Adult: 5-10 mg 3 or 4 times daily. Alternatively, 10-15 mg 8-10 hourly. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines. Child: 6-12 years 4 mg tid. Max treatment duration: 5 days; >12 years Same as adult dose. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.
Administration
May be taken with or without food.
Contraindications
Patient at risk of developing respiratory failure. Asthma attack, chronic bronchitis, COPD, bronchiolitis or bronchiectasis. Hepatic failure. Children <6 years. Concomitant use with or within 14 days of stopping MAOI therapy.
Special Precautions
Patient with decreased respiratory reserve, history of asthma, chronic or persistent cough, history of drug abuse. Concomitant use with benzodiazepines and other CNS depressants. Use of pholcodine within 12 months before undergoing general anaesthesia with neuromuscular blocking agents (NMBAs) is associated with an increased risk of developing an anaphylactic reaction to NMBAs. Renal and hepatic impairment. Treatment with a cough medicine in children should be considered carefully due to potential risks and limited evidence on efficacy. Pregnancy and lactation.
This drug may cause drowsiness and dizziness, if affected, do not drive or operate machinery. Inform your doctor if you are currently taking pholcodine or have taken pholcodine in the last 12 months before undergoing surgery which requires general anaesthesia.
Monitoring Parameters
Monitor respiratory function (in patients with reduced respiratory reserve); signs and symptoms of skin reactions.
Overdosage
Symptoms: Restlessness, excitement, ataxia, drowsiness, nausea, and respiratory depression. Management: Symptomatic and supportive treatment. Gastric emptying may be done by aspiration and lavage. Naloxone may be given in cases of acute poisoning. Administration of activated charcoal (1 g/kg) may also be considered if ingestion is >4 mg/kg, provided the airway is protected and ingestion is recent (within 1 hour).
Drug Interactions
Antihypertensives and diuretics may potentiate the hypotensive effect of pholcodine. Potentially Fatal: Concurrent use with MAOIs (or within 14 days of stopping treatment) may result in serotonin syndrome. Concomitant use with benzodiazepines and other CNS depressants may result in sedation, respiratory depression, and coma.
Food Interaction
May enhance the CNS depressant effects of alcohol.
Action
Description: Mechanism of Action: Pholcodine is a centrally acting cough suppressant that causes depression of the cough reflex, partly due to its direct effect on the cough centre in the medulla. It has a mild sedative effect with little or no analgesic action. Pharmacokinetics: Absorption: Readily absorbed from the gastrointestinal tract. Time to peak plasma concentration: 4-8 hours. Distribution: Enters breast milk. Volume of distribution: 30-49 L/kg. Plasma protein binding: 24%. Metabolism: Metabolised in the liver via hydrolysis followed by conjugation and N-dealkylation. Excretion: Elimination half-life: 32-43 hours.
R05DA08 - pholcodine ; Belongs to the class of opium alkaloids and derivatives. Used as cough suppressant.
References
Anon. Pholcodine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 13/03/2023.Buckingham R (ed). Pholcodine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 23/06/2022.Ducodin Forte Linctus 15 mg/5 mL (Hovid Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 23/06/2022.Ducodin Linctus 5 mg/5 mL (Hovid Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 23/06/2022.Duro-Tuss Cough Linctus (iNova Pharmaceuticals Pte Ltd, Malaysia Branch). MIMS Malaysia. http://www.mims.com/malaysia. Accessed 23/06/2022.EMA Recommends Withdrawal of Pholcodine Medicines from EU Market. European Medicines Agency [online]. Accessed 13/03/2023.Galenphol Paediatric Linctus (Thornton & Ross Limited). MHRA. https://products.mhra.gov.uk. Accessed 23/06/2022.Joint Formulary Committee. Pholcodine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 23/06/2022.Pholcodine Linctus (L.C.M. Ltd.). MHRA. https://products.mhra.gov.uk. Accessed 23/06/2022.Pholcodine-containing Cough and Cold Medicines: Withdrawal from UK Market as a Precautionary Measure. Medicines & Healthcare products Regulatory Agency. https://www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency. Accessed 15/03/2023.Pholcodine: Risk of Anaphylaxis to Neuromuscular Blocking Agents (NMBAs). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 13/03/2023.