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Tuzistra XR

codeine / chlorpheniramine
Used for Allergic Rhinitis, Cold Symptoms, Cough
Used for Allergic Rhinitis, Cold Symptoms, Cough

Codeine/chlorpheniramine is a combination medication that helps relieve cough and symptoms from the common cold and allergies in adults. It requires a prescription from your provider, because it's a lot stronger than over-the-counter cough and cold medications.

Reviewed by:
reviewer
Allison Gourley, PharmD
reviewer
Kristianne Hannemann, PharmD
Last reviewed on April 7, 2022
BasicsWarningsSide effectsPros & consPharmacist tipsFAQsDosageInteractionsCostContraindicationsAlternativesPricesMedicare
Codeine/chlorpheniramine is a controlled substance, which means that it's more likely to be misused or cause dependence. There are federal and state laws that limit the amount of medication that can be prescribed or dispensed within a certain period of time.
basics-icon

What is Codeine/chlorpheniramine?

What is Codeine/chlorpheniramine used for?

  • Cough and symptoms due to the common cold and allergies

How Codeine/chlorpheniramine works

Codeine/chlorpheniramine is a combination of two medications that work together to treat symptoms from the common cold and allergies.

  • Codeine is an opioid pain reliever that also works in your brain to lessen your urge to cough.

  • Chlorpheniramine is an antihistamine. It blocks a natural substance in your body called histamine from causing irritation in the lining of your respiratory tract (nose, lungs, throat). It helps relieve itchy, runny nose and sneezing related to allergies and the common cold.

Are you looking for information on CapCof (chlorpheniramine / codeine / phenylephrine) instead?

Drug Facts

Common BrandsTuxarin ER, Tuzistra XR
Drug ClassOpioid / Antihistamine
Controlled Substance ClassificationSchedule III
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the risks and warnings for Codeine/chlorpheniramine?

Codeine/chlorpheniramine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

risk-warning

Potential for addiction, abuse, and misuse

  • 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-warning

    Life-threatening breathing problems

    • 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-warning

      Accidental overdose

      • 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-warning

        Slowed brain function and decreased alertness

        • 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.

          risk-warning

          Interactions with other medications

          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-warning

          Withdrawal in newborn babies

          • 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-warning

            Low blood pressure

            • 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-warning

              Low hormone levels (adrenal insufficiency)

              • 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-warning

                Seizures

                • 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.

                  basics-icon

                  What are the side effects of Codeine/chlorpheniramine?

                  The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

                  Common Side Effects

                  • Drowsiness
                  • Lowered alertness
                  • Dizziness or lightheadedness
                  • Nausea or vomiting
                  • Constipation
                  • Swelling or bloating of your stomach
                  • Stomach pain
                  • Vision problems (blurred vision, double vision)
                  • Confusion
                  • Dry mouth
                  • Shortness of breath
                  • Sweating

                  Other Side Effects

                  • Headache
                  • Feeling high
                  • Feeling excited or nervous
                  • Feeling agitated, restless, or irritable
                  • Trouble sleeping
                  • Uncontrollable muscle movements
                  • Tremor (shaking)
                  • General feeling of discomfort or illness

                  Serious Side Effects

                  Contact your healthcare provider immediately if you experience any of the following.
                  • Slowed breathing
                  • Overdose: slowed breathing, severe drowsiness or sleepiness, not feeling as aware, not responding to sound or touch, slow heartbeat, small pupils the size of a pinhead, blue-gray skin tone
                  • Withdrawal: suicidal thoughts, anxiety, irritability, chills, runny nose, wide pupils, restlessness, yawning, sweating, trouble sleeping

                  Source: DailyMed

                  The following side effects have also been reported

                  Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

                  Although serious side effects occur rarely when this medicine is taken as recommended, they may be more likely to occur if: too much medicine is taken, it is taken in large doses, or it is taken for a long period of time.

                  Get emergency help immediately if any of the following symptoms of overdose occur:

                  For narcotic antitussive (codeine, dihydrocodeine, hydrocodone, or hydromorphone)-containing

                  Cold, clammy skin

                  confusion (severe)

                  convulsions (seizures)

                  drowsiness or dizziness (severe)

                  nervousness or restlessness (severe)

                  pinpoint pupils of eyes

                  slow heartbeat

                  slow or troubled breathing

                  If you are a nursing mother and you notice any of the following symptoms of overdose in your baby, get emergency help immediately:

                  Difficulty breathing

                  difficulty nursing

                  increased sleepiness (more than usual)

                  limpness

                  For acetaminophen-containing

                  Diarrhea

                  increased sweating

                  loss of appetite

                  nausea or vomiting

                  stomach cramps or pain

                  swelling or tenderness in the upper abdomen or stomach area

                  For salicylate-containing

                  Any loss of hearing

                  bloody urine

                  confusion

                  convulsions (seizures)

                  dizziness or lightheadedness

                  drowsiness (severe)

                  excitement or nervousness (severe)

                  fast or deep breathing

                  fever

                  hallucinations (seeing, hearing, or feeling things that are not there)

                  increased sweating

                  nausea or vomiting (severe or continuing)

                  shortness of breath or troubled breathing (for salicylamide only)

                  stomach pain (severe or continuing)

                  uncontrollable flapping movements of the hands, especially in elderly patients

                  unusual thirst

                  vision problems

                  For decongestant-containing

                  Fast, pounding, or irregular heartbeat

                  headache (continuing and severe)

                  nausea or vomiting (severe)

                  nervousness or restlessness (severe)

                  shortness of breath or troubled breathing (severe or continuing)

                  Check with your doctor as soon as possible if any of the following side effects occur:

                  For all combinations

                  Skin rash, hives, and/or itching

                  For antihistamine- or anticholinergic-containing

                  Clumsiness or unsteadiness

                  convulsions (seizures

                  drowsiness (severe)

                  dryness of mouth, nose, or throat (severe)

                  flushing or redness of face

                  hallucinations (seeing, hearing, or feeling things that are not there)

                  restlessness (severe)

                  shortness of breath or troubled breathing

                  slow or fast heartbeat

                  For iodine-containing

                  Headache (continuing)

                  increased watering of mouth

                  loss of appetite

                  metallic taste

                  skin rash, hives, or redness

                  sore throat

                  swelling of face, lips, or eyelids

                  For acetaminophen-containing

                  Unexplained sore throat and fever

                  unusual tiredness or weakness

                  yellow eyes or skin

                  Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

                  Constipation

                  decreased sweating

                  difficult or painful urination

                  dizziness or lightheadedness

                  drowsiness

                  dryness of mouth, nose, or throat

                  false sense of well-being

                  increased sensitivity of skin to sun

                  nausea or vomiting

                  nightmares

                  stomach pain

                  thickening of mucus

                  trouble in sleeping

                  unusual excitement, nervousness, restlessness, or irritability

                  unusual tiredness or weakness

                  Not all of the side effects listed above have been reported for each of these medicines, but they have been reported for at least one of them. There are some similarities among these combination medicines, so many of the above side effects may occur with any of these medicines.

                  Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

                  Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

                  pros-and-cons

                  Pros and cons of Codeine/chlorpheniramine

                  thumbs-up

                  Pros

                  Combines two medications for convenience

                  Works well to treat common cold and allergy symptoms

                  Comes as both a tablet and a liquid suspension

                  Taken twice a day, unlike other cough and cold medications that are taken every few hours

                  Doesn't need to be taken with food

                  thumbs-down

                  Cons

                  Can cause drowsiness

                  Need to avoid alcohol

                  Not safe for children younger than 18 years of age

                  A controlled substance with a risk of dependency, misuse, and overdose

                  Might cause withdrawal symptoms if stopped suddenly after long-term use

                  pharmacist-tips

                  Pharmacist tips for Codeine/chlorpheniramine

                  pharmacist

                  • If you're taking codeine/chlorpheniramine liquid, make sure that you use an appropriate measuring device (measuring cup or oral syringe). If one doesn't come with your medication, ask your pharmacist to give you one. Don't use household spoons, because they might cause you to take the wrong dose, which can lead to an overdose.

                    • Taking too much of codeine/chlorpheniramine can cause many serious side effects and can even slow down your breathing, which is very dangerous. Don't take more of this medication than you're prescribed, and only take it every 12 hours.

                      • Avoid drinking alcohol and taking sedatives (e.g., benzodiazepines) when taking codeine/chlorpheniramine, because it can lower your alertness and slow down your breathing, which can lead to death.

                        • Don't drive or perform any activities that require you to be alert until you know how codeine/chlorpheniramine affects you.

                          • If you've been taking codeine/chlorpheniramine for longer than 5 days and your symptoms haven't improved, talk with your provider so they can make sure your cough and symptoms aren't caused by something else. Don't stop taking it suddenly though, as you might experience withdrawal symptoms. Follow your provider's instructions to lower your dose safely.

                            • Codeine/chlorpheniramine contains an opioid (codeine), which can cause or worsen constipation. Make sure to tell your healthcare provider about your full medical history, especially if you have a history of bowel disease. To help with constipation, get plenty of fiber in your diet and drink lots of water. You can also talk to your provider or pharmacist about over-the-counter stool softener or laxative recommendations to avoid getting backed up while taking codeine/chlorpheniramine.

                              • It's not recommend to breastfeed while taking codeine/chlorpheniramine, since codeine passes into breast milk and can cause life-threatening breathing problems in your baby. Speak to your provider about safe cough, cold, and allergy medications if you're breastfeeding.

                                faqs

                                Frequently asked questions about Codeine/chlorpheniramine

                                Can I stop taking codeine/chlorpheniramine suddenly?
                                Don't stop taking codeine/chlorpheniramine suddenly if you've been taking codeine/chlorpheniramine for a long period of time, because this could cause opioid withdrawal symptoms like vomiting, sweating, anxiety, and irritability. Talk with your provider about when it's safe to stop taking it. They can help you lower your dose safely over several days if necessary.
                                Why is codeine/chlorpheniramine a controlled substance?
                                Codeine/chlorpheniramine has a risk of abuse (using the medication when it's no longer needed for your condition) or dependence (you need to keep taking the medication to prevent withdrawal symptoms). Keep it in a safe place where it can't get stolen. Since codeine/chlorpheniramine is a controlled substance, it's against the law to sell it or give it to someone else (even if they're having cough, cold, or allergy symptoms), and you can only get a limited supply every month.
                                Do I need to take codeine/chlorpheniramine with food?
                                You can take codeine/chlorpheniramine with or without food. Food won't affect how well this medication works. If you're using the liquid, don't mix your dose with other fluids or medications, because this might cause it to be less effective.
                                Are the tablet and liquid forms of codeine/chlorpheniramine the same?
                                The tablet (Tuxarin ER) and liquid (Tuzistra XR) are different brand names of the same combination product (codeine and chlorpheniramine). They're both extended-release formulations, which means they release the medication slowly over time in your body so you don't have to take another dose so often for your cough and cold symptoms. The liquid version might be a better option for people who have trouble swallowing pills.
                                Is codeine/chlorpheniramine safe during pregnancy?
                                No. Taking codeine/chlorpheniramine during pregnancy can cause neonatal opioid withdrawal syndrome, a condition where your unborn baby becomes dependent on codeine/chlorpheniramine while in the womb. Once your baby is born and they're no longer exposed to codeine/chlorpheniramine, they can experience withdrawal symptoms like high-pitched crying, poor feeding and sucking behavior, trembling, irritability, abnormal sleep patterns, and seizures. This can be life-threatening if it's not recognized and treated, and your baby will need special care after birth from experts in this area. If you're pregnant, talk with your provider about alternative medications you can use for your cough, cold, and allergy symptoms.
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                                dosage

                                Codeine/chlorpheniramine dosage forms

                                The average cost for 60 ml of 14.7mg/2.8mg/5ml of Codeine/chlorpheniramine is $81.10 with a free GoodRx coupon. This is 32.41% off the average retail price of $119.99.
                                ml of oral suspension
                                Ml of oral suspension
                                DosageQuantityPrice as low asPrice per unit
                                14.7mg/2.8mg/5ml60 ml$81.10$1.35

                                Typical dosing for Codeine/chlorpheniramine

                                It's recommended to use the lowest dose possible for the shortest duration of time to manage your symptoms.

                                • Tuxarin ER (extended-release tablets): The typical dose is 1 tablet by mouth every twelve hours. Each tablet contains 40 mg of codeine and 5.6 mg of chlorpheniramine.

                                • Tuzistra XR (extended-release suspension): The typical dose is 10 mL (two teaspoonfuls) by mouth every twelve hours. Each 10 mL of medication contains 40 mg of codeine and 8 mg of chlorpheniramine.

                                interactions

                                Interactions between Codeine/chlorpheniramine and other drugs

                                Codeine/chlorpheniramine may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Codeine/chlorpheniramine. Please note that only the generic name of each medication is listed below.

                                Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

                                Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

                                Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                                drug-cost

                                How much does Codeine/chlorpheniramine cost?

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                                Tuzistra XR (brand)
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                                contraindications-icon

                                Codeine/chlorpheniramine contraindications

                                Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Codeine/chlorpheniramine will not be safe for you to take.

                                • Children 11 years and younger

                                • Postoperative pain in children 17 years and younger following tonsillectomy (tonsil removal) or adenoidectomy (adenoid removal)

                                • Slowed breathing (respiratory depression)

                                • Severe asthma

                                • Stomach or intestinal blockage (paralytic ileus)

                                • Currently take or have taken a monoamine oxidase inhibitor (MAOI) or have used an MAOI within 14 days

                                alternatives

                                What are alternatives to Codeine/chlorpheniramine?

                                There are a number of medications that your doctor can prescribe in place of Codeine/chlorpheniramine. Compare a few possible alternatives below.
                                Codeine/chlorpheniramine
                                Used for:

                                • Cough and symptoms due to the common cold and allergies

                                $81.10 Lowest GoodRx priceView Prices
                                Capron DM (dextromethorphan / pyrilamine)
                                Used for:

                                • Cough

                                • Runny nose

                                • Itchy or watery eyes

                                • Itching of the nose and throat

                                $20.18 Lowest GoodRx priceView Prices
                                Nyquil Cough (dextromethorphan / doxylamine)
                                Used for:

                                • Cough caused by minor throat or lung irritation (e.g., common cold)

                                • Runny nose

                                • Sneezing

                                • Watery eyes

                                • Itching

                                $4.86 Lowest GoodRx priceView Prices

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