This combination product contains four medications: brompheniramine, phenylephrine, guaifenesin, and codeine.

Codeine belongs to the group of medications called narcotic analgesics and cough suppressants. It works by blocking pain signals that are sent out by the brain to various areas of the body and reduces coughing by acting in the brain to dull the cough reflex.

Brompheniramine belongs to the group of medications called antihistamines and helps to relieve sneezing and runny nose.

Phenylephrine belongs to the group of medications called nasal decongestants and is used to decrease nasal stuffiness.

Guaifenesin belongs to the group of medications called expectorants. This medication helps to loosen mucus so it can be coughed up.

This medication is used for the temporary relief of coughing and stuffy or runny nose that is associated with allergies, the common cold, or chest infections.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful and potentially fatal for people to take this medication if their doctor has not prescribed it.

Note: A cough is a symptom. Before taking a cough suppressant, it is important to assess the underlying cause of the cough. This medication should be used at the lowest effective dose for the shortest period of time.

The usual adult dose is 10 mL (2 teaspoonsful) every 6 hours as needed. Do not take more than 40 mL in a 24-hour period. It may be taken with or without food, and should be taken with a glass of water.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Use an oral syringe to measure each dose of the liquid, as it gives a more accurate measurement than household teaspoons.

It is important to take this medication exactly as prescribed by your doctor. If your doctor has told you to take this medication on a regular basis and you miss a dose, take it as soon as you remember and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Each 5 mL of palatable, cherry-red liquid, menthol and raspberry taste and odour, contains brompheniramine maleate 2 mg, phenylephrine HCl 5 mg, guaifenesin 100 mg, and codeine phosphate 10 mg. Nonmedicinal ingredients: alcohol, citric acid, D&C Red No. 33, edetate disodium, FD&C Red No. 40, menthol flavour, raspberry flavours, sorbitol, glycerin, propylene glycol, sodium benzoate, sodium carboxymethylcellulose, sodium saccharin, and water.

Do not use this medication if you:

• are allergic to brompheniramine, phenylephrine, guaifenesin, codeine, or any of the ingredients of the medication
• are allergic to codeine-like narcotics or other similar antihistamines or decongestants
• are pregnant or breast-feeding
• are experiencing slowed, shallow breathing (respiratory depression)
• have a blockage of the intestines or a condition that slows down passage of material through the digestive tract
• have breathing problems or long-term lung disease such as asthma, chronic bronchitis, or emphysema
• have active alcoholism or are experiencing alcohol withdrawal
• have any of the following other medical conditions: diabetes, heart disease, thyroid disease, or glaucoma
• are taking an MAO inhibitor (e.g., phenelzine, tranylcypromine) or have taken one in the past 2 weeks
• are between 12 and 18 years of age and have had your tonsils or adenoids removed to treat sleep apnea
• have a decreased level of consciousness
• have a head injury or increased pressure inside the brain
• have seizures
• have been diagnosed as an ultra-rapid metabolizer

Do not give this medication to children less than 12 years of age.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• constipation
• decreased appetite
• decreased interest in sexual activity
• decreased sexual ability
• difficulty sleeping
• dizziness
• drowsiness
• dry mouth
• headache
• lightheadedness
• nausea
• skin rashes
• sweating
• tiredness
• vomiting
• weakness

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• decreased coordination
• fast, slow, or irregular heartbeat
• itchy skin
• symptoms of bowel blockage (e.g., abdominal pain, severe constipation, nausea)
• symptoms of low blood pressure (e.g., dizziness, fainting, light-headedness, particularly when rising from a lying or sitting position)
• vision changes

Stop taking the medication and seek immediate medical attention if any of the following occur:

• seizures
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• slow, shallow, or weak breathing
• symptoms of serotonin syndrome (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)
• symptoms of overdose of codeine, such as:
• abnormally slow or weak breathing
• cold, clammy skin
• confusion
• extreme drowsiness
• severe dizziness
• slow heartbeat

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abdominal (stomach) conditions: Codeine, like other narcotic medications, may make the diagnosis of abdominal conditions more difficult or it may worsen these conditions. If you have abdominal problems or are scheduled for abdominal surgery, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Accidental use: When this medication is used by anyone other than the person for whom it was prescribed, the effects of the medication may be fatal. Children are particularly at risk. Keep this medication out of sight and reach of children.

Adrenal gland problems: Adrenal glands produce chemical messengers that are responsible for the normal function of the body's organs, including how your body responds to injury or stress. When opioids are taken for a month or longer, the medication may cause your adrenal gland to function improperly. Your doctor may monitor your adrenal gland condition, especially if you have experienced stress such as surgery, injury, or severe infection.

Alcohol and other medications that cause drowsiness: People taking this medication should not combine it with alcohol and should avoid combining it with other medications, such as narcotic pain relievers, sedatives or anxiety medications, that cause drowsiness. Doing so can cause additive drowsiness and reduced breathing, as well as other side effects, which can be dangerous and possibly fatal.

Breathing: Codeine can suppress breathing. Children are more likely to experience serious breathing problems, including death. For this reason, this medication should not be given to children less than 18 years old. If you are at risk for breathing difficulties, such as asthma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Constipation: Codeine can be very constipating. Eating a high-fibre diet and following good bowel habits will help to minimize this effect. If you develop constipation easily, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dependence and withdrawal: This medication contains codeine. Physical dependence, psychological dependence, and abuse have occurred with the use of codeine. People with a history of past or current substance use problems may be at greater risk of developing abuse or addiction while taking this medication. Abuse is not a problem with people who require this medication for pain relief.

If you suddenly stop taking this medication, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shaking, pain, nausea, tremors, diarrhea, and hallucinations. If you have been taking this medication for a while, it should be stopped gradually as directed by your doctor.

Drowsiness/reduced alertness: Codeine may cause drowsiness. Do not drive, operate machinery, or perform any potentially hazardous tasks until you know how this medication affects you.

Glaucoma: Brompheniramine - phenylephrine - guaifenesin - codeine may worsen make glaucoma symptoms. If you have narrow-angle glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Head injury: If you have a head injury or increased pressure in the head, you may have a higher risk of experiencing side effects (breathing problems) or worsening of their condition while taking this medication. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart disease: This medication may make symptoms of certain heart conditions worse. If you have an irregular heart rhythm, ischemic heart disease, high blood pressure or other heart condition, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney disease: If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver disease: If you have liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Other medical conditions:  The medications in brompheniramine - phenylephrine - guaifenesin - codeine can have an effect on other medical conditions. The codeine may worsen symptoms of delirium tremens or acute alcohol intoxication.

As well, brompheniramine and phenylephrine may cause worsening symptoms of your medical condition if you have low thyroid (hypothyroidism), Addison's disease, benign prostatic hypertrophy (enlarged prostate), gallbladder disease, urethral stricture, decreased function of the adrenal glands, or porphyria. If you have any of these conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin Syndrome: Although rare, severe reactions are possible when codeine is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors, medications used to treat depression. These combinations should be avoided if possible. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, or changes in mental state including delirium and agitation. Coma and death are possible.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. Infants born to mothers who have been taking this medication for long periods of time may experience serious breathing difficulties as well as withdrawal symptoms.

Breast-feeding: This medication passes into breast milk. Some of the codeine dose is converted into morphine by the body once it has been taken. For some people, this change happens much faster than for others. If this happens to a nursing mother, the baby is a risk of receiving a morphine overdose through the breast milk. If you are a breast-feeding mother and are taking brompheniramine - phenylephrine - guaifenesin - codeine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: Children may be more likely to experience severe side effects of medications for cough and cold. As a result, this medication is not recommended for adolescents and children less than 18 years of age.

Seniors: This medication is more likely to cause side effects for those 60 years of age and older. Lower doses may be necessary.

There may be an interaction between brompheniramine - phenylephrine - guaifenesin - codeine and any of the following:

• abiraterone acetate
• acetazolamide
• alcohol
• alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
• amantadine
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• antihistamines (e.g., azelastine, cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine, rupatadine)
• antipsychotics (e.g., cariprazine, chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• apalutamide
• aprepitant
• atomoxetine
• atropine
• "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• barbiturates (e.g., phenobarbital, butalbital)
• benzodiazepines (e.g., diazepam, lorazepam, oxazepam)
• benztropine
• bosentan
• brimonidine
• bromocriptine
• buprenorphine
• bupropion
• butorphanol
• cannabis
• celecoxib
• chloral hydrate
• clarithromycin
• clidinium
• clonidine
• cobicistat
• cocaine
• conivaptan
• darifenacin
• decongestant cold medications (e.g., phenylephrine, pseudoephedrine)
• decongestant eye drops and nose sprays (e.g., naphazoline, oxymetazoline, xylometazoline)
• desmopressin
• dexmethylphenidate
• dextromethorphan
• diltiazem
• dimenhydrinate
• diphenoxylate
• disopyramide
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• domperidone
• donepezil
• dronedarone
• efavirenz
• enzalutamide
• entacapone
• ergot alkaloids (e.g., ergotamine, dihydroergotamine)
• esketamine
• etravirine
• galantamine
• general anesthetics (medications used to put people to sleep before surgery)
• glucagon
• glycopyrrolate
• grapefruit juice
• HIV protease inhibitors (e.g., atazanavir, indinavir, lopinavir, ritonavir, tipranavir)
• ipratropium
• ketotifen
• lithium
• methadone
• methylphenidate
• metoclopramide
• mifepristone
• mirabegron
• mirtazapine
• modafinil
• monoamine oxidase inhibitors (MAOIs; e.g., linezolid, moclobemide, rasagiline, selegiline, tranylcypromine)
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
• nabilone
• nalbuphine
• other narcotic pain relievers (e.g., fentanyl, hydrocodone, morphine, tapentadol, tramadol)
• nitroglycerin
• oxybutynin
• ozanimod
• pegvisomant
• pomalidomide
• potassium chloride
• pramipexole
• pregabalin
• protein kinase inhibitors (e.g., ceritinib, crizotinib, imatinib, nilotinib)
• prucalopride
• quinidine
• rifabutin
• rifampin
• rivastigmine
• ropinirole
• rotigotine
• St. John's wort
• seizure medications (e.g., clobazam, gabapentin, levetiracetam, phenobarbital, phenytoin, primidone, rufinamide, topiramate, valproic acid)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline, vortioxetine)
• somatostatin analogues (e.g., lanreotide, octreotide, pasireotide)
• spironolactone
• tetrabenazine
• theophyllines (e.g., oxtriphylline, theophylline)
• tiotropium
• tolterodine
• trazodone
• tricyclic antidepressants (e.g., amitriptyline, desipramine, nortriptyline)
• trospium
• tryptophan
• umeclidinium
• verapamil
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.