Promethazine W. Codeine

Risk of life-threatening respiratory depression and death related to ultra-rapid metabolizers of codeine (esp. in children for post-tonsillectomy and/or adenoidectomy pain). Avoid in adolescents 12–18yrs with conditions associated with hypoventilation (eg, post-op status, obstructive sleep apnea, obesity, severe pulmonary disease, neuromuscular disease, concomitant drugs that cause respiratory depression). Head injury, intracranial lesions or pre-existing increase in intracranial pressure. Avoid in chronic respiratory disease, acute febrile illness with productive cough, compromised respiratory function (eg, COPD, sleep apnea). Discontinue if neuroleptic malignant syndrome (NMS) occurs. Seizure disorders. Bone marrow depression. Acute abdomen. Fever. Hypothyroidism. Addison's disease. Ulcerative colitis. Prostatic hypertrophy. Recent GI or urinary tract surgery. Narrow-angle glaucoma. Stenosing peptic ulcer. Pyloroduodenal or bladder-neck obstruction. Dehydration. Avoid prolonged sun exposure. Severe hepatic or renal impairment. Ultra-rapid metabolizers (due to CYP2D6 polymorphism): avoid. Atopic children. Elderly. Debilitated. Labor & delivery. Pregnancy (Cat.C). Nursing mothers: not recommended.