Tus%2520qd

# Tussionex (Hydrocodone Polistirex/Chlorpheniramine Polistirex) ## Overview Tussionex is an extended-release (ER) oral suspension containing an opioid antitussive (hydrocodone) and a first-generation antihistamine (chlorpheniramine). The polistirex matrix provides delayed release, allowing for once-daily (q12h-q24h) dosing. **Note: This medication is a Schedule II controlled substance.** ## Primary Indications Symptomatic relief of cough and upper respiratory symptoms associated with allergy or the common cold. It is not indicated for chronic cough. ## Adult Dosing * **Dose:** 5 mL (containing 10 mg hydrocodone polistirex / 8 mg chlorpheniramine polistirex) orally every 12 hours. * **Maximum:** 10 mL per 24 hours. ## Pediatric Dosing (≥ 6 years) * **6–12 years:** 2.5 mL orally every 12 hours. * **Maximum:** 5 mL per 24 hours. * **< 6 years:** Not recommended. Safety and efficacy not established in this age group. ## Dose Adjustments * **Renal/Hepatic Impairment:** No specific guidelines provided by the manufacturer. Use with extreme caution; monitor for increased opioid sensitivity and CNS depression. * **Elderly:** Start at the lower end of the dosing range due to increased risk of sedation and respiratory depression. ## Contraindications * Hypersensitivity to any component. * Documented or suspected paralytic ileus. * Severe respiratory depression. * Acute or severe bronchial asthma or hypercapnia (in unmonitored settings). * Concurrent use of MAO inhibitors or use within the last 14 days (risk of serotonin syndrome/hypertensive crisis). ## Adverse Effects * **CNS:** Sedation, dizziness, confusion, impaired motor coordination. * **Gastrointestinal:** Constipation, nausea, vomiting, dry mouth. * **Respiratory:** Respiratory depression. * **Anticholinergic:** Urinary retention, blurred vision, tachycardia. ## Key Drug Interactions * **CNS Depressants:** (e.g., alcohol, benzodiazepines, other opioids) High risk of additive sedation, respiratory depression, and death. * **MAOIs:** Absolute contraindication due to potentially fatal interactions with both active components. * **Anticholinergics:** May exacerbate dry mouth, urinary retention, and constipation. * **CYP3A4 Inhibitors/Inducers:** Hydrocodone is metabolized by CYP3A4; concurrent use may significantly alter serum concentrations. ## Monitoring * **Respiratory Status:** Monitor for signs of shallow breathing or somnolence. * **Mental Status:** Assess for excessive sedation or cognitive impairment. * **Bowel Function:** Monitor for constipation. * **Safety:** Caution patients against driving or operating machinery. ## Clinical Pearls * **Shake well:** Must be shaken vigorously before each dose to ensure uniform suspension of the drug-resin complex. * **Measurement:** Use only the calibrated dosing device provided; do not use kitchen spoons. * **Abuse Potential:** Hydrocodone is a high-risk medication for opioid use disorder. Counsel on limiting duration of therapy. * **Formulation:** Avoid confusing with immediate-release cough preparations; Tussionex is specifically formulated for extended release. *** *Disclaimer: This information is for educational purposes only. Dosing and prescribing standards may vary by local practice, regulatory guidelines, and patient-specific factors. Always verify current prescribing information via official manufacturer labeling (FDA/EMA) or a reliable clinical database (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*