Usage
Chlorpheniramine + Codeine is prescribed for the relief of cough and symptoms associated with upper respiratory tract allergies or the common cold in adults. It is classified as a narcotic antitussive/antihistamine combination. The medication combines the antitussive (cough-suppressing) effects of codeine with the antihistaminic effects of chlorpheniramine to alleviate cold and allergy symptoms.
Alternate Names
Generic Names: Codeine/chlorpheniramine, codeine phosphate/chlorpheniramine maleate
Brand Names: Tuxarin ER, Tuzistra XR
How It Works
Pharmacodynamics: Codeine acts centrally on the cough center in the medulla to suppress the cough reflex. It is an opioid agonist that binds to mu-opioid receptors. Chlorpheniramine is an H1-receptor antagonist that competes with histamine for receptor sites, reducing allergy symptoms such as sneezing, runny nose, and itchy eyes.
Pharmacokinetics:
- Codeine: It is readily absorbed from the gastrointestinal tract. Codeine is metabolized in the liver, primarily by CYP2D6, to morphine, its active metabolite. It is excreted mainly by the kidneys.
- Chlorpheniramine: Well-absorbed from the gastrointestinal tract. Metabolized in the liver and excreted in urine.
Elimination Pathways: Both drugs are primarily eliminated through hepatic (liver) metabolism and renal (kidney) excretion.
Dosage
Standard Dosage
Adults:
One extended-release tablet every 12 hours; not to exceed two tablets in 24 hours.
Children:
Safety and efficacy not established in patients younger than 18 years.
Special Cases:
- Elderly Patients: Dose selection should be made with caution due to potential age-related decline in hepatic and renal function.
- Patients with Renal Impairment: Caution is advised and dosage adjustments may be necessary.
- Patients with Hepatic Dysfunction: Use with caution due to the risk of decreased metabolism. Dosage adjustments may be necessary.
- Patients with Comorbid Conditions: Use with caution in patients with asthma, hypothyroidism, Addison’s disease, prostatic hypertrophy, or urethral stricture.
Clinical Use Cases
This drug is not typically used in the context of intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary indication is the symptomatic relief of cough and upper respiratory symptoms associated with allergies or the common cold. Other medications are more appropriate for the listed clinical use cases.
Dosage Adjustments
Dose adjustments may be required for patients with renal or hepatic impairment. Individual patient factors should be considered when determining the appropriate dose.
Side Effects
Common Side Effects
Sedation (somnolence, mental clouding, lethargy), impaired mental and physical performance, lightheadedness, dizziness, headache, dry mouth, nausea, vomiting, constipation, shortness of breath, and sweating.
Rare but Serious Side Effects
Respiratory depression, confusion, serotonin syndrome, hallucinations, adrenal insufficiency, severe allergic reactions (anaphylaxis).
Long-Term Effects
Constipation, dependence, and tolerance with prolonged use of codeine.
Adverse Drug Reactions (ADR)
Respiratory depression, anaphylaxis, serotonin syndrome.
Contraindications
- Hypersensitivity to codeine or chlorpheniramine.
- Post-operative pain management in children who have undergone tonsillectomy and/or adenoidectomy.
- Patients with severe respiratory depression or acute or severe bronchial asthma.
- Gastrointestinal obstruction.
Drug Interactions
- CNS Depressants: Alcohol, benzodiazepines, other opioids, antihistamines, antipsychotics, or other CNS depressants can potentiate the sedative effects of Chlorpheniramine + Codeine and should be avoided.
- MAO Inhibitors: Avoid concurrent use due to the risk of serotonin syndrome.
- Anticholinergic Drugs: Can enhance anticholinergic side effects like dry mouth, blurred vision, and urinary retention.
- CYP2D6 Inhibitors/Inducers: May affect codeine metabolism and its efficacy.
Pregnancy and Breastfeeding
Pregnancy: Codeine use during pregnancy can result in neonatal respiratory depression and neonatal opioid withdrawal syndrome. Use only if the potential benefits outweigh the risks.
Breastfeeding: Codeine is excreted in breast milk and can cause adverse effects in nursing infants. Breastfeeding is not recommended while taking this medication.
Drug Profile Summary
- Mechanism of Action: Codeine: Centrally acting opioid antitussive. Chlorpheniramine: H1-receptor antagonist.
- Side Effects: Sedation, dizziness, dry mouth, constipation, respiratory depression.
- Contraindications: Respiratory depression, hypersensitivity, post-tonsillectomy/adenoidectomy pain in children.
- Drug Interactions: CNS depressants, MAO inhibitors, anticholinergic drugs.
- Pregnancy & Breastfeeding: Use with caution during pregnancy; avoid during breastfeeding.
- Dosage: Adults: One tablet every 12 hours, not to exceed two tablets in 24 hours. Not for children under 18.
- Monitoring Parameters: Respiratory rate, mental status, bowel function.
Popular Combinations
This medication is itself a combination product and is not typically combined with other drugs for its indicated use.
Precautions
Use with caution in patients with impaired respiratory function, hepatic or renal impairment, and the elderly. Avoid alcohol and other CNS depressants. Avoid in patients with a history of drug abuse. Monitor for respiratory depression and constipation. Patients should avoid driving or operating machinery while taking this medication.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Chlorpheniramine Maleate + Codeine?
A: Adults: One extended-release tablet every 12 hours, not to exceed two tablets in 24 hours. Not recommended for children under 18 years old.
Q2: What are the common side effects?
A: Common side effects include drowsiness, dry mouth, constipation, dizziness, lightheadedness, nausea, and vomiting.
Q3: Can I take this medication if I am pregnant or breastfeeding?
A: It is generally advised to avoid this medication during pregnancy and breastfeeding due to potential risks to the baby. Consult your doctor for alternative options.
Q4: Can I drink alcohol while taking this medication?
A: No, alcohol should be avoided as it can potentiate the sedative effects of the medication, increasing the risk of respiratory depression.
Q5: How long can I take this medication?
A: This medication is intended for short-term use until your cough and cold symptoms subside. Consult your doctor if symptoms persist beyond a week.
Q6: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose.
Q7: What are the signs of a codeine overdose?
A: Signs of a codeine overdose include slow or shallow breathing, confusion, severe drowsiness, pinpoint pupils, and loss of consciousness. Seek immediate medical attention if an overdose is suspected.
Q8: Can I drive while taking this medication?
A: It is generally not recommended to drive or operate heavy machinery while taking this medication, as it can cause drowsiness and impair cognitive function.
Q9: What if I have a history of drug abuse?
A: Due to the potential for abuse and dependence, inform your doctor about any history of drug abuse before taking this medication.
Q10: What are the other names for this combination drug?
A: It can be found under the brand names such as Tuxarin ER and Tuzistra XR. Generic names include codeine/chlorpheniramine and codeine phosphate/chlorpheniramine maleate.
