If you are:
Only When Necessary: CAUTION WITH USE; RISK OF PLATELET AGGREGATION IN NEWBORN
Only When Necessary: NEONATAL WITHDRAWAL/RESP.DEPRESS. W/CHRONIC OR HIGH DOSE; SMALL TERATOGENIC RISK
Only When Necessary: EVIDENCE FOR MALFORMATIONS; CAN REDUCE UTERINE BLOOD FLOW CAUSING FETAL HYPOXIA
Precaution: LIMITED AMOUNT MAY BE EXCRETED DUE TO LOW MW; MONITOR INFANT FOR RESP DEPRESS
Precaution: CNS/RESPIRATORY DEPRESSION,APNEA POSSIBLE;CAUTION W/ FAST CYP2D6 METABOLIZER
Precaution: ORAL BIOAVAILABILITY LOW; INFANT EXPOSURE MAY BE MINIMAL
An adult over 60:
management or monitoring precaution: Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.
management or monitoring precaution: Cardiovascular-Elderly are more sensitive to tachycardia and hypertensive effects. May exacerbate symptomatic coronary insufficiency. Genitourinary-May cause urinary retention. Neuro/Psych-May worsen cognitive impairment in some elderly with dementia. Insomnia risk.
management or monitoring precaution: Pulmonary-Life threatening respiratory depression is more likely to occur with high doses, SR products, cachexia, or debilitation due to altered pharmacokinetics with poor fat stores, muscle wasting, or altered clearance. Monitor closely at initiation and with dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
Giving promethazine-phenyleph-codeine to a child under 12:
Severe Precaution: Contraindicated for pain management post-surgical tonsillectomy and or adenoidectomy. Respiratory depression and death reported in CYP2D6 ultra-rapid metabolizer patients post tonsillectomy or adenoidectomy. Specific CYP2D6 genotypes convert codeine into morphine more rapidly and achieve higher levels of morphine even with standard dosing. Slow or difficult breathing risk in patients with asthma or other underlying breathing problem.
Contraindication: Risk of fatal respiratory depression with CYP 2D6 ultra-rapid metabolizers. Contraindicated age < 6 yrs.
Severe Precaution: Slow or difficult breathing risk in patients with asthma or other underlying breathing problems. Contraindicated for pain management post-surgical tonsillectomy and or adenoidectomy. Respiratory and CNS depression and death has occurred in children following tonsillectomy and/or adenoidectomy with evidence of being CYP2D6 ultra-rapid metabolizers. Specific CYP2D6 genotypes convert codeine into morphine more rapidly and achieve higher levels of morphine even with standard dosing.
Contraindication: Risk of CNS excitation. Do not use age <6 years without clinician consult.
Contraindication: Potential for fatal respiratory depression age < 2 years. Avoid use.
Severe Precaution: Caution:use the lowest effective dose due to risk of respiratory depression.