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# Tussionex (Hydrocodone Polistirex/Chlorpheniramine Polistirex)
## Overview
Tussionex is a fixed-combination, extended-release, oral suspension containing an opioid antitussive (hydrocodone) and a first-generation antihistamine (chlorpheniramine) complexed with a sulfonated styrene-divinylbenzene copolymer (polistirex) to provide sustained release.
## Primary Indications
Symptomatic relief of cough and upper respiratory symptoms associated with allergy or the common cold.
## Adult Dosing
* **Standard Dose:** 5 mL (containing 10 mg hydrocodone polistirex / 8 mg chlorpheniramine polistirex) orally every 12 hours.
* **Maximum Dose:** Do not exceed 10 mL (20 mg hydrocodone / 16 mg chlorpheniramine) in a 24-hour period.
## Pediatric Dosing
* **Children 6 to 12 years:** 2.5 mL orally every 12 hours. Maximum: 5 mL per 24 hours.
* **Children under 6 years:** Safety and efficacy have not been established. Use is generally discouraged due to the risk of respiratory depression and lack of established efficacy.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; dose reduction may be required.
* **Renal Impairment:** No specific guidelines provided by the manufacturer; use with extreme caution as clearance of metabolites may be altered.
* **Geriatric Patients:** Start at the lower end of the dosing range due to increased sensitivity to the CNS-depressant effects of opioids and the anticholinergic effects of chlorpheniramine.
## Contraindications
* Hypersensitivity to any component (hydrocodone, chlorpheniramine, or excipients).
* Patients with known or suspected respiratory depression.
* Patients with acute or severe bronchial asthma or hypercapnia.
* Concomitant use of MAO inhibitors or within 14 days of stopping such therapy.
* Patients with paralytic ileus or GI obstruction.
## Adverse Effects
* **Common:** Drowsiness, sedation, dizziness, dry mouth, constipation, nausea, and blurred vision.
* **Serious:** Respiratory depression, profound sedation, severe constipation, urinary retention, and potential for abuse/misuse.
* **Black Box Warning:** Addiction, abuse, and misuse; life-threatening respiratory depression; accidental ingestion (especially in children); and risk of concomitant use with benzodiazepines or other CNS depressants.
## Key Drug Interactions
* **CNS Depressants:** (e.g., alcohol, benzodiazepines, other opioids) May cause additive CNS depression and respiratory failure.
* **MAOIs:** Potential for serotonin syndrome and severe hypertensive crisis.
* **Anticholinergics:** May cause additive anticholinergic effects (dry mouth, urinary retention, confusion).
* **CYP3A4 inhibitors/inducers:** May significantly alter plasma levels of hydrocodone.
## Monitoring
* Monitor for signs of respiratory depression, especially during initiation or dose escalation.
* Monitor frequency of cough and duration of symptoms.
* Assess for signs of urinary retention or severe constipation.
* Monitor for signs of abuse or misuse.
## Clinical Pearls
* **Preparation:** Shake the suspension well before each dose to ensure uniform distribution of the polistirex complex.
* **Formulation:** It is an extended-release product; do not crush, chew, or split the formulation (if available as a controlled-release tablet) or expect 12-hour coverage if not dosed as directed.
* **Falls Risk:** Due to significant sedative effects, use with caution in the elderly to prevent falls.
* **Regulatory:** Hydrocodone is a Schedule II controlled substance.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always verify current prescribing information, institutional protocols, and patient-specific factors via reliable clinical references (e.g., Lexicomp, UpToDate, or the FDA-approved package insert) before prescribing or administering medication.
