pholcodine monohydrate: clinical use

Prescribing considerations

• Do not prescribe, dispense or sell pholcodine-containing products; all were withdrawn from the UK market in March 2023.
• Ask patients undergoing general anaesthesia about previous exposure, particularly during the preceding 12 months.
• Historical use was limited to dry, non-productive cough; cough suppression can cause sputum retention when secretions are present.

Contraindications and cautions

• Historical product-specific contraindications included liver failure, respiratory failure or risk of it, acute asthma attack, MAOI treatment or recent cessation, and hypersensitivity to ingredients.
• Selected SmPCs contraindicated use in chronic bronchitis, COPD, bronchiolitis or bronchiectasis because of sputum retention.
• Age restrictions differed by formulation: selected adult products excluded children under 12, while a selected paediatric product excluded children under 6.

Monitoring

• For general anaesthesia involving neuromuscular blocking agents, document relevant previous exposure and maintain vigilance for perianaesthetic anaphylaxis.
• After accidental or retained-stock use, assess sedation, respiratory status, sputum retention, hypersensitivity and severe skin reactions as clinically indicated.

Clinical pharmacology

A centrally acting opioid-derived antitussive that suppresses the cough reflex. Selected SmPCs did not provide specific pharmacokinetic data.

Formulation and product differences

• Covonia Dry Cough Sugar Free Formula was a viscous brown oral solution containing parabens and propylene glycol.
• Galenphol Linctus was a viscous red oral solution containing ethanol, amaranth dye and parabens.
• Galenphol Paediatric Linctus was a viscous orange oral liquid containing ethanol, sunset yellow dye and parabens; it was historically licensed for ages 6–12 years.