Promethazine + Codeine (Akorn)
(This is a prescription‑only combination used mainly for short‑term relief of moderate to severe cough or pain. Because of the risk of sedation, respiratory depression, and other serious side effects, it should be used only as directed by a licensed healthcare professional.)
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Typical Adult Dosage
- Dose: 12.5 mg of codeine phosphate + 6.25 mg of promethazine HCl
- Route: Oral (tablet or liquid)
- Frequency: Every 4–6 hours as needed
- Maximum: ≤ 6 doses per 24 hours (≈ 75 mg codeine / 37.5 mg promethazine total/day)
Typical Pediatric Dosage (Age‑Based)
| Age Range | Codeine Dose | Promethazine Dose | Frequency | Notes |
|-----------|--------------|--------------------|-----------|-------|
| 12–17 yrs | 12.5 mg | 6.25 mg | Every 4–6 h as needed | Same adult strength, but use with caution |
| 6–11 yrs | 6.25 mg | 3.13 mg | Every 4–6 h as needed | Lower dose, watch for sedation |
| 4–5 yrs | 3.13 mg | 1.56 mg | Every 4–6 h as needed | Very low dose, only under supervision |
| 0–3 yrs | Not recommended | Not recommended | No use | Significant safety concerns |
Always use the smallest effective dose for the shortest possible duration to minimize the risk of addiction, respiratory depression, and other adverse effects.
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How It Works
- Promethazine: H1‑histamine receptor antagonist → anti‑nausea, anti‑emetic, and sedative properties.
- Codeine: Weak opioid → analgesic and cough‑suppressant (converted to morphine in the body).
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Key Precautions & Contraindications
| Risk | Why It Matters | What to Watch For |
|------|----------------|-------------------|
| Respiratory depression | Especially in older adults, children, or when combined with other CNS depressants (e.g., alcohol, benzodiazepines). | Slowed breathing, shortness of breath, drowsiness. |
| Addiction & Dependence | Codeine is an opioid; chronic use can lead to tolerance and dependence. | Increasing doses to achieve the same effect. |
| Liver dysfunction | Metabolism occurs in the liver; impaired function can raise blood levels. | Liver disease, hepatitis, cirrhosis. |
| Drug interactions | Many drugs (e.g., SSRIs, MAO inhibitors, antihistamines) can enhance sedative or anticholinergic effects. | Excessive drowsiness, dry mouth, blurred vision. |
| Pregnancy & Breastfeeding | Codeine crosses the placenta and breastmilk; may cause neonatal respiratory depression. | Use only under physician’s guidance. |
| Allergy | Hypersensitivity to promethazine, codeine, or other antihistamines. | Rash, itching, swelling, anaphylaxis. |
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Common Side Effects
- Sedation / drowsiness
- Dizziness or light‑headedness
- Constipation (opioid effect)
- Nausea / vomiting
- Dry mouth
- Blurred vision
- Respiratory depression (rare but serious)
If you experience any of the following, seek medical attention immediately:
- Trouble breathing, wheezing, or chest tightness
- Severe drowsiness or inability to wake up
- Persistent vomiting or inability to keep fluids down
- Allergic reactions (rash, swelling, difficulty breathing)
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Practical Tips for Safe Use
- Take with food or milk to reduce stomach irritation.
- Avoid alcohol or other CNS depressants while taking the medication.
- Do not drive or operate heavy machinery until you know how the drug affects you.
- Keep the medication out of reach of children.
- Follow your prescriber’s instructions—do not alter the dose or frequency without medical advice.
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Bottom Line
- Standard adult dose: 12.5 mg codeine + 6.25 mg promethazine every 4–6 h, max 6 doses/day.
- Pediatric doses: scaled down by age; never give to infants <4 yrs.
- Use only as prescribed; watch for sedation, respiratory depression, and signs of overdose.
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> Disclaimer
> This information is for educational purposes only and does not replace professional medical advice. Always consult your healthcare provider before starting, changing, or stopping any medication.