Cautions Inhalation solution , levomenthol 7.9%, with chloro- see notes above and section 4.7.2 butanol, pine oils, terpineol, and thymol, net price 12-

3 Cautions Inhalation solution , levomenthol 7.9%, with chloro- see notes above and section 4.7.2 butanol, pine oils, terpineol, and thymol, net price 12-

Contra-indications see section 4.7.2 mL dropper bottle = £1.90

Side-effects see section 4.7.2 Dose express into handkerchief or add to a pint of hot, not

boiling, water the contents of 1 capsule or 6 drops of solution;

1 Codeine Linctus, BP A avoid in infants under 3 months

Linctus (= oral solution), codeine phosphate 15 mg/

5 mL. Net price 100 mL = 62p (diabetic, 34p) Brands include Galcodine

Dose 5–10 mL 3–4 times daily; CHILD (but not generally recom- mended) 5–12 years, 2.5–5 mL

3.9 Codeine Linctus formulated with a vehicle appropriate for

Note Cough preparations BP directs that when Diabetic Codeine Linctus is prescribed,

administration to diabetics, whether or not labelled ‘Diabetic Codeine Linctus’, shall be dispensed or supplied

3.9.1 Cough suppressants

1. Can be sold to the public provided the maximum single dose

3.9.2 Expectorant and demulcent cough

does not exceed 5 mL

preparations Codeine Linctus, Paediatric, BP

Linctus (= oral solution), codeine phosphate 3 mg/

5 mL. Net price 100 mL = 18p Brands include Galcodine Paediatric (sugar-free)

Dose CHILD 3.9.1 (but not generally recommended) 2–5 years 5 mL 3– Cough suppressants

4 times daily Note BP directs that Paediatric Codeine Linctus may be prepared

Cough may be a symptom of an underlying disorder, extemporaneously by diluting Codeine Linctus with a suitable such as asthma (section 3.1.1), gastro-oesophageal

vehicle in accordance with the manufacturer’s instructions reflux disease (section 1.1), or rhinitis (section 12.2.1),

which should be addressed before prescribing cough Other preparations suppressants. Cough may be a side-effect of another

Tablets, syrup, and injection section 4.7.2 drug, such as an ACE inhibitor (section 2.5.5.1), or it can

be associated with smoking or environmental pollutants. Cough can also have a significant habit component.

PHOLCODINE

When there is no identifiable cause, cough suppressants Indications dry or painful cough may be useful, for example if sleep is disturbed. They

may cause sputum retention and this may be harmful in see under Codeine Phosphate patients with chronic bronchitis and bronchiectasis.

Cautions

Contra-indications see under Codeine Phosphate Side-effects see under Codeine Phosphate

Codeine may be effective but it is constipating and can cause dependence; dextromethorphan and phol-

Pholcodine Linctus, BP

codine have fewer side-effects. Linctus (= oral solution), pholcodine 5 mg/5 mL in a Sedating antihistamines are used as the cough sup-

suitable flavoured vehicle, containing citric acid pressant component of many compound cough prepara-

monohydrate 1%. Net price 100 mL = 43p Brands include Pavacol-D (sugar-free), Galenphol

tions on sale to the public; all tend to cause drowsiness (sugar-free) Dose 5–10 mL 3–4 times daily; CHILD (but not generally recom- which may reflect their main mode of action.

mended, see notes above) 5–12 years 2.5–5 mL

BNF 57

3.9.2 Expectorant and demulcent cough preparations 181

Pholcodine Linctus, Strong, BP

Demulcent cough preparations contain soothing sub- Linctus (= oral solution), pholcodine 10 mg/5 mL in a

stances such as syrup or glycerol and some patients suitable flavoured vehicle, containing citric acid

believe that such preparations relieve a dry irritating monohydrate 2%. Net price 100 mL = 35p

cough. Preparations such as simple linctus have the Dose

5 mL 3–4 times daily advantage of being harmless and inexpensive; paed- Brands include Galenphol

iatric simple linctus is particularly useful in children. Galenphol c (Thornton & Ross)

Compound preparations are on sale to the public for Paediatric linctus (= oral solution), orange, sugar-

the treatment of cough and colds but should not be used free, pholcodine 2 mg/5 mL. Net price 90-mL pack =

in children under 2 years; the rationale for some is £1.11

dubious. Care should be taken to give the correct dose Dose CHILD (but not generally recommended, see notes above) 2–5 years 5–10 mL 3 times daily; 6–12 years 10 mL 3 times daily

and to not use more than one preparation at a time, see MHRA/CHM advice, p. 180.

Ammonia and Ipecacuanha Mixture, BP

Mixture , ammonium bicarbonate 200 mg, liquorice Diamorphine and methadone have been used to control

Palliative care

liquid extract 0.5 mL, ipecacuanha tincture 0.3 mL, distressing cough in terminal lung cancer although mor-

concentrated camphor water 0.1 mL, concentrated phine is now preferred (see p. 16). In other circum-

anise water 0.05 mL, double-strength chloroform stances they are contra-indicated because they induce

water 5 mL, water to 10 mL. It should be recently sputum retention and ventilatory failure as well as

prepared

causing opioid dependence. Methadone linctus should Dose ADULT and CHILD over 12 years, 10–20 mL up to 4 times

be avoided because it has a long duration of action and daily tends to accumulate.

Simple Linctus, BP

Linctus (= oral solution), citric acid monohydrate