RURALMED Posted March 25, 2015 Share Posted March 25, 2015 My preceptor is VERY liberal with codeine cough syrup and almost everyone (w/o an allergy) gets it prescribed for a cough. At first I thought she was being candy man, but she is very conservative with any other narcotic. I haven't noticed any patients coming in requesting a refill or displaying suspicious behavior. Do you guys see a problem with this? Thanks in advance for any comments. Link to comment Share on other sites More sharing options...
BARONEUS Posted March 25, 2015 Share Posted March 25, 2015 I'm seriously gonna request putting a Tessalon Perles gumball machine at the patient exit door. I don't. Besides the above it's good for pts who are kept awake by a cough. Link to comment Share on other sites More sharing options...
Will352ns Posted March 25, 2015 Share Posted March 25, 2015 Nope, I have had the best results with codeine. Just be careful with the type of folks you give it to....if they are already on similar stuff, they don't get it. I have had hit or miss experiences with Tessalon....some love it, some say it does nothing. Link to comment Share on other sites More sharing options...
RetNavyPAC Posted April 6, 2015 Share Posted April 6, 2015 Hard to sell codeine syrup on the street. Works great! I use it a lot for acute bronchitis - but have them use it only qhs. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 6, 2015 Moderator Share Posted April 6, 2015 tessalon is good. also phenergan DM at bedtime if they need to sleep. I write Robitussin ac sometimes, but not often. Link to comment Share on other sites More sharing options...
delco714 Posted April 7, 2015 Share Posted April 7, 2015 Any clues guys? My wife had a really bad non productive cough AFTER a uri and finally got tessalon... Did literally nothing for her..I was perplexed Link to comment Share on other sites More sharing options...
Joelseff Posted April 7, 2015 Share Posted April 7, 2015 Inhaled steroid for RAD and use liquid Benadryl at night for nighttime cough is what I usually suggest. Tessalon sucks. Codeine works I usually only give a little (60mL or 120mL) and only qhs DM in the daytime. About Z-pack, there was a study that showed Macrolides have anti inflammatory effects that improves bronchitis. So it's not the abx action that helps our pts. They really do feel better. On another note, there was another study that showed Ibuprofen also helped bronchitis. 40% better than Z-pack. I can't find it right now... I'm packing for Hawaii in the am ???? Sent from my S5 Active...Like you really care... Link to comment Share on other sites More sharing options...
jmj11 Posted April 7, 2015 Share Posted April 7, 2015 I have noticed several times that when a patient comes to see me who is over-using narcotics and I start a taper program, that the next time they come in they have a cough and are on codeine cough syrup and then again and again from their PCP or urgent care. So, like someone said above, the only patient I would be hesitant for are those who seemed to be hooked already. Link to comment Share on other sites More sharing options...
Febrifuge Posted April 7, 2015 Share Posted April 7, 2015 Tessalon is great, for a specific type of cough. I explain the MOA and how it's a good choice for those coughs that come in fits, leave you gagging or out of breath, and burn the throat. Patients who get no relief from NyQuil or similar often start nodding their heads when I explain the nerve endings low in the throat/ high in the bronchus and how Tessalon gets those to calm down. I don't prescribe codeine much, but I guess I could be less tight with that, in people who haven't had opioids in a while. People who specifically ask for codeine usually get my eyebrow twitching a little. Link to comment Share on other sites More sharing options...
Joelseff Posted April 7, 2015 Share Posted April 7, 2015 Sure but it's hit and miss in my experience. What I dont get is why someone who has coughing spells/attacks etc takes guaifenesin. It's an expectorant... It will make you cough! Even my physician colleagues at work prescribe it frequently for cough suppression. Sent from my S5 Active...Like you care... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 7, 2015 Moderator Share Posted April 7, 2015 try Phenergan DM folks. very underused drug. the phenergan helps with the folks with allergic component and it makes everyone sleepy. bingo. Link to comment Share on other sites More sharing options...
woodsters Posted April 8, 2015 Share Posted April 8, 2015 My go to is promethazine DM - 120 mL is on Walmart's $4 list. Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted April 27, 2015 Share Posted April 27, 2015 I write for a fair bit of promethazine with codiene - works very well, cheap, and helps folks sleep. Link to comment Share on other sites More sharing options...
fyrelight74 Posted April 28, 2015 Share Posted April 28, 2015 My doc does Hydromet (hydrocodone). I'm hesitant. Mostly I do tessalon, or promethazine with DM or promethazine with phenylephrine (for the congested coughers). Occasionally I will do promethazine with codeine. Link to comment Share on other sites More sharing options...
gbrothers98 Posted April 28, 2015 Share Posted April 28, 2015 Tessalon during the day, hydrocodone elixir at night, no refills on the hydrocodone. GB PA-C Link to comment Share on other sites More sharing options...
cinntsp Posted April 28, 2015 Share Posted April 28, 2015 I'll use hycodan for my pts that really need some relief. They have all said it works great. Sent from my Nexus 5 using Tapatalk Link to comment Share on other sites More sharing options...
cbrsmurf Posted April 29, 2015 Share Posted April 29, 2015 There is some evidence that honey has been shown to improve cough in the peds population Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 30, 2015 Moderator Share Posted April 30, 2015 humm scheduled narcotics for something that is self limiting.... ahh nope....... Link to comment Share on other sites More sharing options...
kittryn Posted September 7, 2015 Share Posted September 7, 2015 Sure but it's hit and miss in my experience. What I dont get is why someone who has coughing spells/attacks etc takes guaifenesin. It's an expectorant... It will make you cough! Even my physician colleagues at work prescribe it frequently for cough suppression. Sent from my S5 Active...Like you care... expectorants do not make you cough. they loosen mucous so you can cough it out more easily. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted September 7, 2015 Moderator Share Posted September 7, 2015 Hard to sell codeine syrup on the street. There's an entire genre of hip-hop devoted to music done while drinking codeine cough syrup, aka "lean", aka "purple drank", aka on and on.... Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 7, 2015 Share Posted September 7, 2015 Once heard it described to make a point that a typical adult would have to consume a "barrel" of codeine elixir to suppress the cough at current concentrations, and at that point it would be due to respiratory arrest. I've often wondered why people think that coughing up phlegm makes such a difference? Don't they realize that the body can just produce more of it? In all seriousness, codeine isn't a great drug for anything that I can think of but carries some rather unpleasant side effects. This is why folks switched over to hydrocodone in years past before the DEA reclassification. My suspicion is the preceptor is using it as a "door prize" for clientele. Link to comment Share on other sites More sharing options...
RealityCheck Posted September 7, 2015 Share Posted September 7, 2015 I really like the phenergan DM and use it when sparingly. Tessalon works for a lot of people - not the ones who tell that "nothing else works but hydrocodone". One even told me Roxicet - seriously - the ONLY patients I have ever had on Roxicet were on hospice…. I talk about atelectasis and suppressing central breathing effort and won't give any narcs to my severe COPD patients - waking up dead not an option…. My favorite at home lung exercise - have them buy a pack of party balloons at the drugstore when they pick up their Rx - not water balloons - the bigger ones. They have to blow up one balloon every hour on the hour while awake and cannot blow up the same balloon twice. It is better than incentive spirometry in my opinion. The most common uses I see for codeine are surgical short bowel and using codeine 30 mg TID to slow down the bowel a bit a few leftover "migraine" patients who get #12 T#4 every 90 days and that keeps them happy and out of the ED. Stick with phenergan DM. Compazine and the tremor side effect sucks - super hard to regain patient confidence once they have had a significant side effect. My very old 2 cents…... Link to comment Share on other sites More sharing options...
Joelseff Posted September 8, 2015 Share Posted September 8, 2015 expectorants do not make you cough. they loosen mucous so you can cough it out more easily.Mucolytic and gastric mucosa irritation is the mech of action of guaifenesin. This results in a PROtussive effect... Making you... Cough, yes the secretions are looser but you cough more. It is not an ANTItussive. DM and codeine are ANTItussive And as GMOTM pointed out, once you clear mucus, it returns. Ever blow your nose? Sent from my S5 Active...Like you care... Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 8, 2015 Share Posted September 8, 2015 To decrease the "roll eyes" effect of Tessalon prescribing, I actually explain the mechanism of action and describe it as a way to temporarily increase activity tolerance, whether it be talking for periods of time or walking from one side of a building/complex to another, or in/out to the parking lot. We all know that the world will stop spinning if these folks can't perform their daily activities, or more importantly participate in their organized team activity since they're the team star. I don't try to sell it as a typical cough suppressant. I'm also not getting the calls that I was getting back in the spring about unavailability of benzonatate at pharmacies. Link to comment Share on other sites More sharing options...
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