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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Mar-cof Cg
Generic Name
Codeine Phosphate And Guaifenesin
Active Ingredient
CodeineCategory
Barbiturate [EPC]
Salt Form
Phosphate
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 7.5 mg/5mL | SYRUP | ORAL | 0682-0475 |
Detailed information about Mar-cof Cg
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Mar-cof Cg, you must consult a qualified healthcare professional.
Codeine is an opioid analgesic and antitussive used to manage mild to moderate pain and suppress coughing. It belongs to the opioid agonist class and works by altering the perception of pain in the central nervous system.
Dosage for codeine must be individualized based on the severity of the condition, patient response, and prior analgesic experience. According to standard clinical guidelines:
Warning: The use of codeine in children has become highly restricted due to safety concerns.
In patients with reduced kidney function (renal impairment), codeine and its metabolites (especially morphine-6-glucuronide) can accumulate, increasing the risk of respiratory depression and sedation. For patients with a GFR (Glomerular Filtration Rate) of 10-50 mL/min, providers may reduce the dose by 25%. If GFR is less than 10 mL/min, the dose is typically reduced by 50%.
Since codeine is a prodrug metabolized by the liver, patients with severe hepatic impairment may not effectively convert codeine to morphine, leading to reduced efficacy. Conversely, the inability to clear the drug can lead to CNS accumulation. Dose titration should be performed with extreme caution in these patients.
Geriatric patients (65+) often have decreased renal and hepatic clearance. They are also more sensitive to the CNS effects of opioids. Initial doses for the elderly are typically 25% to 50% lower than standard adult doses, with slow upward titration.
Codeine is often taken on an 'as-needed' basis. If you are on a scheduled dosing regimen and miss a dose, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and resume your regular schedule. Never double the dose to catch up, as this significantly increases the risk of fatal respiratory depression.
An overdose of codeine is a medical emergency. Signs include extreme drowsiness, 'pinpoint' pupils, cold and clammy skin, slow or shallow breathing (bradypnea), and loss of consciousness. If an overdose is suspected, call emergency services (911) immediately. Naloxone (Narcan) is the specific pharmacological antagonist used to reverse opioid-induced respiratory depression and should be administered if available.
> Important: Follow your healthcare provider's dosing instructions precisely. Do not adjust your dose or stop the medication abruptly without medical guidance, as this can lead to withdrawal symptoms.
Most patients taking codeine will experience at least one mild side effect. These are generally dose-dependent and may include:
> Warning: Stop taking Codeine and call your doctor immediately or seek emergency care if you experience any of the following:
The FDA has issued several Black Box Warnings for codeine, the highest level of caution:
Report any unusual symptoms to your healthcare provider to ensure your treatment remains safe and effective.
Codeine is a potent medication that requires careful management. Patients must be aware that it can impair mental and physical abilities. It is vital to disclose your full medical history, including any history of substance abuse, to your healthcare provider before starting treatment. Because of the risk of respiratory depression, codeine should be used with extreme caution in patients with compromised respiratory function, such as those with chronic obstructive pulmonary disease (COPD) or asthma.
As mandated by the FDA, Codeine labels carry prominent warnings regarding:
Patients on long-term codeine therapy require regular monitoring by their healthcare provider:
Codeine causes significant impairment of motor skills and judgment. You should not drive, operate heavy machinery, or engage in potentially hazardous activities until you know how codeine affects you. Even if you feel alert, your reaction times may be significantly slowed.
Do not consume alcohol while taking codeine. Alcohol synergistically increases the sedative and respiratory-depressant effects of codeine. This combination is a frequent cause of fatal drug-related deaths.
Do not stop taking codeine abruptly if you have been using it for more than a few days. Sudden discontinuation can trigger a withdrawal syndrome characterized by anxiety, sweating, muscle aches, insomnia, tremors, and gastrointestinal distress. Your doctor will provide a tapering schedule to slowly reduce the dose.
> Important: Discuss all your medical conditions, especially respiratory or hepatic issues, with your healthcare provider before starting Codeine.
For each major interaction, the management strategy usually involves dose adjustment, choosing an alternative medication, or intensive monitoring for signs of toxicity or reduced efficacy.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking to prevent dangerous interactions.
Codeine must NEVER be used in the following circumstances:
In these cases, a healthcare provider will perform a careful risk-benefit analysis:
Patients who have had an anaphylactic or severe allergic reaction to other phenanthrene-derivative opioids (such as morphine, hydrocodone, oxycodone, or hydromorphone) should be treated with extreme caution, as cross-sensitivity is possible. However, a mild 'itchy' reaction to morphine is often a side effect of histamine release rather than a true allergy and may not preclude the use of codeine, though medical supervision is required.
> Important: Your healthcare provider will evaluate your complete medical history, including respiratory health and genetic factors, before prescribing Codeine.
Codeine is generally classified as FDA Pregnancy Category C (under the old system). Prolonged use of codeine during pregnancy can lead to Neonatal Opioid Withdrawal Syndrome (NOWS), a life-threatening condition for the newborn. Symptoms in the infant include irritability, hyperactivity, abnormal sleep patterns, high-pitched cry, tremor, vomiting, diarrhea, and failure to gain weight. Use during labor and delivery can cause respiratory depression in the newborn. Codeine should only be used during pregnancy if the potential benefit justifies the risk to the fetus.
Codeine is not recommended for breastfeeding women. Codeine and its active metabolite, morphine, are excreted into breast milk. If the mother is an ultra-rapid metabolizer of codeine, the levels of morphine in her breast milk can reach dangerously high levels, leading to life-threatening respiratory depression or death in the nursing infant. Signs of opioid toxicity in an infant include increased sleepiness, difficulty breastfeeding, breathing difficulties, or limpness.
As established, codeine is contraindicated in all children under 12 and in adolescents under 18 for certain post-surgical pain. The FDA has strengthened these warnings because of the unpredictable way children's bodies convert codeine to morphine. There are no safe doses of codeine for children who have underlying breathing issues like obstructive sleep apnea.
In patients over 65, codeine should be started at the low end of the dosing range. The elderly are at an increased risk for:
Codeine metabolites are cleared by the kidneys. In patients with chronic kidney disease (CKD), these metabolites can accumulate. Dose reductions are mandatory for those with a GFR below 50 mL/min to prevent toxicity.
Since the liver is responsible for converting codeine into its active form (morphine) and subsequently clearing it, liver disease significantly alters the drug's profile. Patients with cirrhosis may experience reduced pain relief (due to lack of conversion) or increased sedation (due to lack of clearance). Dosing should be cautious and monitored closely.
> Important: Special populations require individualized medical assessment and often require lower starting doses.
Codeine is an opioid agonist that primarily targets the mu-opioid receptors. It is a 'weak' opioid because it has a low affinity for these receptors in its parent form. Its primary therapeutic effect comes from its conversion into morphine via the O-demethylation pathway, catalyzed by the cytochrome P450 2D6 (CYP2D6) enzyme. Morphine binds to mu-receptors, which are G-protein-coupled receptors. Activation of these receptors leads to the inhibition of adenylate cyclase, a decrease in intracellular cAMP, and the closure of voltage-gated calcium channels. This results in hyperpolarization of the neuron and reduced excitability, effectively blocking the transmission of pain signals through the spinal cord and altering the perception of pain in the brain.
The onset of action for oral codeine is typically 30 to 60 minutes, with peak effects occurring between 1 and 2 hours. The duration of the analgesic effect is usually 4 to 6 hours. Codeine also suppresses the cough reflex through a direct effect on the cough center in the medulla. Unlike its analgesic effects, the antitussive effects of codeine may occur at lower doses that do not produce significant CNS depression.
| Parameter | Value |
|---|---|
| Bioavailability | ~90% |
| Protein Binding | 7% - 25% |
| Half-life | 2.5 - 3.5 hours |
| Tmax (Time to Peak) | 1 - 2 hours |
| Metabolism | Hepatic (CYP2D6, CYP3A4) |
| Excretion | Renal (90%) |
Codeine is classified as an Opioid Agonist and an Antitussive. It is structurally related to morphine and hydrocodone. In the therapeutic hierarchy, it is considered a 'Step 2' analgesic on the World Health Organization (WHO) pain ladder, intended for mild to moderate pain.
Common questions about Mar-cof Cg
Codeine is primarily used to treat mild to moderately severe pain and to suppress a dry, non-productive cough. It is an opioid medication that works by changing how the brain and nervous system respond to pain and by depressing the cough center in the brain. Often, it is prescribed when non-opioid pain relievers, such as acetaminophen or ibuprofen, have not provided sufficient relief. In addition to its use in pain management, it is a common ingredient in prescription cough syrups. It should only be used for the specific condition for which it was prescribed by a healthcare professional.
The most common side effects of codeine include constipation, drowsiness, nausea, and lightheadedness. Constipation is a particularly frequent issue because opioids slow down the movement of the intestines; many doctors recommend increasing fiber or using a stool softener while taking it. Nausea and vomiting may also occur, especially when you first start the medication or if you are moving around. Drowsiness and dizziness are also common, which is why patients are advised not to drive until they know how the drug affects them. Most of these side effects are dose-dependent and may improve as your body adjusts to the medication.
No, you should strictly avoid drinking alcohol while taking codeine. Both codeine and alcohol are central nervous system depressants, meaning they slow down brain activity and breathing. When taken together, they can dangerously enhance each other's effects, leading to extreme sedation, respiratory depression, coma, or even death. Even small amounts of alcohol can increase the risk of these life-threatening complications. Always check the labels of other over-the-counter medicines to ensure they do not contain alcohol while you are on codeine therapy.
Codeine is generally not recommended during pregnancy unless the benefits clearly outweigh the risks, as determined by a doctor. Prolonged use of codeine during pregnancy can cause the baby to become physically dependent on the drug, leading to Neonatal Opioid Withdrawal Syndrome (NOWS) after birth. This condition can be life-threatening and requires specialized medical care in a neonatal intensive care unit. Additionally, use during labor can cause breathing problems in the newborn infant. If you are pregnant or planning to become pregnant, discuss alternative pain management strategies with your healthcare provider.
When taken orally, codeine typically begins to work within 30 to 60 minutes. The peak effect, where you feel the maximum pain relief or cough suppression, usually occurs about 1 to 2 hours after ingestion. The effects of a single dose generally last for about 4 to 6 hours. Because it takes time to be metabolized by the liver into morphine, the onset may be slightly slower than some other immediate-release opioids. If you do not feel relief after an hour, do not take an extra dose; instead, contact your doctor for guidance.
If you have been taking codeine regularly for more than a few days, you should not stop taking it suddenly without consulting your doctor. Stopping abruptly can lead to withdrawal symptoms such as restlessness, watering eyes, runny nose, yawning, sweating, chills, muscle pain, and dilated pupils. You might also experience irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, or increased blood pressure. Your healthcare provider will usually help you gradually reduce your dose (tapering) to prevent these uncomfortable and potentially serious symptoms. Always follow the specific tapering schedule provided by your medical professional.
If you are taking codeine on a fixed schedule and miss a dose, take it as soon as you remember. However, if it is almost time for your next scheduled dose, you should skip the missed dose and return to your regular timing. It is critical that you never take two doses at once to make up for a missed one, as this can lead to an accidental overdose. Since codeine is often prescribed to be taken 'as needed' for pain, you may not have a strict schedule; in that case, simply take the next dose when needed, ensuring you follow the minimum time interval (usually 4-6 hours) between doses.
Weight gain is not a commonly reported direct side effect of short-term codeine use. However, some patients may experience weight changes during long-term opioid therapy due to secondary factors. For instance, codeine can cause significant constipation and bloating, which might feel like weight gain. Additionally, the sedative effects of the medication might lead to decreased physical activity, which can contribute to weight gain over time. If you notice a significant or rapid change in your weight while taking codeine, you should discuss this with your healthcare provider to rule out other underlying causes.
Codeine can interact with many other medications, some of which can cause life-threatening reactions. It is particularly dangerous to mix codeine with other drugs that cause sleepiness or slow your breathing, such as benzodiazepines, sleep aids, or other opioids. Certain antidepressants and antifungal medications can also interfere with how your liver processes codeine, either making it ineffective or increasing the risk of toxicity. You must provide your doctor and pharmacist with a complete list of all medications, vitamins, and herbal supplements you are currently taking. This allows them to check for potential interactions and adjust your treatment plan for safety.
Yes, codeine is widely available as a generic medication, both as a single-ingredient product (Codeine Sulfate) and in combination with other drugs like acetaminophen or aspirin. Generic versions are typically more cost-effective than brand-name products and are required by the FDA to have the same quality, strength, and purity as the original brand-name drug. Because codeine is a controlled substance, you will still need a valid prescription from a licensed healthcare provider to obtain the generic version. Availability may vary depending on local regulations and the specific formulation required for your condition.
Other drugs with the same active ingredient (Codeine)