypertension
- Sleep apnea
- Tonsillectomy in pediatric patient
- Urinary retention
Contraindicated
- Acute asthma attack
- Acute pancreatitis
- Angle-closure glaucoma
- Asthma
- Benign prostatic hyperplasia
- Bladder outflow obstruction
- Chronic idiopathic constipation
- Chronic obstructive pulmonary disease
- CYp2d6 poor metabolizer
- CYp2d6 ultrarapid metabolizer
- Diabetes mellitus
- Drug abuse
- Gastrointestinal obstruction
- History of opioid overdose
- Hypertension
- Hyperthyroidism
- Intracranial hypertension
- Kidney disease with likely reduction in GFR
- Obstructive sleep apnea syndrome
- Shock
- Stenosing peptic ulcer
- Systemic mastocytosis
- Urinary retention
Severe
Moderate
- Adrenal cortical insufficiency
- Alcohol intoxication
- Biliary tract disorder
- Constipation
- Cor pulmonale
- Debilitation
- Hypertension
- Hyperthyroidism
- Hypotension
- Ocular hypertension
- Seizure disorder
- Severe hepatic disease
- Untreated hypothyroidism
- Urinary retention
MAR-COF BP (BROMPHENIRAMINE MALEATE/PSEUDOEPHEDRINE HCL/CODEINE)
- Cold symptoms
- Cough
- Rhinorrhea
- Allergic rhinitis
- Nasal congestion
- None
- Abdominal pain with cramps
- Constipation
- Dizziness
- Drowsy
- Headache disorder
- Insomnia
- Nausea
- Sedation
- Thick bronchial secretions
More Frequent
Severe
Less Severe
- Atelectasis
- CNS depression
- Dyspnea
- Orthostatic hypotension
- Respiratory depression
- Acute confusion
- Agitation
- Anorexia
- Dizziness
- Drowsy
- Dysphoric mood
- Dysuria
- General weakness
- Headache disorder
- Hyperhidrosis
- Hypotension
- Nausea
- Nervousness
- Oliguria
- Pallor
- Palpitations
- Pruritus of skin
- Sedation
- Skin rash
- Syncope
- Tachycardia
- Tremor
- Urticaria
- Visual changes
- Vomiting
- Xerostomia
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Acute generalized exanthematous pustulosis
- Acute respiratory insufficiency
- Adrenal cortical insufficiency
- Anaphylaxis
- Androgen deficiency
- Blood dyscrasias
- Bradycardia
- Cardiac arrest
- Circulatory depression
- Dyspnea
- Extrasystoles
- Hallucinations
- Hemolytic anemia
- Hypertension
- Hypotension
- Ileus
- Ischemic colitis
- Opioid dependence
- Pancreatitis
- Seizure disorder
- Shock
- Sleep apnea
- Vomiting
Less Severe
- Abdominal distension
- Abdominal pain with cramps
- Acute abdominal pain
- Acute confusion
- Anorexia
- Ataxia
- Biliary spasm
- Blurred vision
- Cardiac arrhythmia
- Chest discomfort
- Chills
- Constipation
- Diarrhea
- Diplopia
- Dry nose
- Dry throat
- Dyspepsia
- Dyspnea
- Dysuria
- Erectile dysfunction
- Euphoria
- Excitement
- Fatigue
- Flushing
- Gastrointestinal irritation
- Headache disorder
- Hyperhidrosis
- Infertility
- Insomnia
- Irritability
- Libido changes
- Maculopapular rash
- Malaise
- Migraine
- Nervousness
- Nightmares
- Palpitations
- Paresthesia
- Pruritus of skin
- Skin photosensitivity
- Skin rash
- Symptoms of anxiety
- Tachycardia
- Tinnitus
- Tremor
- Urinary retention
- Urticaria
- Vertigo
- Visual changes
- Wheezing
- Xerostomia
Contraindicated
Brompheniramine
Possible CNS excitation, convulsions in newborns.
Risk of serious and life-threatening adverse effects of CNS depression or excitation. Not recommended age <2 years. Avoid using with underlying asthma.
Not indicated for symptoms of cough and cold in pediatrics. Risk of slowed or difficult breathing and respiratory depression. Death reported in CYP2D6 ultra-rapid metabolizers post tonsillectomy or adenoidectomy.
High risk of adverse CNS effects. Not recommended for use age < 6 years.
- 1 Day – 29 Days
- 1 Possible CNS excitation, convulsions in newborns.
- 1 Risk of serious and life-threatening adverse effects of CNS depression or excitation. Not recommended age <2 years. Avoid using with underlying asthma.
- 30 Days – 2 Years
- 1 Possible CNS excitation, convulsions in newborns.
- 1 Risk of serious and life-threatening adverse effects of CNS depression or excitation. Not recommended age <2 years. Avoid using with underlying asthma.
- 1 Day – 18 Years
- 1 Possible CNS excitation, convulsions in newborns.
- 1 Risk of serious and life-threatening adverse effects of CNS depression or excitation. Not recommended age <2 years. Avoid using with underlying asthma.
- 1 Day – 6 Years
- 1 Possible CNS excitation, convulsions in newborns.
- 1 Risk of serious and life-threatening adverse effects of CNS depression or excitation. Not recommended age <2 years. Avoid using with underlying asthma.
Codeine (cough_cold)
Possible CNS excitation, convulsions in newborns.
Risk of serious and life-threatening adverse effects of CNS depression or excitation. Not recommended age <2 years. Avoid using with underlying asthma.
Not indicated for symptoms of cough and cold in pediatrics. Risk of slowed or difficult breathing and respiratory depression. Death reported in CYP2D6 ultra-rapid metabolizers post tonsillectomy or adenoidectomy.
High risk of adverse CNS effects. Not recommended for use age < 6 years.
- 1 Day – 29 Days
- 1 Not indicated for symptoms of cough and cold in pediatrics. Risk of slowed or difficult breathing and respiratory depression. Death reported in CYP2D6 ultra-rapid metabolizers post tonsillectomy or adenoidectomy.
- 30 Days – 2 Years
- 1 Not indicated for symptoms of cough and cold in pediatrics. Risk of slowed or difficult breathing and respiratory depression. Death reported in CYP2D6 ultra-rapid metabolizers post tonsillectomy or adenoidectomy.
- 1 Day – 18 Years
- 1 Not indicated for symptoms of cough and cold in pediatrics. Risk of slowed or difficult breathing and respiratory depression. Death reported in CYP2D6 ultra-rapid metabolizers post tonsillectomy or adenoidectomy.
- 1 Day – 6 Years
- 1 Not indicated for symptoms of cough and cold in pediatrics. Risk of slowed or difficult breathing and respiratory depression. Death reported in CYP2D6 ultra-rapid metabolizers post tonsillectomy or adenoidectomy.
Pseudoephedrine (Immed. Release)
Possible CNS excitation, convulsions in newborns.
Risk of serious and life-threatening adverse effects of CNS depression or excitation. Not recommended age <2 years. Avoid using with underlying asthma.
Not indicated for symptoms of cough and cold in pediatrics. Risk of slowed or difficult breathing and respiratory depression. Death reported in CYP2D6 ultra-rapid metabolizers post tonsillectomy or adenoidectomy.
High risk of adverse CNS effects. Not recommended for use age < 6 years.
- 1 Day – 29 Days
- 1 High risk of adverse CNS effects. Not recommended for use age < 6 years.
- 30 Days – 2 Years
- 1 High risk of adverse CNS effects. Not recommended for use age < 6 years.
- 1 Day – 18 Years
- 1 High risk of adverse CNS effects. Not recommended for use age < 6 years.
- 1 Day – 6 Years
- 1 High risk of adverse CNS effects. Not recommended for use age < 6 years.
Severe Precaution
Brompheniramine
Risk of CNS excitation and respiratory depression. Avoid using with underlying asthma. Consult healthcare provider.
- 2 Years – 6 Years
- Risk of CNS excitation and respiratory depression. Avoid using with underlying asthma. Consult healthcare provider.
Management or Monitoring Precaution
None
Brompheniramine
- Severity Level:
C
- Additional Notes: Brompheniramine tannate fda category c, brompheniramine maleate category b.
Codeine
- Severity Level:
C
- Additional Notes: Neonatal withdrawal/resp.depress. w/chronic or high dose; small teratogenic risk
Pseudoephedrine
- Severity Level:
C
- Additional Notes: Fda c w/combo prod; poss risk of gastroschisis/sia with 1st trimester exposure
Contraindicated
Codeine
Cns/respiratory depression,apnea possible;Caution w/ fast cyp2D6 metabolizer
| General | Excretion Potential | Effect on Infant | Notes |
| Drug should not be given to breast feeding mothers | Excreted | Drug shown to have adverse effect | Cns/respiratory depression,apnea possible;Caution w/ fast cyp2D6 metabolizer |
Precaution Exists
Brompheniramine
Not recommended. may cause paradoxical excitation/inhibit lactation.
May decrease milk supply, and cause irritability
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Unknown | Not known; no or inclusive data | Not recommended. may cause paradoxical excitation/inhibit lactation. |
Pseudoephedrine
Not recommended. may cause paradoxical excitation/inhibit lactation.
May decrease milk supply, and cause irritability
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Excreted | Drug shown to have adverse effect | May decrease milk supply, and cause irritability |
No Known Risk
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Contraindicated
None
Precaution Exists
Brompheniramine
Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Non-sedating agents preferred. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.
General-Consider adding naloxone Rx. Pulmonary-Life threatening respiratory depression risk with high doses, cachexia, or debilitation due to altered pharmacokinetics (poor fat stores, muscle wasting, or altered clearance). Monitor closely at initiation and dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
Cardiovascular-Elderly are more sensitive to tachycardia and hypertensive effects. May exacerbate symptomatic coronary insufficiency. Genitourinary-May cause urinary retention. Neuro/Psych-May worsen cognitive impairment in some elderly with dementia. Insomnia risk.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | N | N | Y | Y | N | N |
BEERS: Y HEDIS: Y STOPP: Y
Codeine
Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Non-sedating agents preferred. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.
General-Consider adding naloxone Rx. Pulmonary-Life threatening respiratory depression risk with high doses, cachexia, or debilitation due to altered pharmacokinetics (poor fat stores, muscle wasting, or altered clearance). Monitor closely at initiation and dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
Cardiovascular-Elderly are more sensitive to tachycardia and hypertensive effects. May exacerbate symptomatic coronary insufficiency. Genitourinary-May cause urinary retention. Neuro/Psych-May worsen cognitive impairment in some elderly with dementia. Insomnia risk.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | N | Y | Y | Y | Y | N |
BEERS: Y HEDIS: N STOPP: Y
Pseudoephedrine
Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Non-sedating agents preferred. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.
General-Consider adding naloxone Rx. Pulmonary-Life threatening respiratory depression risk with high doses, cachexia, or debilitation due to altered pharmacokinetics (poor fat stores, muscle wasting, or altered clearance). Monitor closely at initiation and dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
Cardiovascular-Elderly are more sensitive to tachycardia and hypertensive effects. May exacerbate symptomatic coronary insufficiency. Genitourinary-May cause urinary retention. Neuro/Psych-May worsen cognitive impairment in some elderly with dementia. Insomnia risk.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | Y | N | Y | Y | N | N |
BEERS: N HEDIS: N STOPP: N
No Known Risk
None
- This medication has a risk for abuse and addiction, which can lead to overdose and death. This medication may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose that works, and take it for the shortest possible time.<br /><br />See also How to Use section for more information about addiction. The risk for severe breathing problems is higher when you start this medication, or if you take the wrong dose or take more of this medication than prescribed. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death.<br /><br /> Also, other medications can affect the removal of this product from your body, which may affect how it works. Be sure you know how to take this product and what other drugs you should avoid taking with it. See also Drug Interactions section.<br /><br />Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up. Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away.<br /><br /> Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or think you may be pregnant. During pregnancy, this medication is not recommended.<br /><br />It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time.<br /><br />Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn't stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.
| Allergic rhinitis | |
| J30.1 | Allergic rhinitis due to pollen |
| J30.2 | Other seasonal allergic rhinitis |
| J30.5 | Allergic rhinitis due to food |
| J30.8 | Other allergic rhinitis |
| J30.81 | Allergic rhinitis due to animal (cat) (dog) hair and dander |
| J30.89 | Other allergic rhinitis |
| J30.9 | Allergic rhinitis, unspecified |
| Cold symptoms | |
| J00 | Acute nasopharyngitis [common cold] |
| Cough | |
| R05 | Cough |
| Nasal congestion | |
| R09.81 | Nasal congestion |
| Rhinorrhea | |
| R09.82 | Postnasal drip |
| 0-9 | A-Z |
|---|---|
| J00 | Acute nasopharyngitis [common cold] |
| J30.1 | Allergic rhinitis due to pollen |
| J30.2 | Other seasonal allergic rhinitis |
| J30.5 | Allergic rhinitis due to food |
| J30.8 | Other allergic rhinitis |
| J30.81 | Allergic rhinitis due to animal (cat) (dog) hair and dander |
| J30.89 | Other allergic rhinitis |
| J30.9 | Allergic rhinitis, unspecified |
| R05 | Cough |
| R09.81 | Nasal congestion |
| R09.82 | Postnasal drip |
Formulary Reference Tool