chlorpheniramine and hydrocodone, Tussionex
Eni Williams, PharmD, PhD
Eni Williams, PharmD, PhD
Dr. Eni Williams graduated from Creighton University in 1988 with a B.S. degree in pharmacy and a Doctor of Pharmacy from Howard University in 1994. She also obtained a Ph.D. in Public Policy in 2009 at the University of Maryland, Baltimore County.
Medical and Pharmacy Editor:
GENERIC NAME: chlorpheniramine and hydrocodone
BRAND NAME: Tussionex
DRUG CLASS AND MECHANISM: Tussionex is a combination of an antihistamine that blocks allergic reactions and reduces the production of mucus (chlorpheniramine), and a narcotic that relieves pain and cough (hydrocodone). Tussionex is a liquid that slowly releases the chlorpheniramine and hydrocodone after it is ingested.
GENERIC AVAILABLE: Yes
PREPARATIONS: Liquid suspension. Each teaspoonful (5 ml) contains chlorpheniramine, 8 mg and hydrocodone, 10 mg.
STORAGE: The suspension should be stored at room temperature, between 15-30 C (59-86 F).
DOSING: The usual dose is 2.5 ml (1/2 teaspoon) to 5 ml (1 teaspoonful) twice daily. The suspension should be shaken prior to each use.
DRUG INTERACTIONS: Chlorpheniramine (although not generally sedating itself) and hydrocodone both add to the sedating effects of alcohol and other drugs that can cause sedation such as the benzodiazepine class of anti-anxiety drugs (for example, diazepam [Valium], lorazepam [Ativan], clonazepam [Klonopin], alprazolam [Xanax]); the narcotic class of pain medications and its derivatives (for example, oxycodone and acetaminophen [Percocet], hydrocodone/acetaminophen [Vicodin], Dilaudid, codeine, propoxyphene [Darvon]); the tricyclic class of antidepressants (for example, amitriptyline [Elavil, Endep], imipramine [Tofranil], desipramine [Norpramin]); the antipsychotic class of drugs (for example, thioridazine (Mellaril), triflupromazine (Stelazine)]; and certain antihypertensive medications (for example, clonidine [Catapres], propranolol [Inderal]).
Chlorpheniramine also can intensify the drying effects (due to decreased production of mucus) of other medications with anticholinergic properties (for example, dicyclomine [Bentyl], bethanechol [Urecholine], Probanthine).
PREGNANCY: Antihistamines are typically not recommended for use in pregnancy, especially during the third trimester, because of a risk of seizures in the fetus. The risk for depressed breathing in the newborn infant when the mother ingests hydrocodone is greatest in premature infants who are particularly sensitive to the effects of hydrocodone. Physicians may decide to prescribe chlorpheniramine and hydrocodone during pregnancy if the benefits to the mother are deemed to outweigh the risks to the fetus and newborn.
NURSING MOTHERS: Chlorpheniramine and hydrocodone both are secreted in breast milk. Owing to the risk in infants of antihistamines causing hyperexcitability and even seizures, particularly in newborns and premature infants, the combination of chlorpheniramine and hydrocodone is not recommended for use in nursing mothers.
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