promethazine / phenylephrine / codeine
Promethazine VC with Codeine is a combination medication containing promethazine (an antihistamine), phenylephrine (a decongestant), and codeine (an opioid cough suppressant). Promethazine VC with Codeine is a prescription oral solution (liquid) used for the treatment of symptoms caused by allergies or the common cold, such as congestion, cough, runny nose, and sneezing. The medication is taken by mouth, typically every 4 to 6 hours as needed. Side effects include sleepiness, headache, and dizziness.
What is Promethazine VC with Codeine?
What is Promethazine VC with Codeine used for?
- Respiratory symptoms caused by allergies or the common cold, including cough, congestion, runny nose, and sneezing
How Promethazine VC with Codeine works
Promethazine VC with Codeine is a combination of three medications that work together to relieve the symptoms related to allergies and the common cold like cough, runny nose, and congestion.
- Promethazine is a phenothiazine that acts like an antihistamine. It treats allergy symptoms by blocking a chemical called histamine.
- Phenylephrine is a decongestant. It works by squeezing the blood vessels around your nose and sinuses, which helps to relieve congestion.
- Codeine is an opioid receptor agonist. It eases cough by attaching to opioid receptors in the brain that control the urge to cough.
Drug facts
Risks and warnings for Promethazine VC with Codeine
Promethazine VC with Codeine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Potential for dependence and misuse
- Risk factors: History of alcohol or substance misuse | Taking more Promethazine VC with Codeine than prescribed | Suddenly stopping Promethazine VC with Codeine
The codeine in Promethazine VC with Codeine carries a risk of addiction or misuse, even at recommended doses. In serious cases, addiction and misuse of an opioid medication can lead to overdose and death. For these reasons, Promethazine VC with Codeine is a schedule V controlled substance. Your healthcare professional (HCP) will prescribe the lowest amount of Promethazine VC with Codeine for the shortest period of time needed to treat your symptoms. If you've taken Promethazine VC with Codeine for 5 days and your cough hasn't gotten better, then this medication isn't likely a good choice for you. In this case, contact your prescriber to discuss alternatives.
Dangerously slow breathing (respiratory depression)
- Risk factors: Older adults | Children younger than 12 years old | Children younger than 18 years old after tonsil or adenoid surgery | Taking medications that can cause slow breathing | Drinking alcohol | Having medical conditions that affect breathing | Taking higher doses of Promethazine VC with Codeine | Ultra-rapid metabolizers of Promethazine VC with Codeine | Breastfed babies from mothers taking Promethazine VC with Codeine
Promethazine VC with Codeine can cause dangerously slow breathing, which can be life-threatening. This can happen at any time, but you're at higher risk 1 to 3 days right after you start Promethazine VC with Codeine or if your HCP raises your dose. Drinking alcohol and taking other medications, like benzodiazepines, can also raise your risk for this dangerous side effect. You're recommended to ask your prescriber about getting naloxone (Narcan) before you start Promethazine VC with Codeine so that you can have it available in case of an accidental overdose. If you or your loved one notice you have trouble breathing or have bluish-colored lips, fingers, or toes, call 911 to get medical help right away.
Difficulty concentrating and extreme sleepiness
- Risk factors: Taking higher doses of Promethazine VC with Codeine | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Promethazine VC with Codeine can cause extreme sleepiness and lower your ability to think, react, and focus. Your risk is higher if you're taking other medications that can make you sleepy, such as benzodiazepines, muscle relaxants, and sleep medications. Make sure you know how this medication affects you before driving a car or doing activities that require your concentration. Talk to your HCP right away if you feel too sleepy from taking Promethazine VC with Codeine.
Risk of accidental overdose
To prevent accidentally taking too much Promethazine VC with Codeine, only use an accurate measuring device, such as an oral medication syringe, to measure your dose. If you don't already have one at home, ask your pharmacist.
Serious medication interactions
Promethazine VC with Codeine can interact with many medications. For example, taking certain medications, like erythromycin (Ery-tab) and ritonavir (Norvir), can raise the level of codeine and put you at higher risk for breathing problems. And starting certain medications, like rifampin (Rifadin) or carbamazepine (Tegretol), while you're already taking Promethazine VC with Codeine might lower the level of codeine and put you at risk for withdrawal symptoms.
Before starting Promethazine VC with Codeine, make sure your care team is aware of all the medications you're currently taking. Don't start or stop any medications without first checking with your care team.
Harm to newborn babies
If you take Promethazine VC with Codeine during pregnancy, you can pass the medication to your unborn baby. Long-term use during pregnancy can cause your unborn baby to become dependent on opioids. Once your baby is born, they can experience withdrawal symptoms, such as high-pitched crying, poor feeding and sucking behavior, trembling, irritability, abnormal sleep patterns, and seizures. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if not recognized and treated in time. Let your healthcare professional know if you've used Promethazine VC with Codeine during pregnancy or if you notice these symptoms in your baby.
Caution in certain medical conditions
People with certain medical conditions shouldn't take Promethazine VC with Codeine.
For example, this medication can't be taken by people with certain stomach-related conditions, such as slow movement of the gut. The codeine in this medication can worsen gut movement.
Promethazine VC with Codeine isn't appropriate for people with head injuries, brain tumors, or other brain-related medical conditions. This is because this medication can slow breathing and lower oxygen levels in the brain, which can be dangerous.
Before starting Promethazine VC with Codeine, make sure to let your medical team know about what medical conditions you have so that they can check to see if this medication is safe for you to take.
Neuroleptic malignant syndrome (NMS)
- Risk factors: Taking other antipsychotic medications
The promethazine in Promethazine VC with Codeine can cause a rare, but life-threatening condition called neuroleptic malignant syndrome (NMS). Symptoms include fever, sweating, stiff muscles, confusion, not aware of your surroundings, and fast or irregular heartbeat. If you experience any of these symptoms while taking Promethazine VC with Codeine, seek medication attention as soon as possible. Your HCP will likely have you stop taking Promethazine VC with Codeine and switch you to something else.
Changes in blood pressure
- Risk factors: Heart problems | Taking other medications that lower blood pressure | History of low blood volume
Promethazine VC with Codeine contains phenylephrine, which can raise your heart rate and blood pressure, even at recommended doses. However, Promethazine VC with Codeine also contains codeine, which can have the opposite effect and cause your blood pressure to drop, especially when you stand from a sitting or lying down position. This can lead to dizziness and cause you to pass out or fall. People with certain heart conditions are more likely to experience this side effect. To avoid falling, get up slowly if you've been sitting or lying down. If dizziness or lightheadedness doesn't go away, talk to your healthcare professional. Depending on your medical conditions, your prescriber might recommend measuring your blood pressure at home to see how you react to the medication.
Seizures
- Risk factors: History of seizure conditions
Codeine and promethazine can cause people with a history of seizures to have seizures more often. Promethazine VC with Codeine can also raise your risk of seizures in certain situations. Let your HCP know if you have seizures more often while taking Promethazine VC with Codeine.
Low white blood cell counts
- Risk factors: History of low blood cell counts
Though not common, promethazine in Promethazine VC can lower your white blood cell counts, especially if they've been low previously from other conditions. This can raise your risk of serious infection. If you develop any signs of infection, such as fever, tiredness, chills, cough, or trouble breathing, and they don't go away, contact your prescriber right away.
Difficulty controlling body movements
- Risk factors: Taking other antipsychotic medications | Dehydrated | Children
The promethazine in Promethazine VC with Codeine can cause uncontrolled body movements (called tardive dyskinesia), such as eye-twitching or lip-smacking. The risk is higher for people who are dehydrated. If you experience any uncontrolled movements and aren't able to stop them, talk to your HCP right away.
Low adrenal hormone levels
Though rare, opioids like Promethazine VC with Codeine can cause your adrenal hormone levels to drop. This is more likely to happen after taking opioids for longer than 1 month. Symptoms include nausea, vomiting, not feeling hungry, tiredness, dizziness, and weakness. Let your HCP know right away if you experience these symptoms because you might need to stop Promethazine VC with Codeine and be treated with corticosteroids.
Risk of inaccurate lab results
Promethazine VC with Codeine can interfere with certain lab tests. For example, it can cause pregnancy tests to have false-positive or false-negative results. It can also cause blood sugar tests to be falsely high. Make sure to tell your HCP you're taking Promethazine VC with Codeine if you're receiving any lab tests.
Side effects of Promethazine VC with Codeine
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Sleepiness
- Difficulty concentrating
- Feeling tired
- Lightheadedness
- Dizziness
- Headache
- Dry mouth
- Nausea
- Vomiting
- Constipation
- Sweating
- Fast heart rate
- Anxiety
- Restlessness
- Nervousness
- Tremor
- Irritability
Less Common Side Effects
- Weakness
- Injuries from accidental falls
- Raised body temperature
- Confusion
- Difficulty sleeping
- Rash
- Diarrhea
- Stomach pain
- Sensitivity to light
- Blurry vision
- Muscle pain
- Backache
Promethazine VC with Codeine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Accidentally taking too much (overdose): not responding to sound or touch, slowed breathing, extreme sleepiness, slow heartbeat, upper right-sided stomach pain, dark urine, cold or clammy skin, yellowing of your skin or eyes
- Opioid withdrawal: anxiety, suicidal thoughts, restlessness, runny nose, yawning, sweating, chills, wide pupils, irritability
- Dangerously slow breathing: trouble breathing; bluish-colored lips, fingers, or toes
- Neuroleptic malignant syndrome (NMS): fever, sweating, stiff muscles, confusion, not aware of your surroundings, fast or irregular heartbeat
Get your GoodRx coupon
Pros and cons of Promethazine VC with Codeine
Pros
- Taken by mouth
- Combines three different medications within a single product
- Comes as a flavored liquid that might be easier to swallow than tablets
Cons
- Can cause sleepiness, which can affect your ability to drive and focus on tasks
- Can be habit-forming so it should only be used short-term
- Might not work well at relieving cough or congestion
Pharmacist tips for Promethazine VC with Codeine
- You can take Promethazine VC with Codeine with or without food. If it's upsetting your stomach, try taking it with food to help.
- Use a medication dose cup, spoon, or syringe to measure out your dose of Promethazine VC with Codeine. Don't use household teaspoons because they're not accurate, so you might end up taking the wrong dose.
- If you've been taking Promethazine VC with Codeine regularly for a period of time and want to stop, talk with your prescriber first. They might need to lower your dose slowly over time before you can stop completely. This is to help you avoid withdrawal symptoms, such as anxiety, sweating, chills, and irritability.
- Promethazine VC with Codeine causes dizziness and sleepiness. Avoid activities that require you to be alert (like driving) until you know how it affects you. Avoid alcohol because it can worsen sleepiness and dizziness, and can also harm your ability to think or react.
- Phenylephrine in Promethazine VC can raise your heart rate and blood pressure. If you get severe headaches, nosebleeds, difficulty breathing, irregular heartbeat, or chest pain while taking Promethazine VC with Codeine, stop the medication and seek medical attention right away. These could be signs of dangerously high blood pressure.
- Promethazine and codeine in Promethazine VC with Codeine can both cause dizziness and sleepiness. Avoid activities that require you to be alert (like driving) until you know how it affects you. Also, avoid alcohol because it can worsen sleepiness and dizziness, and can also harm your ability to think or react.
- Constipation can happen after taking Promethazine VC with Codeine because of the codeine that's in it. Drink enough water each day and add more foods with fiber to your diet. Speak to your care team if these lifestyle changes aren't enough to help with this side effect. They can recommend medications or a change in your treatment.
- Let your prescriber know if you're pregnant before starting Promethazine VC with Codeine. It isn't recommended during pregnancy because codeine raises the risk for birth defects and complications at birth, including neonatal abstinence syndrome. Also, phenylephrine generally isn't recommended during pregnancy due to risk of harm to babies.
- Tell your healthcare team if you're breastfeeding. It's typically recommended to avoid Promethazine VC with Codeine because codeine can get into breast milk. This raises the risk for serious side effects to your baby (e.g., sleepiness, slowed breathing).
- Store the medication at room temperature and keep in the original container it came in from the pharmacy. Make sure to keep it out of reach from children, pets, or visitors. If you don't need to take Promethazine VC with Codeine anymore, choose a medication take-back option to get rid of it safely. This lowers the risk of accidental overdose and helps prevent medication misuse.
Common questions about Promethazine VC with Codeine
Promethazine VC with Codeine contains codeine, an opioid cough suppressant. It's thought to work by attaching to certain receptors in the brain that control the urge to cough. But studies are mixed about how well it works for cough. Contact your prescriber if your cough doesn't get better after 5 days of starting Promethazine VC with Codeine because they will ask you to consider other options. Continuing to take Promethazine VC with Codeine can raise your risk for dependence and serious side effects, such as extreme sleepiness and trouble breathing.
Yes, Promethazine VC with Codeine contains phenylephrine, a decongestant. Based on how it works in the body, you should expect to feel relief from your symptoms about 15 to 20 minutes after a dose. But recent studies suggest that oral phenylephrine doesn't work well at easing nasal or sinus congestion. If your congestion symptoms aren't getting better with Promethazine VC with Codeine, ask your prescriber about other recommendations. Continuing to take Promethazine VC with Codeine when it isn't helping won't make you feel better, but can put you at risk for serious side effects.
One of the ingredients in Promethazine VC with Codeine is codeine, which can be habit-forming. To lower the risk for dependence or addiction, your healthcare professional (HCP) will prescribe the lowest dose of Promethazine VC with Codeine needed for the shortest period of time to treat your symptoms. Only take Promethazine VC with Codeine as directed by your HCP.
Yes, Promethazine VC with Codeine is only available by prescription from a healthcare professional.
The brand version, Promethazine VC with Codeine, is a strawberry-flavored liquid that's a clear, reddish-orange color. But generic versions of this medication can look and taste different.
How to save using GoodRx
Promethazine VC with Codeine dosage
Typical dosage for Promethazine VC with Codeine
Each 5 mL of Promethazine VC with Codeine contains 6.25 mg of promethazine, 5 mg of phenylephrine, and 10 mg of codeine.
- Adults: The typical dose ranges from 5 mL (1 teaspoonful) by mouth every 4 to 6 hours as needed. Don't take more than 30 mL (6 teaspoonfuls) in a day.
How much does Promethazine VC with Codeine cost?
$24.75
Promethazine VC with Codeine contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Promethazine VC with Codeine will not be safe for you to take.
- Children younger than 12 years of age
- Children younger than 18 years of age for pain management after tonsil or adenoid surgery
- Severely slowed breathing (respiratory depression)
- Severe asthma
- Conditions that cause blockage of the stomach passageway
- Narrow-angle glaucoma (high pressure in the eyes), trouble urinating, severely high blood pressure, certain heart and blood vessel conditions
- Current or recent (within 2 weeks) use of a monoamine oxidase inhibitor (MAOI)
What are alternatives to Promethazine VC with Codeine?
