Cheratussin AC syrup is an over-the-counter cough medicine that contains the active ingredients guaifenesin and codeine. Guaifenesin is an expectorant that helps thin mucus and make coughs more productive. Codeine is an opioid that works as a cough suppressant by depressing the cough reflex in the brain. So while cheratussin AC does contain an opioid component, it is combined with an expectorant and is formulated specifically for relief of cough symptoms.
What is cheratussin AC syrup?
Cheratussin AC syrup is an over-the-counter medication used to treat coughs caused by minor throat and bronchial irritation. The “AC” in the name stands for the two active ingredients:
- Guaifenesin – an expectorant that helps thin mucus secretions and make coughs more productive
- Codeine – an opioid cough suppressant that depresses the urge to cough
In each 5mL dose of cheratussin AC there is 100mg of guaifenesin and 10mg of codeine. The guaifenesin helps loosen mucus so it can be coughed up more easily. The codeine acts on the cough reflex in the brain to reduce coughing.
Other inactive ingredients in cheratussin AC include:
- Purified water
The syrup is available over-the-counter in 4 and 8 ounce bottles. It is approved for use in adults and children over 12 years old.
Is codeine an opioid?
Yes, codeine is considered an opioid drug. Specifically, it is classified as an opiate analgesic that is derived from morphine.
Codeine works by binding to opioid receptors in the brain and spinal cord. This blocks pain signals and activates the brain’s reward system producing analgesic (pain-relieving) effects. It also depresses the cough reflex in the medulla oblongata region of the brainstem.
Like morphine, codeine can produce feelings of euphoria and relaxation in addition to cough suppression and analgesia. For this reason it carries a risk of misuse and addiction. However, codeine is considered a weaker opioid with lower potency compared to more powerful opioids like oxycodone or fentanyl.
The World Health Organization classifies codeine as a Class II opioid. Other well-known opioids in this category include hydrocodone, oxycodone and fentanyl.
So in summary:
- Codeine is derived from morphine and shares similar effects
- It binds to opioid receptors and alters pain signaling and perception
- It has analgesic, cough suppressant, and euphoric properties typical of opioids
- The WHO classifies it as a “Class II Opioid” along with other potent pain medications
Therefore, yes codeine is considered an opioid drug.
Is cheratussin AC considered an opioid medication?
Cheratussin AC contains codeine, which qualifies it as an opioid-containing cough syrup. However, the codeine dosage is relatively low at just 10mg per 5mL dose. It is combined with a 100mg dose of guaifenesin expectorant in a formulation optimized for cough relief, not analgesia.
For these reasons, cheratussin AC is not considered an opioid in the same sense as prescription pain medications. Some key differences include:
- Lower codeine content – 10mg vs 30-60mg in many opioid pain pills
- Contains expectorant – guaifenesin has cough-relieving properties
- Cannot be used to get high in the same way as other opioids
- Produces less euphoria due to lower codeine dosage
- Comes in syrup form, discouraging misuse
- Approved for over-the-counter sale for coughs
- Not intended for chronic pain management
The FDA classifies cheratussin AC as an antitussive (cough suppressant) containing codeine rather than a potent opioid painkiller. While it does technically contain an opioid in the form of codeine, its formulation, dosage, and intended use differs significantly from Schedule II opioids that carry a high risk of addiction and abuse.
So in summary – while cheratussin AC syrup does contain codeine, it is not considered an abusable opioid due to its low codeine content, inclusion of guaifenesin, and intended use for coughs rather than pain management or recreational abuse. It has significantly less potential for misuse than other codeine-containing medications.
What are the side effects of cheratussin AC syrup?
The most common side effects of cheratussin AC include:
- Stomach pain
- Dry mouth
- Difficulty urinating
These effects typically occur as a result of the codeine component. Codeine is able to cross the blood-brain barrier and interact with opioid receptors in the brain, which can lead to drowsiness, cognitive impairment, and gastrointestinal effects like nausea and constipation.
Less common side effects of cheratussin AC may include:
- Allergic reaction – itching, rash, swelling, breathing problems
- Severe dizziness or drowsiness
- Mood changes or confusion
- Slurred speech
These require prompt medical care. Mild codeine overdose can also result in dangerously slowed breathing. Seek emergency help if someone taking cheratussin AC has very slow, shallow breathing or seems excessively sleepy or unarousable.
To reduce side effects, use the smallest effective dose for the shortest duration needed. Avoid alcohol and sedatives when taking cheratussin AC syrup due to excessive drowsiness. Those with respiratory conditions like asthma or COPD may be more sensitive to respiratory depression from codeine. Overall, side effects should be minimal when used at recommended OTC doses. But they demonstrate codeine’s opioid effects on the brain and body.
Does cheratussin AC get you high?
The codeine in cheratussin AC syrup does have the ability to produce slight feelings of euphoria or relaxation due to its opioid effects on the brain. However, at the standard over-the-counter dosage of 10mg per 5mL, its psychoactive effects are relatively mild. The cough-suppressing effects typically predominate.
Higher doses may provide more pronounced pain relief, sedation, and mild euphoria similar to other opioids. But the large volume of syrup required makes intentional abuse and overdose highly unlikely.
Some key factors that limit recreational abuse potential include:
- Low codeine content – 10mg is sub-therapeutic for analgesia
- Unpleasant taste and need to ingest large volumes
- Significant GI side effects with excessive intake like nausea
- Presence of guaifenesin does not enhance high
- Cough suppression counters recreational value
Attempting to consume the multiple ounces of syrup required to produce intoxication would likely result in vomiting, not euphoria.
So while the opioid effects of codeine present at higher doses can technically result in mild euphoria or relaxation, cheratussin AC syrup is very unlikely to be abused for recreational use. The high volume, unpleasant taste, likelihood of vomiting, relatively low codeine content, and lack of pain relief diminish any potential desirability for misuse. It is not considered an abusable opioid formulation.
Is cheratussin AC a controlled substance?
No, cheratussin AC is not classified as a controlled substance in the United States. It is regulated as an over-the-counter (OTC) medication that does not require a prescription or pharmacist dispensing.
Controlled substances are drugs and chemicals that are tightly regulated by the DEA under the Controlled Substances Act. Drugs are placed on one of five schedules based on their potential for addiction and abuse:
- Schedule 1 – High abuse potential, no medical use
- Schedule 2 – High abuse potential but some medical use
- Schedule 3-5 – Lower abuse potential
Many opioids like morphine, fentanyl, oxycodone and hydrocodone are categorized as Schedule II controlled substances.
While cheratussin AC does contain the Schedule II opioid codeine, it is exempt from controlled substance status for the following reasons:
- Low codeine content (10mg per dose)
- Cannot be easily extracted or concentrated
- Formulated specifically for coughs
- Contains guaifenesin expectorant
- Unpleasant taste deters abuse
- High volumes required for intoxication
- OTC status since 1984
The exemption allows cheratussin AC to be sold without the strict storage, prescribing, dispensing and record-keeping requirements applied to scheduled codeine preparations intended for analgesic or recreational use.
So while it contains an opioid component, cheratussin AC syrup is not classified as a controlled substance or scheduled medication. Its OTC status reflects the low risk of misuse and abuse in the formulated cough syrup preparation.
Is a prescription required for cheratussin AC?
No, as an over-the-counter (OTC) medication, cheratussin AC syrup does not require a prescription. It can be purchased directly off store shelves without physician authorization.
Some key reasons cheratussin AC is available OTC include:
- Low codeine concentration (10mg per 5mL)
- Cannot be extracted or concentrated easily
- Added expectorant (guaifenesin)
- Unpleasant taste deters abuse
- High volume required for intoxication
- FDA approved as safe for OTC use
The FDA determined that the balance of risks versus benefits allowed cheratussin AC to be used safely without physician monitoring or prescription control.
While prescription opioids like Vicodin contain higher codeine doses and require strict prescribing, the low 10mg codeine content and co-formulation with guaifenesin in cheratussin AC enables over-the-counter availability.
There are also no age restrictions on purchasing cheratussin AC. While intended for adults and children over 12, state laws do not prohibit minors from buying the cough syrup without a prescription.
One exception is that some states may restrict sale of dextromethorphan (DXM)-containing cough syrups to minors to prevent recreational DXM abuse. But cheratussin AC syrup formulations do not contain DXM.
So in summary – cheratussin AC can be purchased OTC without any prescription requirement or age restrictions. Its modest codeine content and cough-suppressant formulation allow self-medication for cough symptoms without physician oversight.
What are the regulations around codeine medications?
Codeine regulations differ substantially depending on the specific formulation and intended use of the medication. Some key codeine regulatory issues include:
Prescription vs OTC formulations
Codeine is available in some prescription-only pain relievers and cough/cold medications. Common examples include Tylenol #3 (codeine/acetaminophen), Tylenol #4 (codeine/acetaminophen/caffeine), and codeine linctus cough syrup. These higher dose codeine formulations usually require prescriptions and may have dispensing restrictions.
In contrast, products like cheratussin AC syrup contain lower OTC-appropriate doses of codeine and do not require physician authorization.
Controlled substance classification
Many codeine analgesic and anti-tussive formulations are classified as Schedule II or III controlled substances. This includes codeine tablets, solutions over 1.8mg/mL, and non-exempt codeine cough syrups. Extra security requirements, prescribing limits, and record keeping apply to these scheduled codeine products.
Cheratussin AC is exempt from controlled substance status due to its low codeine dose, OTC formulation, and co-ingredients that deter misuse.
Some states further restrict codeine sale and dispensing beyond federal regulations:
- Prescription-only laws in select states like New York
- Pharmacist dispensing restrictions for OTC codeine products
- Limits on volume or duration of OTC codeine sales
- Age restrictions for purchase in a few states
So codeine regulation occurs at both the federal and state levels based on formulation, strength, scheduling status, and jurisdictions’ perceived abuse potential. The lower-dose cheratussin AC retains OTC status nationally but some additional state restrictions may apply to its sale.
In summary, cheratussin AC does contain the opioid codeine as an active ingredient. However, the relatively low codeine dose, presence of the expectorant guaifenesin, concentration in syrup form, and FDA-approved OTC status means it is not considered to have high abuse or overdose potential. While containing an opioid component, cheratussin AC syrup is specially formulated, dosed, and packaged to enable safe, effective, over-the-counter short-term relief of cough symptoms without the risks associated with higher-dose prescription opioid medications.