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Codeine cough syrup for all patients with cough


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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. 

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  • 2 weeks later...

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 ????

 

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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.

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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.

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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.

 

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  • 4 months later...

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.

 

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expectorants do not make you cough. they loosen mucous so you can cough it out more easily.

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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.

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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…...

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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?

 

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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.

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