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: no

PRESCRIPTION: yes

PREPARATIONS: Liquid suspension. Each teaspoonful (5 ml) contains chlorpheniramine 8 mg and hydrocodone 10 mg.

STORAGE: Liquid should be stored at room temperature, between 15 and 30 °C (59-86 °F).

PRESCRIBED FOR: Tussionex is used to treat cough and congestion associated with severe colds and other infections of the lungs and breathing tubes.

DOSING: Tussionex usually is taken 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 (e.g., Valium, Ativan, Klonopin, Xanax), the narcotic class of pain medications and its derivatives (e.g., Percocet, Vicodin, Dilaudid, Codeine, Darvon), the tricyclic class of antidepressants (e.g., Elavil, Tofranil, Norpramin), and certain antihypertensive medications (e.g., Catapres, Inderal). Chlorpheniramine also can intensify the drying effects (due to decreased production of mucus) of other medications with anticholinergic properties (e.g., Bentyl, Urecholine, Probanthine).

PREGNANCY: Antihistamines generally are 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 prescribe hydrocodone, however, if the benefits to the mother are felt to outweigh the risks to the fetus and newborn.

NURSING MOTHERS: Chlorpheniramine and hydrocodone both are secreted in breast milk. Because of the risk of antihistamines in infants (they may cause hyperexcitability and even seizures)--especially newborns and prematures--antihistamines should not be used by nursing mothers.

SIDE EFFECTS: The most frequent side effects of chlorpheniramine and hydrocodone include lightheadedness, dizziness, sedation, nausea, vomiting, disturbed coordination, and drying and thickening of oral and other respiratory secretions. Other side effects include constipation, spasm of the ureter (which can lead to difficulty urinating), palpitations, increased heart rate, confusion, nervousness, irritability, blurred vision, double vision, and tremor.

Hydrocodone can depress breathing, and is used with caution in elderly, debilitated patients and in patients with serious lung disease. Hydrocodone can impair thinking and the physical abilities required for driving or operating machinery. Hydrocodone may be habit forming. Mental and physical dependence can occur but are unlikely when used for short-term relief of pain.

Reference: FDA Prescribing Information