Mepyramine Maleate/ Codeine Phosphate/ Ephedrine Hydrochloride/ Ammonium Chloride/ Sodium Citrate

Registered South African indications:

• Relief of cough

Contraindications

• Hypersensitivity to the active ingredient or any of the excipients in this combination product
• Renal impairment
• Hepatic impairment
• Coronary thrombosis
• Hypertension
• Hyperthyroidism
• Closed-angle glaucoma
• Epilepsy
• Children <12 years (12.5mg/10mg/10mg/125mg/50mg formulation)
• Coadministration with monoamine oxidase inhibitors or within 10 days of their use

Cautions

• Pregnancy
• Breastfeeding
• Elderly
• Organic heart disease
• Cardiac decompensation
• Angina of effort
• Prostatic enlargement
• Diabetes mellitus
• Fructose intolerance
• Glucose-galactose malabsorption
• Sucrase-isomaltase insufficiency
• Coadministration with digitalis
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: syr

Relief of cough

Mepyramine Maleate/ Codeine Phosphate/ Ephedrine Hydrochloride/ Ammonium Chloride/ Sodium Citrate
12.5/10/10/125/50 (mg/5ml)

• Oral (syr): 5-10ml, 8hrly and at night, as needed

---

Mepyramine maleate/ codeine phosphate/ ephedrine hydrochloride/ ammonium chloride/ sodium citrate should be used at the lowest effective dose

Paed. forms avail. in SA and covered in this monograph: syr

Relief of cough

Mepyramine Maleate/ Codeine Phosphate/ Ephedrine Hydrochloride/ Ammonium Chloride/ Sodium Citrate
12.5/10/10/125/50 (mg/5ml)

• Younger than 12 years: Contraindicated
• 12 years and older: See adult dosage

6.25/5/5/62.5/25 (mg/5ml)

• Information not available at publication

---

Mepyramine maleate/ codeine phosphate/ ephedrine hydrochloride/ ammonium chloride/ sodium citrate should be used at the lowest effective dose

Pregnancy

• Caution; no information available
• The safety of the use of this medicine during pregnancy has not been established

Breastfeeding

• Caution; no information available 
• The safety of the use of this medicine during breastfeeding has not been established

Fertility

• No information available

Renal Impairment

• Contraindicated 

Hepatic Impairment

• Contraindicated 

Elderly

• Caution; no information available 

Drugs in Sport

• Prohibited - In competition

Combination products may have additional pharmacological effects not accounted for by the action of the individual ingredients

Mepyramine
Central Nervous System Disorders

• Dizziness
• Sedation
  - Slight drowsiness
  - Deep sleep
• Inability to concentrate
• Tingling
• Seizures
• Headache
• Elation
• Depression
• Irritability
• Nightmares
• Insomnia
• Nervousness
• Lassitude

Cardiovascular Disorders

• Hypotension
• Tachycardia
• Heaviness and weakness of the hands

Respiratory Disorders

• Tightness of chest

Gastrointestinal Disorders

• Nausea and vomiting
• Diarrhoea
• Constipation
• Epigastric pain

Genitourinary Disorders

• Difficulty in micturition

Endocrine and Metabolic Disorders

• Anorexia

Musculoskeletal Disorders

• Muscular weakness
• Incoordination
• Tremors
• Muscle twitching

Immune, Blood and Lymphatic System Disorders

• Agranulocytosis
• Haemolytic anaemia
• Allergy

Sensory Disorders

• Blurred vision
• Tinnitus

Codeine
Central Nervous System Disorders

• Confusion
• Changes of mood
• Drowsiness
• Restlessness

Cardiovascular Disorders

• Bradycardia
• Palpitations
• Facial flushing
• Orthostatic hypotension

Gastrointestinal Disorders

• Nausea and vomiting
• Constipation
• Dry mouth

Hepatobiliary Disorders

• Ureteric or biliary spasm

Genitourinary Disorders

• Difficulty in micturition
• Antidiuretic effect

Skin and Subcutaneous Tissue Disorders

• Skin rashes
• Sweating

Immune, Blood and Lymphatic System Disorders

• Hypersensitivity
  - Skin rashes
• Hypothermia

Sensory Disorders

• Miosis
• Vertigo

Ephedrine
Central Nervous System Disorders

• Anxiety
• Insomnia
• Giddiness
• Headache

Cardiovascular Disorders

• Tachycardia
• Palpitations

Gastrointestinal Disorders

• Nausea and vomiting

Genitourinary Disorders

• Difficulty in micturition

Endocrine and Metabolic Disorders

• Thirst

Musculoskeletal Disorders

• Muscular weakness
• Tremor
• Precordial pain

Skin and Subcutaneous Tissue Disorders

• Sweating

Ammonium chloride
Central Nervous System Disorders

• Headache
• Progressive drowsiness

Respiratory Disorders

• Hyperventilation

Gastrointestinal Disorders

• Nausea and vomiting

Endocrine and Metabolic Disorders

• Profound acidosis
• Hypokalaemia
• Thirst

Sodium citrate
Endocrine and Metabolic Disorders

• Hypernatraemia

• Monoamine oxidase inhibitors
• Digitalis
• Chloroform
• Cyclopropane
• Halothane
• Other halogenated anaesthetics

None routine

Mepyramine
Mepyramine reversibly competes for histamine-1 receptors in target tissues, thereby preventing the action of histamine. Mepyramine is a 1st generation antihistamine that has sedative, mild anticholinergic and local anaesthetic activity.

Codeine
Codeine is a centrally acting weak analgesic. It exerts its effect through mu opioid receptors. It resembles morphine in its pharmacodynamic actions although much weaker in its effects.

Ephedrine
Ephedrine is a sympathomimetic amine which directly activates post-synaptic α- and β-adrenergic receptors. It acts indirectly by enhancing the release of noradrenaline, from storage sites in the sympathetic nerves to the effector organ.

Ammonium chloride
Ammonium chloride is used as an expectorant. It causes irritation of the bronchial mucosa, which results in the production of excess respiratory tract fluid. This allows for easier mucus expulsion due to its decreased viscosity.

Sodium citrate
Sodium citrate is metabolized to sodium bicarbonate and acts as a systemic alkaliser.

COMBINATION PREPARATIONS

Mepyramine Maleate/ Codeine Phosphate/ Ephedrine Hydrochloride/ Ammonium Chloride/ Sodium Citrate

Syrup (per 5ml) 12.5mg/10mg/10mg/125mg/50mg

• Coughcod Senior (Pharmacare)

Syrup (per 5ml) 6.25mg/5mg/5mg/62.5mg/25mg

• Coughcod Junior (Pharmacare)