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GUAIFENESIN DAC (PSEUDOEPHEDRINE HCL/CODEINE PHOSPHATE/GUAIFENESIN)
- Cold symptoms
- Cough
- Nasal congestion
- Rhinitis
- Rhinorrhea
- Virtussin Dac Syrup
- Virtussin Dac Oral Syrup
- Lortuss Ex Oral Syrup
- Guaifenesin Dac Syrup
- Guaifenesin Dac Oral Syrup
- By Indication
30 mg-10 mg-100 mg/5 mL oral syrup
- 5 milliliters by oral route every 6 hours as needed
30 mg-10 mg-100 mg/5 mL oral syrup
- 5 milliliters by oral route every 6 hours as needed
30 mg-10 mg-100 mg/5 mL oral syrup
- 5 milliliters by oral route every 6 hours as needed
30 mg-10 mg-100 mg/5 mL oral syrup
- 5 milliliters by oral route every 6 hours as needed
30 mg-10 mg-100 mg/5 mL oral syrup
- 5 milliliters by oral route every 6 hours as needed
Cold symptoms
- 5 milliliters by oral route every 4 hours as needed
- 5 milliliters by oral route every 6 hours as needed
- 5 milliliters by oral route every 4-6 hours as needed
- 10 milliliters by oral route every 6 hours as needed
- 10 milliliters by oral route every 4 hours as needed not to exceed 40 ml in 24Hrs
- 10 milliliters by oral route every 4-6 hours as needed not to exceed 40 ml in 24Hrs
Cough
- 5 milliliters by oral route every 4 hours as needed
- 5 milliliters by oral route every 6 hours as needed
- 5 milliliters by oral route every 4-6 hours as needed
- 10 milliliters by oral route every 6 hours as needed
- 10 milliliters by oral route every 4 hours as needed not to exceed 40 ml in 24Hrs
- 10 milliliters by oral route every 4-6 hours as needed not to exceed 40 ml in 24Hrs
- 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
- Asthma
- Benign prostatic hyperplasia
- 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
- Systemic mastocytosis
Severe
Moderate
- Adrenal cortical insufficiency
- Alcohol intoxication
- Biliary tract disorder
- Constipation
- Cor pulmonale
- Debilitation
- Hypotension
- No disease contraindications
- Seizure disorder
- Severe hepatic disease
- Untreated hypothyroidism
- Urinary retention
GUAIFENESIN DAC (PSEUDOEPHEDRINE HCL/CODEINE PHOSPHATE/GUAIFENESIN)
- Cold symptoms
- Cough
- Nasal congestion
- Rhinitis
- Rhinorrhea
- None
- Abdominal pain with cramps
- Constipation
- Drowsy
- Headache disorder
- Insomnia
- Nausea
- Sedation
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
- 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
- Bradycardia
- Cardiac arrest
- Circulatory depression
- Dyspnea
- Hallucinations
- Hypertension
- Ileus
- Ischemic colitis
- Opioid dependence
- Pancreatitis
- Seizure disorder
- Shock
- Sleep apnea
- Vomiting
Less Severe
- Abdominal pain with cramps
- Biliary spasm
- Cardiac arrhythmia
- Diarrhea
- Dyspepsia
- Erectile dysfunction
- Euphoria
- Excitement
- Fatigue
- Flushing
- Gastrointestinal irritation
- Hyperhidrosis
- Infertility
- Insomnia
- Libido changes
- Nausea
- Palpitations
- Symptoms of anxiety
- Vertigo
- Vomiting
Contraindicated
Codeine (cough_cold)
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 – 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)
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 – 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
Guaifenesin (Liquid)
No established efficacy for cough and cold products age < 2 years. Do not use unless directed by clinician consultation.
- 1 Day – 2 Years
- No established efficacy for cough and cold products age < 2 years. Do not use unless directed by clinician consultation.
Management or Monitoring Precaution
None
Codeine
- Severity Level:
C
- Additional Notes: Neonatal withdrawal/resp.depress. w/chronic or high dose; small teratogenic risk
Guaifenesin
- Severity Level:
C
- Additional Notes:
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
Guaifenesin
Insufficient data available
May decrease milk supply, and cause irritability
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Unknown | Not known; no or inclusive data | Insufficient data available |
Pseudoephedrine
Insufficient data available
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
Codeine
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
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.
| Cold symptoms | |
| J00 | Acute nasopharyngitis [common cold] |
| Cough | |
| R05 | Cough |
| Nasal congestion | |
| R09.81 | Nasal congestion |
| Rhinitis | |
| J30 | Vasomotor and allergic rhinitis |
| J30.0 | Vasomotor 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 |
| J31.0 | Chronic rhinitis |
| Rhinorrhea | |
| R09.82 | Postnasal drip |
| 0-9 | A-Z |
|---|---|
| J00 | Acute nasopharyngitis [common cold] |
| J30 | Vasomotor and allergic rhinitis |
| J30.0 | Vasomotor 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 |
| J31.0 | Chronic rhinitis |
| R05 | Cough |
| R09.81 | Nasal congestion |
| R09.82 | Postnasal drip |
Formulary Reference Tool