Consumer Information for: COPHYLAC

Consumer Information

Information about the product including what the product is used for, dosage, warnings, proper use and side effects. This summary will not tell you everything about the product. Contact your healthcare professional if you have any questions about the product.


What the medication is used for

COPHYLAC® is used for the temporary relief of cough associated with inflamed mucosa, which does not respond to products of lesser potency.

COPHYLAC® is not for use in patients younger than 18 years of age. In patients this age, the risks of life-threatening breathing problems outweigh the benefits of treatment.

What it does

Normethadone hydrochloride (HCl) and p-hydroxyephedrine hydrochloride (HCl) drops act on the brain to supress cough.

When it should not be used

Do not use COPHYLAC® if:

  • Your doctor did not prescribe it for you
  • You are allergic to normethadone HCl or p-hydroxyephedrine HCl or to any of the other ingredients in COPHYLAC®
  • You have severe asthma, trouble breathing, or other breathing problems
  • You have bowel blockage or narrowing of the stomach or intestines
  • You have a head injury
  • You are at risk for having seizures
  • You have diabetes
  • You have heart or thyroid problems
  • You have glaucoma
  • You have a brain tumor
  • You suffer from alcoholism
  • You are taking or have taken within the past 2 weeks a Monoamine Oxidase inhibitor (MAOi) (such as phenelzine sulphate, tranylcypromine sulphate, moclobemide or selegiline)
  • are pregnant or planning to become pregnant or you are in labour
  • are breastfeeding. The use of normethadone-containing products while breast-feeding may harm your baby. If you breastfeed and take COPHYLAC®, seek immediate medical care for your baby if they are overly drowsy, sedated, have difficulty breast-feeding, have breathing difficulties, or are floppy (have decreased muscle tone). This is very serious for the baby and can lead to death. Tell the baby’s doctor that you are breastfeeding and took COPHYLAC®
What the medicinal ingredient is

Medicinal ingredients: Normethadone HCl and p-hydroxyephedrine HCl.

What the non-medicinal ingredients are

Non-medicinal ingredients: Citric acid anhydrous, glycerine, lemon oil, methylparaben and purified water.

What dosage form it comes in

Sugar free solution (drops) containing 1% normethadone HCl and 2% p-hydroxyephedrine HCl.

Warnings and precautions

Serious Warnings and Precautions

  • Even if you take COPHYLAC® as prescribed you are at a risk for opioid addiction, abuse and misuse. This can lead to overdose and death.
  • You may get life-threatening breathing problems while taking COPHYLAC®. This is less likely to happen if you take it as prescribed by your doctor. Babies are at risk of life-threatening breathing problems if their mothers take opioids while pregnant or nursing.
  • You should never give anyone your COPHYLAC®. If a person has not been prescribed COPHYLAC®, they could die from taking it. This is especially true for children.
  • If you took COPHYLAC® while you were pregnant, whether for short or long periods of time or in small or large doses, your baby can suffer life-threatening withdrawal symptoms after birth. This can occur in the days after birth and for up to 4 weeks after delivery. If your baby has any of the following symptoms:
    • has changes in their breathing (such as weak, difficult or fast breathing)
    • is unusually difficult to comfort
    • has tremors (shakiness)
    • has increased stools, sneezing, yawning, vomiting, or fever
    Seek immediate medical help for your baby.
  • Taking COPHYLAC® with other opioid medicines, benzodiazepines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, decreased awareness, breathing problems, coma, and death.

To help avoid side effects and ensure proper use, talk to your healthcare professional before you take COPHYLAC®. Talk about any health conditions or problems you may have, including if you:

  • have a history of illicit or prescription drug or alcohol abuse
  • have severe kidney or lung disease
  • have low blood pressure
  • have past or current depression
  • suffer from chronic or severe constipation
  • have persistent or chronic cough (as occurs with smoking), high blood pressure
  • have problems with your adrenal or prostate gland
  • have, or had in the past hallucinations or other severe mental problems
  • or under a physician’s care

Other warnings you should know about:

Stop taking COPHYLAC® and seek immediate medical help if you start feeling confused, have shallow breathing, or extreme sleepiness.

Stop taking COPHYLAC® and consult with your healthcare professional if:

  • you get a high fever, rash or persistent headache along with the cough.
  • your symptoms or cough worsen.

These could be signs of a serious condition.

Opioid dependence and addiction: There are important differences between physical dependence and addiction. It is important that you talk to your doctor if you have questions or concerns about abuse, addiction or physical dependence.

Breathing problems: COPHYLAC® is not recommended for anyone who has or is at risk for breathing problems such as:

  • lung infections, or respiratory conditions
  • neuromuscular disorders
  • severe heart problems
  • recent multiple traumas or extensive surgical procedures

Pregnancy, nursing, labour and delivery:
Do not use COPHYLAC® while pregnant, nursing, during labour or delivery. Opioids can be transferred to your baby through breast milk, or while still in the womb. COPHYLAC® can then cause life-threatening breathing problems in your unborn baby or nursing infant.

If you are pregnant and are taking COPHYLAC®, it is important that you don’t stop taking your medication all of a sudden. If you do, it can cause a miscarriage or a still-birth. Your doctor will monitor and guide you on how to slowly stop taking COPHYLAC®. This may help avoid serious harm to your unborn baby.

Driving and using machines: Before you do tasks, which may require special attention, you should wait until you know how you react to COPHYLAC®. COPHYLAC® can cause:

  • drowsiness
  • dizziness or
  • lightheadedness

This can usually occur after you take your first dose and when your dose is increased.

Disorder of the adrenal gland: You may develop a disorder of the adrenal gland called adrenal insufficiency. This means that your adrenal gland is not making enough of certain hormones. You may experience symptoms such as:

  • nausea, vomiting
  • feeling tired, weak or dizzy
  • decreased appetite

You may be more likely to have problems with your adrenal gland if you have been taking opioids for longer than one month. Your doctor may do tests, give you another medication, and slowly take you off COPHYLAC®.

Serotonin Syndrome: Normethadone, the ingredient in COPHYLAC® can cause Serotonin Syndrome, a rare but potentially life-threatening condition. It can cause serious changes in how your brain, muscles and digestive system work. You may develop Serotonin Syndrome if you take COPHYLAC® with certain anti-depressants or migraine medications.

Serotonin Syndrome symptoms include:

  • fever, sweating, shivering, diarrhea, nausea, vomiting;
  • muscle shakes, jerks, twitches or stiffness, overactive reflexes, loss of coordination;
  • fast heartbeat, changes in blood pressure;
  • confusion, agitation, restlessness, hallucinations, mood changes, unconsciousness, and coma.

Sexual Function/Reproduction: Long term use of opioids may lead to a decrease in sex hormone levels. It may also lead to low libido (desire to have sex), erectile dysfunction or being infertile.

Interactions with this medication

Tell your healthcare professional about all the medicines you take, including any drugs, vitamins, minerals, natural supplements or alternative medicines.

The following may interact with COPHYLAC®:

  • Alcohol. This includes prescription and non-prescription medications that contain alcohol. Do not drink alcohol while you are taking COPHYLAC®. It can lead to:
    • drowsiness
    • unusually slow or weak breathing
    • serious side effects or
    • a fatal overdose
  • other sedative drugs which may enhance the drowsiness caused by COPHYLAC®
  • opioid analgesics (drugs used to treat pain)
  • general anesthetics (drugs used during surgery)
  • benzodiazepines (drugs used to help you sleep or that help reduce anxiety) antidepressants (for depression and mood disorders). Do not take COPHYLAC® with MAO inhibitors (MAOi) or if you have taken MAOi’s in the last 14 days.
  • drugs used to treat serious mental or emotional disorders (such as schizophrenia)
  • antihistamines (drugs used to treat allergies)
  • anti-emetics (drugs used to prevent vomiting)
  • drugs used to treat muscle spasms and back pain
  • some heart medications (such as beta blockers)
  • drugs used to treat migraines (e.g. triptans)
  • St. John’s Wort
Proper use of this medication

COPHYLAC® may be taken plain with sugar or in any beverage, preferably after breakfast and at bedtime.

  • Your doctor will prescribe the lowest dose that works to control your symptoms.
  • Higher doses can lead to more side effects and a greater chance of overdose.

Usual Dose

Be sure to follow your doctor’s dosing instructions exactly. Do not increase or decrease your dose without consulting your doctor.

Your doctor will prescribe the lowest dose that works to control your cough. Higher doses can lead to more side effects and a greater chance of overdose. Review your symptoms regularly with your doctor to determine if you still need COPHYLAC®. Be sure to use COPHYLAC® only for the condition for which it was prescribed.

If you develop any side effect as a result of taking COPHYLAC®, tell your doctor immediately.

Adults: The recommended dosage is 15 drops twice daily.

Stopping your Medication

If you have been taking COPHYLAC® for more than a few days, you should not stop taking it all of a sudden. Your doctor will monitor and guide you on how to slowly stop taking COPHYLAC®. You should do it slowly to avoid uncomfortable symptoms such as having:

  • body aches
  • diarrhea
  • goosebumps
  • loss of appetite
  • nausea
  • feeling nervous or restless
  • runny nose
  • sneezing
  • tremors or shivering
  • stomach cramps
  • rapid heart rate (tachycardia)
  • having trouble sleeping
  • an unusual increase in sweating
  • heart palpitations
  • an unexplained fever
  • weakness
  • yawning

By reducing or stopping your opioid treatment, your body will become less used to opioids. If you start treatment again, you will need to start at the lowest dose. You may overdose if you restart at the last dose you took before you slowly stopped taking COPHYLAC®.

Refilling your Prescription for COPHYLAC®:

A new written prescription is required from your doctor each time you need more COPHYLAC®. Only obtain prescriptions for this medicine from the doctor in charge of your treatment. Do not seek prescriptions from other doctors unless you switch to another doctor.

Overdose

If you think you have taken too much COPHYLAC®, contact your healthcare professional, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms.

Signs of overdose may include:

  • unusually slow or weak breathing
  • dizziness
  • confusion
  • extreme drowsiness

Missed Dose

If you missed a dose of this medication, take it as soon as you remember. But if it is almost time for your next dose, skip the missed dose and continue with your next scheduled dose. Go back to the regular dosing schedule. Do not take two doses at the same time. If you miss several doses in a row, talk to your doctor before restarting your medication.

Side effects and what to do about them

These are not all the possible side effects you may feel when taking COPHYLAC®. If you experience any side effects not listed here, contact your healthcare professional. Side effects may include:

  • Drowsiness
  • Insomnia
  • Dizziness
  • Fainting
  • Nausea, vomiting, or a poor appetite
  • Dry mouth
  • Headache
  • Problems with vision
  • Weakness, uncoordinated muscle movement
  • Itching
  • Light headedness
  • Sweating
  • Constipation
  • Low sex drive, impotence (erectile dysfunction), infertility

Talk with your doctor or pharmacist about ways to prevent constipation when you start using COPHYLAC®

Serious side effects and what to do about them
Symptom / effect Talk to your healthcare professional Only if severe Talk to your healthcare professional In all cases Stop taking drug and get immediate medical help
Rare
Overdose: hallucinations, confusion, inability to walk normally, slow or weak breathing, extreme sleepiness, sedation, or dizziness, floppy muscles/low muscle tone cold and clammy skin    
Respiratory Depression:
Slow, shallow or weak breathing
   
Allergic Reaction: rash, hives, swelling of the face, lips, tongue or throat, difficulty swallowing or breathing    
Bowel Blockage (impaction):
abdominal pain, severe constipation, nausea
   
Withdrawal: nausea, vomiting, diarrhea, anxiety, shivering, cold and clammy skin, body aches, loss of appetite, sweating    
Fast, Slow or Irregular Heartbeat: heart palpitations    
Low Blood Pressure: dizziness, fainting, lightheadedness    
Serotonin Syndrome: a reaction which may cause feelings of agitation or restlessness, flushing, muscle twitching, involuntary eye movements, heavy sweating, high body temperature (>38°C ), or rigid muscles    

If you have a troublesome symptom or side effect that is not listed here or becomes bad enough to interfere with your daily activities, talk to your healthcare professional.

How to store
  • Keep unused or expired COPHYLAC® in a secure place to prevent theft, misuse or accidental exposure to children and pets.
  • Keep COPHYLAC® out of sight and reach of children and pets.
  • Never take medicine in front of small children as they will want to copy you. Accidental ingestion by a child is dangerous and may result in death. If a child accidentally takes COPHYLAC®, get emergency help right away.
  • Store at room temperature (15-30ºC).

Disposal:

COPHYLAC® should never be thrown into household trash, where children and pets may find it. It should be returned to a pharmacy for proper disposal.

Reporting side effects

You can report any suspected side effects associated with the use of health products to Health Canada by:

NOTE: Contact your health professional if you need information about how to manage your side effects. The Canada Vigilance Program does not provide medical advice.

More information

If you want more information about COPHYLAC®:

This leaflet was prepared by Bausch Health, Canada Inc.

Last revised: June 24, 2020