Tussionex (Hydrocodone and phenyltoloxamine) is a combination of an opioid and an antihistamine. It is used for the relief of dry cough caused by allergies or other upper respiratory pathologies that is not responsive to other cough medications.
Hydrocodone and phenyltoloxamine Uses:
Note: It is not approved in the US
-
Cough:
- It is used for symptomatic relief of non productive cough due to cold or upper respiratory allergies non responsive to nonopioid antitussives
Tussionex (Hydrocodone and phenyltoloxamine) Dose in Adults
Tussionex (Hydrocodone and phenyltoloxamine) Dose in the treatment of Cough:
- Oral: Suspension (hydrocodone 5 mg and phenyltoloxamine 10 mg per 5 mL)
- 5 mL every 8 - 12 hours
- Maximum: 10 mL (hydrocodone 10 mg/phenyltoloxamine 20 mg) per day
Tussionex (Hydrocodone and phenyltoloxamine) Dose in Children
Tussionex (Hydrocodone and phenyltoloxamine) Dose in the treatment of Cough:
-
Manufacturer's labeling:
-
Children ≥6 years and Adolescents:
- Oral: Suspension (hydrocodone 5 mg and phenyltoloxamine 10 mg per 5 mL)
- 5 mL every 12 hours
- Maximum: 10 mL (hydrocodone 10 mg/phenyltoloxamine 20 mg) per day
- Oral: Suspension (hydrocodone 5 mg and phenyltoloxamine 10 mg per 5 mL)
-
Note: Due to the risk of adverse effects, FDA recommends against the use of codeine/hydrocodone containing cough/cold products for patients less than 18 years of age.
Tussionex (Hydrocodone and phenyltoloxamine) Pregnancy Category: B
- Neonatal withdrawal syndrome can develop from prolonged opioid use.
- It should be treated promptly according to the protocols of neonatology experts. If not treated promptly, it can become life-threatening
- Prevent prolonged opioid use in pregnant women.
Use during breastfeeding:
- Breast milk contains hydrocodone.
- The manufacturer doesn't recommend lactation because it can have serious adverse effects on the infants who are breastfeed.
Dose in Kidney disease:
No dosage adjustment recommended.
Dose in Liver disease:
No dosage adjustment recommended.
Side effects of Tussionex (Hydrocodone and phenyltoloxamine):
-
Cardiovascular:
- Tachycardia
-
Central Nervous System:
- Drowsiness
- Drug Dependence
- Hallucination
- Seizure
-
Dermatologic:
- Facial Pruritus
-
Gastrointestinal:
- Constipation
- Nausea
-
Hypersensitivity:
- Hypersensitivity Reaction
-
Respiratory:
- Dyspnea
- Respiratory Depression
Contraindications to Tussionex (Hydrocodone and phenyltoloxamine):
- Hypersensitivity to any ingredient of the formulation
- Known or suspected GI obstruction (eg bowel obstruction or strictures), or any disease/condition which affects bowel transit (e.g. ileus
- A surgical abdomen, including acute pancreatitis or appendicitis
- Bronchitis, acute or severe
- Chronic obstructive pulmonary disease
- Status asthmaticus
- Hypertension is a serious condition.
- Acute alcoholism
- Delirium tremens
- Convulsive disorders
- Concurrent use within 14 days of monoamine oxidase inhibition (MAOI), therapy
- Acute respiratory depression
- Hypercapnia
- Cor pulmonale
- Severe CNS depression
- Elevated cerebrospinal and intracranial pressure
- Head injury
Warnings and precautions
-
CNS depression:
- It can cause CNS depression, which may lead to impaired mental or physical abilities.
- Patient should exercise caution when performing work that requires mental alertness.
-
Hypotension
- You can get severe hypotension from its use.
- Reduced blood volume, concurrent use of CNS depressants (e.g. phenothiazines, general aesthetics).
- If the patient is experiencing a circulatory crisis, do not use it.
-
Phenanthrene hypersensitivity:
- Use cautiously if the patient is sensitive to other phenanthrene-derivative opioid agonists e.g. codeine, hydromorphone, levorphanol, morphine, oxycodone, oxymorphone
-
Respiratory depression: [Canadian boxed warning]
- Hydrocodone can cause severe respiratory depressions.
- The patient must be aware of the dangers and consequences of fatal overdose.
- After the dose increase or start of therapy, monitoring is recommended for respiratory depression.
- Patients may experience excessive sedation after experiencing opioid effects and CO2 due to respiratory depression.
-
Serotonin syndrome:
- Serotonin syndrome can be caused by concurrent use of serotonergic drugs. This is a rare, but potentially life-threatening condition.
- Do not combine it with MAOIs and serotonin precursors.
- Take caution when using serotonergic drugs (eg, triptans TCAs, lithium and tramadol),
- Stop immediately.
-
Conditions abdominales:
- Acute abdominal conditions can make it difficult to diagnose or determine the course of treatment.
- Contraindicated when there is GI obstruction (known and suspected) or any condition that affects bowel transit (e.g. ileus
-
Insufficiency of the adrenals:
- Avoid using this product if you have adrenal insufficiency or Addison's syndrome.
- Secondary hypogonadism can occur with long-term opioid use. This can lead to infertility and sexual dysfunction.
-
Insufficiency of the biliary tract:
- Be cautious if you have biliary dysfunction, such as acute pancreatitis. This can cause constriction to the sphincter.
-
Cardiovascular disease
- Cardiovascular disease: Use caution
-
Diabetes:
- Diabetes mellitus: Be cautious
-
Head trauma
- It is not recommended to use it in cases of head injury.
- Patients with space-occupying brain lesion are contraindicated
-
Hepatic impairment
- In severe hepatic impairment, use caution
-
Glaucoma/increased intraocular pressure
- Glaucoma and increased intraocular pressure should be avoided.
-
Peripheral Vascular Disease:
- Avoid using this product if you have peripheral vascular disease.
-
Prostatic hyperplasia/urinary block:
- Be cautious if you have prostatic hyperplasia or GU obstruction
-
Renal impairment
- For severe renal impairment, use caution
-
Respiratory disease
- Avoid use in the case of pulmonary disease or decreased ventilatory function
- Contraindicated for COPD, acute respiratory depression and hypercapnia.
-
Seizure:
- It can cause seizures or worsen existing ones.
- Contraindicated in patients with a history of seizure disorders
-
Thyroid dysfunction:
- Thyroid dysfunction: Use caution
Hydrocodone and phenyltoloxamine: Drug Interaction
|
Risk Factor C (Monitor therapy) |
|
|
Acetylcholinesterase Inhibitors |
May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. |
|
Alizapride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Amantadine |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Amezinium |
Antihistamines may enhance the stimulatory effect of Amezinium. |
|
Amphetamines |
May enhance the analgesic effect of Opioid Agonists. |
|
Amphetamines |
May diminish the sedative effect of Antihistamines. |
|
Anticholinergic Agents |
May enhance the adverse/toxic effect of other Anticholinergic Agents. |
|
Anticholinergic Agents |
May enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. |
|
Aprepitant |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Betahistine |
Antihistamines may diminish the therapeutic effect of Betahistine. |
|
Bosentan |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Botulinum Toxin-Containing Products |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Brimonidine (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Bromopride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabis |
May enhance the CNS depressant effect of CNS Depressants. |
|
Chlorphenesin Carbamate |
May enhance the adverse/toxic effect of CNS Depressants. |
|
Clofazimine |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
CYP2D6 Inhibitors (Strong) |
May decrease serum concentrations of the active metabolite(s) of HYDROcodone. Specifically, concentrations of hydromorphone may be decreased. |
|
CYP3A4 Inducers (Moderate) |
May decrease the serum concentration of HYDROcodone. |
|
CYP3A4 Inducers (Strong) |
May decrease the serum concentration of HYDROcodone. |
|
CYP3A4 Inhibitors (Moderate) |
May increase the serum concentration of HYDROcodone. |
|
CYP3A4 Inhibitors (Strong) |
May increase the serum concentration of HYDROcodone. |
|
Deferasirox |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Desmopressin |
Opioid Agonists may enhance the adverse/toxic effect of Desmopressin. |
|
Dimethindene (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Diuretics |
Opioid Agonists may enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. |
|
Dronabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Duvelisib |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Erdafitinib |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Erdafitinib |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Fosaprepitant |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Fosnetupitant |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Gastrointestinal Agents (Prokinetic) |
Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). |
|
Gastrointestinal Agents (Prokinetic) |
Opioid Agonists may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). |
|
Glucagon |
Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. |
|
Itopride |
Anticholinergic Agents may diminish the therapeutic effect of Itopride. |
|
Ivosidenib |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Kava Kava |
May enhance the adverse/toxic effect of CNS Depressants. |
|
Larotrectinib |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Lofexidine |
May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Magnesium Sulfate |
May enhance the CNS depressant effect of CNS Depressants. |
|
MetyroSINE |
CNS Depressants may enhance the sedative effect of MetyroSINE. |
|
Minocycline |
May enhance the CNS depressant effect of CNS Depressants. |
|
Mirabegron |
Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. |
|
Nabilone |
May enhance the CNS depressant effect of CNS Depressants. |
|
Netupitant |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Nitroglycerin |
Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. |
|
Palbociclib |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Pegvisomant |
Opioid Agonists may diminish the therapeutic effect of Pegvisomant. |
|
Piribedil |
CNS Depressants may enhance the CNS depressant effect of Piribedil. |
|
Pramipexole |
CNS Depressants may enhance the sedative effect of Pramipexole. |
|
Ramosetron |
Anticholinergic Agents may enhance the constipating effect of Ramosetron. |
|
Ramosetron |
Opioid Agonists may enhance the constipating effect of Ramosetron. |
|
ROPINIRole |
CNS Depressants may enhance the sedative effect of ROPINIRole. |
|
Rotigotine |
CNS Depressants may enhance the sedative effect of Rotigotine. |
|
Rufinamide |
May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. |
|
Sarilumab |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Selective Serotonin Reuptake Inhibitors |
CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. |
|
Serotonin Modulators |
Opioid Agonists may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Exceptions: Nicergoline. |
|
Siltuximab |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Simeprevir |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Succinylcholine |
May enhance the bradycardic effect of Opioid Agonists. |
|
Tetrahydrocannabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Tetrahydrocannabinol and Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Thiazide and Thiazide-Like Diuretics |
Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. |
|
Tocilizumab |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Risk Factor D (Consider therapy modification) |
|
|
Alvimopan |
Opioid Agonists may enhance the adverse/toxic effect of Alvimopan. This is most notable for patients receiving long-term (i.e., more than 7 days) opiates prior to alvimopan initiation. Management: Alvimopan is contraindicated in patients receiving therapeutic doses of opioids for more than 7 consecutive days immediately prior to alvimopan initiation. |
|
Benzylpenicilloyl Polylysine |
Antihistamines may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Suspend systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing and delay testing until systemic antihistaminic effects have dissipated. A histamine skin test may be used to assess persistent antihistaminic effects. |
|
Blonanserin |
CNS Depressants may enhance the CNS depressant effect of Blonanserin. |
|
Chlormethiazole |
May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. |
|
CNS Depressants |
May enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Dabrafenib |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). |
|
Droperidol |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Enzalutamide |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. |
|
Flunitrazepam |
CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. |
|
Hyaluronidase |
Antihistamines may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving antihistamines (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. |
|
HYDROcodone |
CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Lorlatinib |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences. |
|
Methotrimeprazine |
CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. |
|
MiFEPRIStone |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus. |
|
Mitotane |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. |
|
Monoamine Oxidase Inhibitors |
May enhance the adverse/toxic effect of HYDROcodone. Management: Consider alternatives to this combination when possible. |
|
Nalmefene |
May diminish the therapeutic effect of Opioid Agonists. Management: Avoid the concomitant use of nalmefene and opioid agonists. Discontinue nalmefene 1 week prior to any anticipated use of opioid agonistss. If combined, larger doses of opioid agonists will likely be required. |
|
Naltrexone |
May diminish the therapeutic effect of Opioid Agonists. Management: Seek therapeutic alternatives to opioids. See full drug interaction monograph for detailed recommendations. |
|
Ombitasvir, Paritaprevir, and Ritonavir |
May increase the serum concentration of HYDROcodone. Management: Reduce the hydrocodone dose by 50% during concurrent use of ombitasvir, paritaprevir, and ritonavir; monitor closely for both analgesic effectiveness and for signs of toxicity or withdrawal. |
|
Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir |
May increase the serum concentration of HYDROcodone. Management: Reduce the hydrocodone dose by 50% during concurrent use of ombitasvir, paritaprevir, ritonavir, and dasabuvir; monitor closely for both analgesic effectiveness and for signs of toxicity or withdrawal. |
|
OxyCODONE |
CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Perampanel |
May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. |
|
PHENobarbital |
May enhance the CNS depressant effect of HYDROcodone. PHENobarbital may decrease the serum concentration of HYDROcodone. Management: Avoid use of hydrocodone and phenobarbital when possible. Monitor for respiratory depression/sedation. Because phenobarbital is also a strong CYP3A4 inducer, monitor for decreased hydrocodone efficacy and withdrawal if combined. |
|
Pitolisant |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Combined use of pitolisant with a CYP3A4 substrate that has a narrow therapeutic index should be avoided. Other CYP3A4 substrates should be monitored more closely when used with pitolisant. |
|
Pramlintide |
May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. |
|
Primidone |
May enhance the CNS depressant effect of HYDROcodone. Primidone may decrease the serum concentration of HYDROcodone. Management: Avoid use of hydrocodone and primidone when possible. Monitor for respiratory depression/sedation. Because primidone is also a strong CYP3A4 inducer, monitor for decreased hydrocodone efficacy and withdrawal if combined. |
|
Secretin |
Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. |
|
Sincalide |
Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. |
|
Sodium Oxybate |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. |
|
St John's Wort |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. |
|
Stiripentol |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring. |
|
Suvorexant |
CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. |
|
Tapentadol |
May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Zolpidem |
CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. |
|
Risk Factor X (Avoid combination) |
|
|
Aclidinium |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Alcohol (Ethyl) |
May enhance the CNS depressant effect of HYDROcodone. Alcohol (Ethyl) may increase the serum concentration of HYDROcodone. Management: Patients using the Zohydro ER brand of extended-release hydrocodone must not consume alcohol or alcohol-containing products due to possibly fatal outcomes. Other hydrocodone products are also expected to interact, but to a less significant degree. |
|
Azelastine (Nasal) |
CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). |
|
Bromperidol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cimetropium |
Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. |
|
Conivaptan |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Eluxadoline |
Opioid Agonists may enhance the constipating effect of Eluxadoline. |
|
Eluxadoline |
Anticholinergic Agents may enhance the constipating effect of Eluxadoline. |
|
Fusidic Acid (Systemic) |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Glycopyrrolate (Oral Inhalation) |
Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). |
|
Glycopyrronium (Topical) |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Idelalisib |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Ipratropium (Oral Inhalation) |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Levosulpiride |
Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. |
|
Opioids (Mixed Agonist / Antagonist) |
May diminish the analgesic effect of Opioid Agonists. Management: Seek alternatives to mixed agonist/antagonist opioids in patients receiving pure opioid agonists, and monitor for symptoms of therapeutic failure/high dose requirements (or withdrawal in opioid-dependent patients) if patients receive these combinations. |
|
Orphenadrine |
CNS Depressants may enhance the CNS depressant effect of Orphenadrine. |
|
Oxatomide |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Oxomemazine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Paraldehyde |
CNS Depressants may enhance the CNS depressant effect of Paraldehyde. |
|
Potassium Chloride |
Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. |
|
Potassium Citrate |
Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. |
|
Revefenacin |
Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. |
|
Thalidomide |
CNS Depressants may enhance the CNS depressant effect of Thalidomide. |
|
Tiotropium |
Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. |
|
Umeclidinium |
May enhance the anticholinergic effect of Anticholinergic Agents. |
Monitoring parameters:
- Relief of symptoms
- Respiratory and mental status
- Bowel function
- Signs/symptoms of addiction
- Abuse, or misuse
How to administer Tussionex (Hydrocodone and phenyltoloxamine)?
Oral:
- Do not dilute or mix with other medications or fluid
- Shake well before use
- Take measured dose and use calibrated oral syringe.
Mechanism of action of Tussionex (Hydrocodone and phenyltoloxamine):
- It works on the opiate receptors of the CNS, alters the perception and response to pain, suppresses cough in medullary centre, and causes generalized CNS depression.
- Histamine and phenyltoloxamine are competitors for H-1 receptor sites on effector cells.
- It can increase the antitussive properties of hydrocodone, and it also has sedative effects.
TimeAntitussive effects >=8 hours
Metabolism: Hydrocodone
- Hepatic.
- O-demethylation via primarily CYP2D6 and hydromorphone (It's a major and active metabolite and has 10 – 33-fold or more than a >100% higher binding affinity for mu-opioid receptors than hydrocodone.
- N-demethylation via CYP3A4 (major metabolite to norhydrocodone)
- Approximately 40% of metabolism/clearance takes place via non-CYP pathways.
- These include 6-ketosteroid reductions to 6-alpha-hydrocol or 6-betahydrocol and other elimination pathways (eg fecal and biliary, renal).
Half-life elimination:
- Hydrocodone: ~4 hours
Excretion: Hydrocodone:
- Urine
- 26% of a single dose is excreted in 72 hours
- 12% as unchanged drug
- 5% as norhydrocodone
- 4% as conjugated hydrocodone
- 3% as 6-hydrocodol, and
- 0.21% as conjugated 6-hydromorphol.
International Brand Names of Hydrocodone and phenyltoloxamine:
- Tussionex
Hydrocodone and phenyltoloxamine Brand Names in Pakistan:
No Brands Available in Pakistan.
