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Palliative cancer care - cough - Management
What general information about pholcodine should I be aware of?
- If the person is already taking a strong opioid such as morphine, do not try a weak opioid such as pholcodine. Instead an 'as required' dose of morphine solution should be used to relieve cough and, if this is beneficial, continue to use in this way, or increase the regular morphine dose [Twycross et al, 2002]. The 'as required' dose is a sixth of the total daily dose of regular morphine.
- Pholcodine Linctus BP 10 mg may be taken three to four times a day for symptomatic relief of unproductive coughs. Sugar-free brands are available where preferred, and for people with diabetes.
- The adverse effects usually associated with opioids (e.g. constipation) are rarely reported, as pholcodine is such a weak opioid. However, it has mild sedative properties and so people should be warned to avoid activities where drowsiness may be detrimental.
- If pholcodine (or codeine) is ineffective, switch to morphine solution 5 mg to 10 mg every 4 hours and 'as required'.
[ABPI Medicines Compendium, 2003; BNF 53, 2007]
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