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# Tussionex (Hydrocodone Polistirex/Chlorpheniramine Polistirex) ## Overview Tussionex is a fixed-combination, extended-release antitussive preparation containing an opioid agonist (hydrocodone) and a first-generation antihistamine (chlorpheniramine) formulated as a cation-exchange resin complex. ## Primary Indications Symptomatic relief of cough and upper respiratory symptoms associated with allergy or the common cold. It is a Schedule II controlled substance. ## Adult Dosing * **Standard Dose:** 5 mL (containing 10 mg hydrocodone polistirex / 8 mg chlorpheniramine polistirex) orally every 12 hours. * **Maximum Dose:** 10 mL (one dose) per 24 hours. ## Pediatric Dosing * **Children 6 to 12 years:** 2.5 mL orally every 12 hours. * **Children < 6 years:** Safety and efficacy not established; use is generally discouraged due to risk of fatal respiratory depression. * **Maximum Dose (Children 6-12 years):** 5 mL per 24 hours. ## Dose Adjustments * **Hepatic/Renal Impairment:** No specific manufacturer guidelines; initiate at the lower end of the dosing range and monitor for excessive sedation or respiratory depression. * **Elderly:** Use extreme caution; increased risk of sedation, confusion, and urinary retention. Dose reduction is often necessary. ## Contraindications * Hypersensitivity to hydrocodone or chlorpheniramine. * Known or suspected paralytic ileus. * Concomitant use of MAO inhibitors (or within 14 days). * Respiratory depression or acute/severe asthma in an unmonitored setting. ## Adverse Effects * **Common:** Sedation, drowsiness, dizziness, nausea, vomiting, constipation, and dry mouth. * **Serious:** Respiratory depression, hypotension, CNS depression, urinary retention in patients with prostatic hypertrophy, and potential for abuse/addiction. ## Key Drug Interactions * **CNS Depressants:** Alcohol, benzodiazepines, and other opioids significantly increase the risk of severe respiratory depression, profound sedation, and death. * **Anticholinergics:** Synergistic effects (e.g., dry mouth, constipation, urinary retention). * **CYP3A4 Inhibitors/Inducers:** Hydrocodone is metabolized via CYP3A4; strong inhibitors may significantly increase drug levels and toxicity. ## Monitoring * Monitor for signs of respiratory depression, especially during initiation or dose titration. * Assess bowel function (constipation is common). * Monitor for signs of misuse, abuse, or diversion. ## Clinical Pearls * **Extended-Release Formulation:** This product is designed for 12-hour dosing; do not crush or chew the suspension if it were in a different form, though this is a liquid suspension. Shake well before use. * **Misuse Potential:** As a Schedule II narcotic, strictly limit quantity and monitor for signs of dependence. * **Antihistamine Effects:** The chlorpheniramine component is highly sedating; warn patients regarding driving and operating machinery. * **Avoid Opioid Stacking:** Ensure patients are not taking additional hydrocodone-containing analgesic products concomitantly to avoid overdose. *** **Educational Disclaimer:** This information is for educational purposes only. Always verify current prescribing information, clinical guidelines, and institutional protocols via official drug labels (FDA/EMA) or resources such as Lexicomp or Micromedex before prescribing or administering medication.