Uses. This morphine derivative has no officially recognized medical use in the United States. Elsewhere, in countries ranging from Germany to Australia, it is used in dozens of cough remedies and has often been given to children for that purpose. Pholcodine is also a component of preparations used to fight colds and influenza, with effects likened to those of dextromethorphan. Various species of animals tolerate higher doses of pholcodine than codeine, and pholcodine appears safer than codeine in humans. Animal experiments show pholcodine to be an anticonvulsant, unlike morphine, which can worsen convulsions.
The drug has been administered to mice and rats in low daily doses for one to three months without evidence of ill effect. Rats show normal appetite, weight, red and white blood cell counts, and appearance of other body cells.
Drawbacks. Animal studies show pholcodine to depress breathing and heart actions more than codeine does, but impact on those functions has not been noted in humans. Unwanted effects can include sleepiness, nausea, and constipation, but medical doses normally avoid other typical adverse actions associated with opiates. In Scotland accidental poisonings of children who drank a pleasant-tasting cough syrup containing pholcodine became common enough that a call arose to sell the product in child-resistant packaging.
Abuse factors. Pholcodine is one of the few opiates that athletes are allowed to use in Olympic and other sports competitions. The general ban exists not because opiates inherently promote better performance but because their ability to relieve pain can give an athlete an advantage over competitors who are hurting; animal studies show pholcodine to have little value in pain relief.
The substance can still be detected in urine seven weeks after a single dose of cough medicine, a characteristic that can cause positive opiate results for persons undergoing drug screens from employers. Body chemistry slowly breaks down pholcodine into several substances. Some studies find tiny amounts of morphine in breakdown products, but other studies do not. Phol-codine has been described as unable to cause euphoria, a lack that reduces its abuse potential. No tolerance has been observed among patients using the substance every day for months. Experiments looking for dependence find none. Tests for cross-tolerance with morphine produce negative results in humans. One scientific review of pholcodine describes it as having no addiction potential, a view supported by UN drug control authorities. A World Health Organization committee characterizes the drug as having no more addiction potential than codeine. U.S. government officials have ruled that pholcodine is extremely prone to abuse and list the drug as a Schedule I controlled substance.
Drug interactions. Not enough scientific information to report.
Cancer. Not enough scientific information to report.
Pregnancy. Birth defects have not been associated with the substance. A study of women who used pholcodine during pregnancy found no impact on infants. In Europe the drug has been classified as safe for use in pregnancy, but in the United States the drug is not recommended for pregnant women; safety for use during pregnancy has not been established. The substance passes into human milk, and nursing infants are supposed to be watched for signs of drug effects.
Additional scientific information may be found in:
Cahen, R. "The Pharmacology of Pholcodine." Bulletin on Narcotics 13 no. 2 (1961): 19-37.
Findlay, J.W. "Pholcodine." Journal of Clinical Pharmacy and Therapeutics 13 (1988): 5-17.
"Pholcodine." In Therapeutic Drugs, ed. C. Dollery. 2d ed. New York: Churchill Livingstone, 1999. P115-P116.
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