What happens if I overdose M&B?
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local, or emergency room immediately. Symptoms may include confusion; excitement; hallucinations; slowed breathing.
Proper storage of M&B:
Store M&B between 68 and 77 degrees F (20 and 25 degrees C), away from heat, moisture, and light. Do not store in the bathroom. Keep M&B out of the reach of children and away from pets.
Overdose of M&B in details
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fast heartbeat, vomiting, sweating, nervousness, feeling high (euphoria), hallucinations, problems walking (staggering), agitation, severe drowsiness.
Notes
Keep all regular medical and laboratory appointments.
Missed Dose
If you are taking this product on a regular schedule and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
Storage
Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
What should I avoid while taking M&B?
Avoid drinking alcohol. It can increase some of the side effects of M&B. This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
Avoid taking diet pills, caffeine pills, or other stimulants (such as ADHD medications) without your doctor's advice. Taking a stimulant together with cough medicine can increase your risk of unpleasant side effects.
Do not use any other over-the-counter cough, cold, or allergy medication without first asking your doctor or pharmacist. M&B is contained in many combination medicines available over the counter. If you take certain products together you may accidentally take too much of this medicine. Read the label of any other medicine you are using to see if it contains dextromethorphan hydrobromide.
M&B warnings
Before taking Pholcodine, tell your doctor or pharmacist if you are allergic to it; or to other anti-tussives; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist in case of: long term lung/ breathing problems; bronchitis (inflammation of the airways), bronchiectasis (abnormal widening of one or more airways) or damaged/ inflamed lungs caused by a build up of too much mucus (phlegm).
Before using this medication tell your doctor or pharmacist your medical history, especially any of the following: kidney problems; liver problems; a history of drug abuse; long-term cough or asthma; a cough which produces lots of mucus (phlegm); an intolerance to some sugars.
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
* Limit the amount of alcohol you drink, as it may increase the drug side effects, such as dizziness and drowsiness.
The
Elderly: there is no need to alter the adult dose of Pholcodine for the elderly.
Pregnancy and breastfeeding - please ensure you read the detailed information below
PREGNANCY
The safety of Pholcodine has not been established during pregnancy. Ask your doctor or pharmacist if you have any doubts or questions about this.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
BREAST FEEDING
It is not known whether Pholcodine passes into breast-milk. The manufacturer therefore states that it should not be taken if you are breastfeeding.
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
What should I discuss with my healthcare provider before taking M&B?
Some medical conditions may interact with M&B. Tell your health care provider if you have any medical conditions, especially if any of the following apply to you:
- if you are pregnant, planning to become pregnant, or are breast-feeding
- if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
- if you have allergies to medicines, foods, or other substances
- if you have a history of chronic cough, asthma, lung problems (eg, chronic bronchitis, emphysema), chronic obstructive pulmonary disease (COPD), or if cough occurs with a large amount of mucus
Some MEDICINES MAY INTERACT with M&B. Tell your health care provider if you are taking any other medicines, especially any of the following:
- Furazolidone or MAO inhibitors (eg, phenelzine) because the risk of serious side effects, such as severe low blood pressure, fever, severe muscle problems, and possibly death, may be increased by M&B
This may not be a complete list of all interactions that may occur. Ask your health care provider if M&B may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
M&B precautions
Concurrent drug therapy issues:
• Serotonin syndrome: Symptoms of agitation, confusion, hallucinations, hyper-reflexia, myoclonus, shivering, and tachycardia may occur with concomitant proserotonergic drugs (ie, SSRIs/SNRIs or triptans); especially with higher M&B doses.
Special populations:
• CYP2D6 poor metabolizers: M&B is metabolized by hepatic CYP2D6. Poor metabolizers of CYP2D6 may have exaggerated or prolonged effects of M&B. Increased risk may be seen with concomitant use of potent CYP2D6 inhibitors; use with caution (Abduljalil 2010; Jurica 2012; Sager 2014; Zhou 2009).
• Debilitated patients: Use with caution in patients who are sedated, debilitated or confined to a supine position.
• Pediatric: Use with caution in atopic children. Not for OTC use in children <4 years of age.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer
What happens if I miss a dose of M&B?
Since cough medicine is usually taken only as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.
References
- DailyMed. "PSEUDOEPHEDRINE SULFATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DailyMed. "GUAIFENESIN; HYDROCODONE BITARTRATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DailyMed. "DEXTROMETHORPHAN HYDROBROMIDE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
