Cough syrup with codeine

Cough syrups with codeine Some pharmacies still allow cough syrups with codeine to be sold over the counter. 

Examples are cough syrups containing codeine diphenoxylate preparations opium preparations 100 mg/mL and antidiarrheal and analgesics. Some examples are cough preparations containing not more than 200 mg of codeine per 100 mL or per 100 g (Robitussin AC), Phenergan with codeine. 

In the United States and other countries, some cough syrups and tablets containing codeine are available without prescription, usually those with less than 10 mg of codeine. Houston, Texas, has been called the city of syrup because of the city s high rates of codeine abuse (see sidebar). In France, 95 percent of the consumption of a codeine-containing cough... 

Fig. 7.15. Analysis of alkaloids in cough syrup after derivatization with dansyl-chloride2 Column Lichrosorb SilOO 10 wm (250x2.8 mm ID), mobile phase diisopropyl ether - isopropanol -cone, ammonia (48 2 0.3), detection UV 254 nm. Peaks 1, Dns-ephedrine 2, noscapine 3, Dns--cephaeline 4, Dns-emetine 5, codeine t, dodecylbenzene. Fluorescence detection witn excitation 360 nm and emission 500-510 nm.

Most of us are aware of the big Codeine cough-syrup scare of the early 60 s. All of a sudden, with a history going back to the Civil War, we "discover" a few milder Codeine addicts are still around, and set out to stomp them out via the media. As a result, some heavy anti-cough syrup legislation was created, and millions of people became aware that Codeine existed. Abuse rate shot way up, and to this date we still have... 

Prometh with codeine syrup 10 mg codeine phosphate and 6.25 mg promethazine hydrochloride) Promethazine competitively antagonizes histamine at H,-receptor sites and prodnces sedative as well as antiemetic effects. Codeine stimnlates opiate receptors in the CNS in addition to cansing respiratory depression, peripheral vasodilation, inhibition of intestinal peristalsis, stimulation of the chemoreceptors that cause vomiting, increased bladder tone, and suppression of cough. They are indicated in the temporary relief of coughs and upper respiratory tract symptoms associated with allergy or the common cold. 

Morphine is also stiU in use today for extreme pain, as in cases of severe burns or open fractures, where its application is limited to emergencies, because of the significant risk of addiction. Conversely (+)-morphine, like (+)-codeine or (+)-heroin, possesses no analgesic effect. By comparison with (-)-morphine, (-)-codeine is much less effective however, it inhibits selectively the cough centre, and has a substantially lower potential for addiction. It is therefore the main component of many cough syrups. Thebaine, on the other hand, produces like strychnine severe convulsions, and finds therefore no therapeutic applica-... 

The antitussive effects of opioids occur both centrally and peripherally. Mu-receptors [24] in the brainstem cough center and in the sensory arm of the vagus nerve, which controls airway reflexes, appear to mediate this effect. The weak analgesia associated with codeine makes it a good choice as an antitussive and it has frequently been used as a component of cough syrups. These cough syrups are sold over-the-counter in some areas and have been a source of opioid misuse and diversion. Codeine is not an active antitussive in young children and has potential for respiratory suppression in this patient populatiOTi for that reason, it is not recommended for children [25]. 

Although codeine is dealt with in this Annual alongside the other opiates in Chapter 7, a recent paper by von Muhlendahl on codeine intoxication in children (13) merits brief mention here in view of its importance as regards the use and abuse of codeine-containing cough syrups, which in many countries are still on free sale. 

While primarily employed as an analgesic, hydromor-phone is an excellent cough suppressant and is associated with less histamine release and pruritus than codeine. Hydrocodone is only available for oral administration, as either a tablet, capsule, or syrup formulation, and is usually combined with acetaminophen or ibuprofen. Standard immediate-release tablets provide 4-6 h of analgesia for patients with... 

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