Tuzistra XR

• Risk factors: Personal or family history of substance abuse | History of mental health condition

Like other opioid-containing medications, codeine/chlorpheniramine has a potential for abuse, misuse, or addiction, which can lead to serious complications, such as overdose and death. This can happen even if you're using the medication at prescribed or recommended doses. It's recommended to use codeine/chlorpheniramine at the lowest possible dose for the shortest period of time needed. If you're using this medication for 5 days and don't feel any better, contact your provider to discuss alternatives.

• Risk factors: Age 65 years and older | Genes that quickly break down codeine | Using medications that slow down the body | Drinking alcohol | Severe asthma | History of severe chronic obstructive pulmonary disease (COPD) | Older or weaker people | Accidental overdose | Children | Breastfed infants

Codeine/chlorpheniramine can cause life-threatening breathing problems (respiratory depression) and lead to death. Your risk is higher if you're 65 years or older or have certain medical conditions, such as asthma or COPD. Some people have genes that break down codeine into morphine faster in their body, which raises their exposure to morphine and their risk of serious opioid side effects. In addition, using medications that slow down your body (e.g., benzodiazepines) together with opioid-containing medications like codeine/chlorpheniramine can cause slowed breathing, coma, or death. If you or your loved one has shortness of breath, wheezing, slowed breathing, tiredness or sleepiness during the day, anxiety, or confusion, call for emergency medical help right away.

Codeine/chlorpheniramine should only be used in adults 18 years or older. This medication can cause life-threatening breathing problems and death in children, especially those ages 12 to 18 years after certain surgeries (tonsil or adenoid removal), those younger than 12 years, and those with certain conditions.

Breastfeeding isn't recommended while taking codeine/chlorpheniramine. Codeine and morphine can pass into breast milk and cause serious side effects in your baby, like breathing problems and even death. Speak to your provider about safer alternatives if you're breastfeeding.

• Risk factors: Dosing errors

Never use household measuring spoons or cups to measure your dose of the codeine/chlorpheniramine liquid, since this might cause you to take the wrong dose and lead to overdose. Ask your pharmacist if you need a new measuring syringe or spoon. If you live in a home with children or if children frequently visit your home, store the medication in a secure place. Symptoms of an overdose include slowed breathing, sleepiness, muscle weakness, small pupils, cold or clammy skin, abnormal snoring, slow heart rate, or unresponsiveness. If you, your child, or anyone around you accidentally overdoses on codeine/chlorpheniramine, get emergency medical help right away. A medication called naloxone (Narcan) is available to reverse the side effects of an opioid overdose quickly. Speak to your provider to learn more.

• Risk factors: Using other medications that slow down brain function | Drinking alcohol | Taking more codeine/chlorpheniramine than prescribed

Codeine/chlorpheniramine can slow down brain activity and lead to severe sleepiness. Taking codeine/chlorpheniramine with alcohol, benzodiazepines, sleep medications, muscle relaxers, and other opioids can make these side effects worse, and lead to slowed breathing, coma, and even death. If you take any of these medications, work with your healthcare provider to take the lowest and safest dose. Due to the risks of excessive sleepiness and dizziness, don't drive or use any heavy machinery until you know how codeine/chlorpheniramine affects you.

Using codeine/chlorpheniramine with certain medications or suddenly stopping some medications can change the levels of codeine/chlorpheniramine in your body. For example, taking erythromycin (Ery-Tab), ketoconazole, or ritonavir (Norvir) can raise codeine/chlorpheniramine levels, leading to greater side effects, such as slowed breathing. Other medications, like phenytoin (Dilantin), carbamazepine (Tegretol), or rifampin (Rifadin), can lower codeine/chlorpheniramine levels in your body, leading to withdrawal symptoms or lessened pain relief. In these situations, your provider might need to adjust your medications or dosage. Talk to your pharmacist or healthcare provider before starting or stopping any medications, so they can make sure it's safe to continue using codeine/chlorpheniramine.

• Risk factors: Long-term use of codeine/chlorpheniramine during pregnancy

Long-term use of codeine/chlorpheniramine during pregnancy can cause your unborn baby to become dependent on opioids the same way that you can. Once your baby is born, they can experience withdrawal symptoms just like if you were to stop the medication suddenly. Withdrawal symptoms in your newborn can include high-pitched crying, poor feeding and sucking behavior, trembling, irritability, abnormal sleep patterns, and seizures. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if not recognized and treated in time. Let your healthcare provider know if you've used codeine/chlorpheniramine during pregnancy or if you notice these symptoms in your baby.

• Risk factors: Age 65 years or older | Taking other medications that lower blood pressure | Dehydration | History of low blood pressure | Taking certain antipsychotics | Starting codeine/chlorpheniramine | Dose adjustments

Codeine/chlorpheniramine can cause severe low blood pressure, including a drop in blood pressure when you stand from a sitting or lying position. This can lead to dizziness and fainting. Your risk is greater if you take medications for high blood pressure or if you take certain antipsychotics. Be careful as you stand up after sitting for an extended period of time and make sure to sit back down if you feel faint or dizzy. The chances of low blood pressure are higher when you first start using codeine/chlorpheniramine or with dose changes. If dizziness or lightheadedness doesn't go away, talk to your healthcare provider.

• Risk factors: Using opioids for greater than 1 month | History of low cortisol levels

Using opioids like codeine/chlorpheniramine, especially for longer than 1 month, can lead to low levels of cortisol hormone (adrenal insufficiency). Cortisol helps control your mood, stress, blood pressure, and blood sugar levels. If you have symptoms such as nausea, vomiting, loss of appetite, tiredness, weakness, dizziness, or low blood pressure, let your healthcare provider know so that tests can be performed. If your cortisol levels are too low, your provider will treat you with corticosteroids and you might slowly be weaned off of codeine/chlorpheniramine or switched to another medication if necessary.

• Risk factors: History of seizures | Taking other medications or having health conditions that raise your risk of seizures

Codeine/chlorpheniramine can raise your risk of seizures if you have a history of seizures. If your seizures have worsened or become harder to control after starting codeine/chlorpheniramine, let your healthcare provider know right away.