Can I still take pholcodine?

Can I still take pholcodine?

As of 2023, pholcodine-containing medicines are no longer available to buy either over the counter or with a prescription. Well-known products impacted by this recall include Boots Day Cold & Flu Relief Oral Solution, Covonia Dry Cough Sugar Free Formula, Day & Night Nurse Capsules and Galenphol Linctus[1].

But with many of us keeping a well-stocked medicine cupboard for minor illnesses and infections, some people may have a backlog of pholcodine-based medicines already at home. Here, we explain whether or not it’s safe to continue taking these medicines and what your alternative options are.

Is pholcodine safe?

Pholcodine was taken off the market due to concerns over its safety in patients who later go under general anaesthesia. Taking pholcodine can cause a small increase in the risk of such patients experiencing anaphylaxis in response to the neuromuscular blocking agents (NMBAs) contained in general anaesthetic[1]. For this reason, it’s obviously a good idea to avoid pholcodine if you have any surgeries or dental procedures planned. But what if you don’t?

To be clear, there is no evidence to suggest that pholcodine has any other ill effects aside from the increased risk of anaphylaxis when combined with NMBAs. This side effect has only been seen in conjunction with general anaesthetic, not local anaesthetic. However, it’s still recommended that nobody should take pholcodine going forward, to be as safe as possible[1]

Simply put, accidents can happen, no matter how much we’d like them not to. If you have to have emergency surgery, dental or otherwise, you might not be able to alert your doctors that you’ve taken pholcodine before the anaesthetic is applied. It’s far better to use an alternative treatment for your sore throat and dry cough, and avoid the increased risk of anaphylaxis associated with pholcodine.

How long does pholcodine stay in your system?

Up until the product recall, pholcodine-containing medicines were a familiar sight on pharmacy shelves, so many of us will have taken pholcodine at some point. We know that pholcodine can cause adverse reactions when combined with NMBAs, but for how long is that risk increased? 

While the treatment effects of the medicine – i.e. soothing a dry cough – may wear off in hours to days, the actual medicine can sometimes be detected in the body for weeks[2]. Furthermore, the research which prompted the product recall suggests that the risk of anaphylaxis is increased when pholcodine is combined with NMBAs in patients who’ve taken pholcodine as long as 12 months before the surgery. In other words, the effects of taking pholcodine that led to the recall can last for as long as a year after you last took the medication[1].

What to do if you’ve taken pholcodine

The first thing to do if you’ve been taking pholcodine is to stop taking it and, if necessary, find alternative treatment. We’ll outline some options in the next section, but if you need any advice, speaking to a pharmacist is a good idea. If you have a cough medicine at home but you’re not sure whether or not it contains pholcodine, check the ingredients list and patient information leaflet. If you’re still not sure, your pharmacist should be able to help you. 

It can be tempting to use up the last of your pholcodine-based medicines so as not to waste them, but this is definitely not recommended. The safest thing to do is to dispose of them – but that doesn’t mean you can pour syrups down the sink or put your unwanted medications in the bin. Whatever the medication, the best way to dispose of it is to take it to a pharmacy, as they will have access to the facilities and services to correctly dispose of medications without contaminating the environment or risking others’ health. 

For many people, this is all you need to do. But if you’re going into hospital, having dental treatment or seeing your GP, it’s a good idea to mention that you have taken pholcodine so you can make sure they’re aware. Your surgeons will then be able to keep a close eye on your condition and act quicker in the rare event of complications.

Your GP should be able to add the information to your patient notes, so that if for some reason you can’t tell doctors yourself, they should still be able to access the information. If you can remember, it’s good to give doctors a rough estimate of when it was that you last took pholcodine as well. 

Pholcodine alternatives

Pholcodine may have been recalled, but minor illnesses are still around. If your medicine cabinet was full of pholcodine before, you may want to restock with other treatments to fight off throat infections. Fortunately, there are plenty available. 

Medicinal alternatives – i.e. those that contain a specific medication to tackle symptoms and illnesses – include: 

Alternatively, you could try an at-home sore throat remedy. These use ingredients and items many people already have around the home. Because of this, they can be good stop-gap measures if you have a sore throat or cough and don’t have time to head to the shops. Examples include:

  • A hot lemon and honey drink
  • Drinking lots of water
  • Consuming natural infection-fighters such as garlic or cayenne pepper
  • Gargling salt water (not recommended for children)
  • Drinking hot drinks like tea