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Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

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Tussionex (Hydrocodone and phenyltoloxamine) - Uses, Brands

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

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.

Disclaimer Notice:

Emedz.net is not an online pharmacy:

We are not affiliated with any pharmaceutical companies:

Tussionex (Hydrocodone and phenyltoloxamine) - Uses, Brands

Hydrocodone and phenyltoloxamine Uses:

Cough:

Tussionex (Hydrocodone and phenyltoloxamine) Dose in Adults

Tussionex (Hydrocodone and phenyltoloxamine) Dose in the treatment of Cough:

Tussionex (Hydrocodone and phenyltoloxamine) Dose in Children

Tussionex (Hydrocodone and phenyltoloxamine) Dose in the treatment of Cough:

Manufacturer's labeling:

Tussionex (Hydrocodone and phenyltoloxamine) Pregnancy Category: B

Use during breastfeeding:

Dose in Kidney disease:

Dose in Liver disease:

Side effects of Tussionex (Hydrocodone and phenyltoloxamine):

Cardiovascular:

Central Nervous System:

Dermatologic:

Gastrointestinal:

Hypersensitivity:

Respiratory:

Contraindications to Tussionex (Hydrocodone and phenyltoloxamine):

Warnings and precautions

CNS depression:

Hypotension

Phenanthrene hypersensitivity:

Respiratory depression: [Canadian boxed warning]

Serotonin syndrome:

Conditions abdominales:

Insufficiency of the adrenals:

Insufficiency of the biliary tract:

Cardiovascular disease

Diabetes:

Head trauma

Hepatic impairment

Glaucoma/increased intraocular pressure

Peripheral Vascular Disease:

Prostatic hyperplasia/urinary block:

Renal impairment

Respiratory disease

Seizure:

Thyroid dysfunction:

Monitoring parameters:

How to administer Tussionex (Hydrocodone and phenyltoloxamine)?

Mechanism of action of Tussionex (Hydrocodone and phenyltoloxamine):

International Brand Names of Hydrocodone and phenyltoloxamine:

Hydrocodone and phenyltoloxamine Brand Names in Pakistan:

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