pholcodine

Last edited 03/2023 and last reviewed 05/2023

Pholcodine is an antitussive, given to treat dry or painful cough.

Pholcodine is an opioid medicine approved in adults and children older than 6 years of age to treat non-productive (dry) cough and, in combination with other active substances, for the treatment of symptoms of cold and influenza:

• reviews have examined the link between prior use of pholcodine and an increased risk of anaphylaxis during general anaesthesia involving neuromuscular blocking agents (NMBAs)
• has been a decision for the withdrawal of pholcodine from UK market as a precautionary measure (1)

• pholcodine-containing cough and cold medicines are being withdrawn from the UK market as a precaution following a review which found that their benefits do not outweigh the increased risk of the very rare event of anaphylaxis to neuromuscular blocking agents (NMBAs) used in general anaesthesia
• ask patients scheduled to undergo general anaesthesia involving NMBAs whether they have used pholcodine-containing medicines, particularly in the past 12 months, and maintain awareness about the potential for perianaesthetic anaphylaxis related to NMBAs
• do not dispense or sell pholcodine-containing medicines
  • consider recommending appropriate treatment alternatives for patients who present with a new dry cough or who are currently taking pholcodine
• pharmacies should follow the MHRA Class 2 Medicines Recall Notice to quarantine stock of pholcodine-containing medicines and return it to the manufacturer
• report suspected adverse drug reactions to the Yellow Card scheme

Reference:

• Drug Safety Update volume 16, issue 8: March 2023: 1