These individuals convert codeine into its active metabolite, morphine, more rapidly and completely than other people. Attention should be given to the reestablishment of adequate respiratory exchange through provision of a patent airway and institution of assisted or controlled ventilation. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.Sedating drugs may cause confusion and over-sedation in the elderly; elderly patients generally should be started on low doses of Promethazine Hydrochloride and Codeine Phosphate Syrup and observed closely.To report SUSPECTED ADVERSE REACTIONS, contact Hi-Tech Pharmacal Co., Inc. at 1-800-262-9010 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.Nervous System - CNS depression, particularly respiratory depression, and to a lesser extent circulatory depression; light-headedness, dizziness, sedation, euphoria, dysphoria, headache, transient hallucination, disorientation, visual disturbances, and convulsions.Cardiovascular – Tachycardia, bradycardia, palpitation, faintness, syncope, orthostatic hypotension (common to narcotic analgesics).Gastrointestinal – Nausea, vomiting, constipation, and biliary tract spasm. In arriving at a diagnosis, it is important to identify cases where the clinical presentation includes both serious medical illness (e.g., pneumonia, systemic infection, etc.) Data are not available for other ethnic groups. The prevalence of this CYP2D6 phenotype varies widely and has been estimated at 0.5 to 1% in Chinese and Japanese, 0.5 to 1% in Hispanics, 1 to 10% in Caucasians, 3% in African Americans, and 16 to 28% in North Africans, Ethiopians, and Arabs. These higher levels of morphine in breast milk may lead to life-threatening or fatal side effects in nursing babies. Other reported reactions include hyperreflexia, hypertonia, ataxia, athetosis, and extensor-plantar reflexes (Babinski reflex).Stimulation may be evident, especially in children and geriatric patients. It is soluble in water and freely soluble in alcohol. The drug is excreted primarily in the urine, largely as inactive metabolites and small amounts of free and conjugated morphine. Codeine resembles morphine both structurally and pharmacologically, but its actions at the doses of codeine used therapeutically are milder, with less sedation, respiratory depression and gastrointestinal, urinary, and pupillary effects. A paradoxical-type reaction has been reported in children receiving single doses of 75 mg to 125 mg orally, characterized by hyperexcitability and nightmares.Atropine-like signs and symptoms – dry mouth, fixed dilated pupils, flushing, as well as gastrointestinal symptoms may occur.The treatment of overdosage with promethazine and codeine is essentially symptomatic and supportive. A pharmacist can recommend an appropriate measuring device and can provide instructions for measuring the correct dose.Promethazine and codeine may cause marked drowsiness or may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks, such as driving a vehicle or operating machinery. Convulsions may rarely occur. Resuscitation may be required (see ).Limited data suggest that use of promethazine hydrochloride during labor and delivery does not have an appreciable effect on the duration of labor or delivery and does not increase the risk of need for intervention in the newborn.The effect of promethazine and/or codeine on later growth and development of the newborn is unknown.It is not known whether promethazine is excreted in human milk.Codeine is secreted into human milk. A rise in temperature or pulmonary complications may signal the need for institution of antibiotic therapy.Severe hypotension usually responds to the administration of norepinephrine or phenylephrine. Concomitant administration of promethazine products with other respiratory depressants has an association with respiratory depression, and sometimes death, in pediatric patients. Withdrawal signs include irritability, excessive crying, tremors, hyperreflexia, fever, vomiting, and diarrhea. Diazepam may be used to control convulsions. & Articles,All Valid at all major chains including Walgreens, CVS Pharmacy, Target, WalMart Pharmacy, Duane Reade and 65,000 pharmacies nationwide.Codeine Phosphate-Promethazine HCl offers may be in the form of a printable coupon, rebate, savings card, trial offer, or free samples. Despite the common use of codeine products to manage postpartum pain, reports of adverse events in infants are rare. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmias).The diagnostic evaluation of patients with this syndrome is complicated. Promethazine was nonmutagenic in the test system of Ames.A study in rats and rabbits reported no teratogenic effect of codeine administered during the period of organogenesis in doses ranging from 5 to 120 mg/kg. Hallucinations have also been reported.Increased or decreased blood pressure, tachycardia, bradycardia, faintness.Leukopenia, thrombocytopenia, thrombocytopenic purpura, agranulocytosis.Asthma, nasal stuffiness, respiratory depression (potentially fatal) and apnea (potentially fatal).