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Tuzistra XR
CHLORPHENIRAMINE; CODEINE is a combination of an antihistamine and cough suppressant. It is used to treat the symptoms of cough, allergies, and colds. Compare antihistamine / opioid combinations.
Prescription Settings
brand
ml of oral suspension
14.7mg/2.8mg/5ml
120 ml
Tuzistra XR(brand)
ml of oral suspension
14.7mg/2.8mg/5ml
120 ml
Coupon Notice: This drug is a controlled substance. Note that some pharmacies may not honor coupons for controlled substances.
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Commonly Used Brand Name(s)Ala-Hist AC, Ala-Hist DHC, Alavert-D 12-Hour, Aldex D, Alka-Seltzer Plus Cold and Sinus, AllanVan-S, Allegra-D, Aller-Chlor, Allerx-D, Allfen CD, Allres PD, Amibid LA, Benadryl, BPM Pseudo, Bromcomp HC, Bromfed-PD, BroveX CB, By-Ache, Canges-HC, Ceron, Ceron-DM, Chlor-Trimeton Nasal Decongestant, Clarinex-D, Codimal DH, Cotab A, Cotabflu, Cypex-LA, Deconamine SR, Delsym, Dexphen w/C, Donatussin DC, Donnatussin, D-Tann HC, EndaCof-DC, FluTuss XP, Genapap Sinus, G Phen DM, HC Tussive, Histex PD, Humibid DM, Hycodan, Hycofenix, Hydone, HyTan, Kie, Levall 12, Lusonal, Maxiflu CD, Maxiphen CD, M-End Max D, Mucinex D, Nasop, Notuss-Forte, Notuss-NX, Notuss-NXD, Novahistine DH, Pancof HC, Pediatex 12, Pediatex 12D, Pediatex 12DM, Pediatex-D, Phenergan w/Codeine, Phenflu CD, Phenylephrine CM, Phenylhistine, Poly-Tussin AC, Poly-Tussin DHC, Pro-Clear AC, Promethazine VC With Codeine, Pro-Red AC, RelaTuss HC, Robitussin, Robitussin DM, Ryneze, Semprex-D, SSKI, Stahist, Sudafed, SymTan, SymTan A, Tanafed DMX, Tannate Pediatric, Tessalon Perles, Triacin C, Tricold Pediatric Drops, Tripohist D, Tussi-12 S, TussiCaps, Tuzistra XR, Tylenol, Uni-Tann D, Vituz, Xpect-PE, Y-Cof DM, Z-COF DM, Zhist, Zodryl DAC 25, Zotex-D, Zymine, Zymine HC, ZyrTEC-D, Actifed Sinus Regular, Adult Nighttime Cold/Flu Relief - Cherry Flavor, Adult Nighttime Cold/Flu Relief - Original Flavor, Allergy Sinus Medication Extra Strength, Atoma Night Adult Cold/Flu Relief, Balminil, Balminil Dm Children, Balminil Dm Sugar-Free, Balminil Expectorant, Balminil Expectorant Sugar-Free, Balminil With Sugar, Benadryl Allergy, Sinus And Headache

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OverviewTOP

Cough/cold combinations are used mainly to relieve the cough due to colds, influenza, or hay fever. They are not to be used for the chronic cough that occurs with smoking, asthma, or emphysema or when there is an unusually large amount of mucus or phlegm (pronounced flem) with the cough.

Cough/cold combination products contain more than one ingredient. For example, some products may contain an antihistamine, a decongestant, and an analgesic, in addition to a medicine for coughing. If you are treating yourself, it is important to select a product that is best for your symptoms. Also, in general, it is best to buy a product that includes only those medicines you really need. If you have questions about which product to buy, check with your pharmacist.

Since different products contain ingredients that will have different precautions and side effects, it is important that you know the ingredients of the medicine you are taking. The different kinds of ingredients that may be found in cough/cold combinations include:

Antihistamines—Antihistamines are used to relieve or prevent the symptoms of hay fever and other types of allergy. They also help relieve some symptoms of the common cold, such as sneezing and runny nose. They work by preventing the effects of a substance called histamine, which is produced by the body. Some examples of antihistamines contained in these combinations are:

Decongestants—Decongestants produce a narrowing of blood vessels. This leads to clearing of nasal congestion. However, this effect may also increase blood pressure in patients who have high blood pressure. These include:

Antitussives—Antitussives help relieve coughing and are some contain a narcotic. These antitussives act directly on the cough center in the brain. Narcotics may become habit-forming, causing mental or physical dependence, if used for a long time. Physical dependence may lead to withdrawal side effects when you stop taking the medicine.

Expectorants—Expectorants work by loosening the mucus or phlegm in the lungs. The main expectorant used in cough and cold medicines is guaifenesin. Other ingredients added as expectorants (for example, ammonium chloride, calcium iodide, iodinated glycerol, ipecac, potassium guaiacolsulfonate, potassium iodide, and sodium citrate) have not been proven to be effective. In general, the best thing you can do to loosen mucus or phlegm is to drink plenty of water.

Analgesics—Analgesics are used in these combination medicines to help relieve the aches and pain that may occur with the common cold. These include:

The use of too much acetaminophen and salicylates at the same time may cause kidney damage or cancer of the kidney or urinary bladder. This may occur if large amounts of both medicines are taken together for a long time. However, taking the recommended amounts of combination medicines that contain both acetaminophen and a salicylate for short periods of time has not been shown to cause these unwanted effects.

Anticholinergics—Anticholinergics, such as homatropine may help produce a drying effect in the nose and chest.

These cough and cold combinations are available both over-the-counter (OTC) and with your doctor's prescription.

Do not give any over-the-counter (OTC) cough and cold medicine to a baby or child under 4 years of age. Using these medicines in very young children might cause serious or possibly life-threatening side effects .

Proper UseTOP

To help loosen mucus or phlegm in the lungs, drink a glass of water after each dose of this medicine, unless otherwise directed by your doctor.

Take this medicine only as directed. Do not take more of it and do not take it more often than recommended on the label, unless otherwise directed by your doctor. To do so may increase the chance of side effects.

Do not give any over-the-counter (OTC) cough and cold medicine to a baby or child under 4 years of age. Using these medicines in very young children might cause serious or possibly life-threatening side effects .

For patients taking the extended-release capsule or tablet form of this medicine:

  • Swallow the capsule or tablet whole.
  • Do not crush, break, or chew before swallowing.
  • If the capsule is too large to swallow, you may mix the contents of the capsule with applesauce, jelly, honey, or syrup and swallow without chewing.

For patients taking the extended-release oral solution or oral suspension form of this medicine:

  • Do not dilute with fluids or mix with other drugs.

For patients taking a combination medicine containing an antihistamine and/or aspirin or other salicylate:

  • Take with food or a glass of water or milk to lessen stomach irritation, if necessary.

If a combination medicine containing aspirin has a strong vinegar-like odor, do not use it. This odor means the medicine is breaking down. If you have any questions about this, check with your pharmacist.

Missed DoseTOP

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Use & StorageTOP

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Keep the liquid form of this medicine from freezing. Do not refrigerate the syrup.

AllergiesTOP

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

PediatricTOP

Very young children are usually more sensitive to the effects of this medicine. Before giving any of these combination medicines to a child, check the package label very carefully. Some of these medicines are too strong for use in children. If you are not certain whether a specific product can be given to a child, or if you have any questions about the amount to give, check with your health care professional, especially if it contains:

  • Antihistamines—Nightmares, unusual excitement, nervousness, restlessness, or irritability may be more likely to occur in children taking antihistamines.
  • Decongestants (e.g., ephedrine, phenylephrine, pseudoephedrine—Increases in blood pressure may be more likely to occur in children taking decongestants.
  • Iodides (e.g., calcium iodide and iodinated glycerol)—These medicines pass into the breast milk and may cause unwanted effects, such as underactive thyroid, in the baby.
  • Narcotic antitussives (e.g., codeine, dihydrocodeine, hydrocodone, and hydromorphone)—Breathing problems may be especially likely to occur in children younger than 2 years of age taking narcotic antitussives. Also, unusual excitement or restlessness may be more likely to occur in children receiving these medicines.
  • Salicylates (e.g., aspirin)—Do not give medicines containing aspirin or other salicylates to a child or teenager with a fever or other symptoms of a virus infection, especially flu or chickenpox, without first discussing its use with your child's doctor. This is very important because salicylates may cause a serious illness called Reye's syndrome in children with fever caused by a virus infection, especially flu or chickenpox. Also, children may be more sensitive to the aspirin or other salicylates contained in some of these medicines, especially if they have a fever or have lost large amounts of body fluid because of vomiting, diarrhea, or sweating.

Do not give any over-the-counter (OTC) cough and cold medicine to a baby or child under 4 years of age. Using these medicines in very young children might cause serious or possibly life-threatening side effects .

GeriatricTOP

The elderly are usually more sensitive to the effects of this medicine, especially if it contains:

  • Antihistamines—Confusion, difficult or painful urination, dizziness, drowsiness, feeling faint, or dryness of mouth, nose, or throat may be more likely to occur in elderly patients. Also, nightmares or unusual excitement, nervousness, restlessness, or irritability may be more likely to occur in the elderly taking antihistamines.
  • Decongestants (e.g., ephedrine, phenylephrine, pseudoephedrine—Confusion, hallucinations, drowsiness, or convulsions (seizures) may be more likely to occur in the elderly, who are usually more sensitive to the effects of this medicine. Also, increases in blood pressure may be more likely to occur in elderly persons taking decongestants.

PregnancyTOP

The occasional use of a cough/cold combination is not likely to cause problems in the fetus or in the newborn baby. However, when these medicines are used at higher doses and/or for a long time, the chance that problems might occur may increase. For the individual ingredients of these combinations, the following information should be considered before you decide to use a particular cough/cold combination:

  • Acetaminophen—Studies on birth defects have not been done in humans. However, acetaminophen has not been shown to cause birth defects or other problems in humans.
  • Alcohol—Some of these combination medicines contain a large amount of alcohol. Too much use of alcohol during pregnancy may cause birth defects.
  • Antihistamines—Antihistamines have not been shown to cause problems in humans.
  • Caffeine—Studies in humans have not shown that caffeine causes birth defects. However, studies in animals have shown that caffeine causes birth defects when given in very large doses (amounts equal to the amount of caffeine contained in 12 to 24 cups of coffee a day).
  • Codeine—Although studies on birth defects with codeine have not been done in humans, it has not been reported to cause birth defects in humans. Codeine has not been shown to cause birth defects in animal studies, but it caused other unwanted effects. Also, regular use of narcotics during pregnancy may cause the baby to become dependent on the medicine. This may lead to withdrawal side effects after birth. In addition, narcotics may cause breathing problems in the newborn baby if taken by the mother just before delivery.
  • Hydrocodone—Although studies on birth defects with hydrocodone have not been done in humans, it has not been reported to cause birth defects in humans. However, hydrocodone has been shown to cause birth defects in animals when given in very large doses. Also, regular use of narcotics during pregnancy may cause the baby to become dependent on the medicine. This may lead to withdrawal side effects after birth. In addition, narcotics may cause breathing problems in the newborn baby if taken by the mother just before delivery.
  • Iodides (e.g., calcium iodide and iodinated glycerol)—Not recommended during pregnancy. Iodides have caused enlargement of the thyroid gland in the fetus and resulted in breathing problems in newborn babies whose mothers took iodides in large doses for a long period of time.
  • Phenylephrine—Studies on birth defects with phenylephrine have not been done in either humans or animals.
  • Pseudoephedrine—Studies on birth defects with pseudoephedrine have not been done in humans. In animal studies pseudoephedrine did not cause birth defects but did cause a decrease in average weight, length, and rate of bone formation in the animal fetus when given in high doses.
  • Salicylates (e.g., aspirin)—Studies on birth defects in humans have been done with aspirin, but not with salicylamide or sodium salicylate. Salicylates have not been shown to cause birth defects in humans. However, salicylates have been shown to cause birth defects in animals.

Some reports have suggested that too much use of aspirin late in pregnancy may cause a decrease in the newborn's weight and possible death of the fetus or newborn infant. However, the mothers in these reports had been taking much larger amounts of aspirin than are usually recommended. Studies of mothers taking aspirin in the doses that are usually recommended did not show these unwanted effects. However, there is a chance that regular use of salicylates late in pregnancy may cause unwanted effects on the heart or blood flow in the fetus or newborn baby.

Use of salicylates, especially aspirin, during the last 2 weeks of pregnancy may cause bleeding problems in the fetus before or during delivery, or in the newborn baby. Also, too much use of salicylates during the last 3 months of pregnancy may increase the length of pregnancy, prolong labor, cause other problems during delivery, or cause severe bleeding in the mother before, during, or after delivery. Do not take aspirin during the last 3 months of pregnancy unless it has been ordered by your doctor.

Breast FeedingTOP

If you are breastfeeding, the chance that problems might occur depends on the ingredients of the combination. For the individual ingredients of these combinations, the following apply:

  • Acetaminophen—Acetaminophen passes into the breast milk. However, it has not been reported to cause problems in nursing babies.
  • Alcohol—Alcohol passes into the breast milk. However, the amount of alcohol in recommended doses of this medicine does not usually cause problems in nursing babies.
  • Antihistamines—Small amounts of antihistamines pass into the breast milk. Antihistamine-containing medicine is not recommended for use while breastfeeding since most antihistamines are especially likely to cause side effects, such as unusual excitement or irritability, in the baby. Also, since antihistamines tend to decrease the secretions of the body, the flow of breast milk may be reduced in some patients.
  • Caffeine—Small amounts of caffeine pass into the breast milk and may build up in the nursing baby. However, the amount of caffeine in recommended doses of this medicine does not usually cause problems in nursing babies.
  • Codeine and other narcotic cough medicines (e.g., dihydrocodeine, hydrocodone, and hydromorphone)—Codeine is changed to morphine in the body. Some people change codeine to morphine more quickly than others. These individuals are called "ultra-rapid metabolizers of codeine". If a nursing mother is an ultra-rapid metabolizer of codeine, it could lead to a morphine overdose in the nursing baby and cause very serious side effects. A nursing mother should talk to her doctor if she has any questions about taking codeine or about how this medicine may affect her baby .
  • Decongestants (e.g., ephedrine, phenylephrine, pseudoephedrine—Phenylephrine has not been reported to cause problems in nursing babies. Ephedrine and pseudoephedrine pass into the breast milk and may cause unwanted effects in nursing babies (especially newborn and premature babies).
  • Iodides (e.g., calcium iodide and iodinated glycerol)—These medicines pass into the breast milk and may cause unwanted effects, such as underactive thyroid, in the baby.
  • Salicylates (e.g., aspirin)—Salicylates pass into the breast milk. Although salicylates have not been reported to cause problems in nursing babies, it is possible that problems may occur if large amounts are taken regularly.

Drug InteractionsTOP

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.

Other InteractionsTOP

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Using medicines in this class with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use your medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol
  • Grapefruit Juice
  • Tobacco

Other Medical ProblemsTOP

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse (or history of)—Acetaminophen-containing medicines increase the chance of liver damage; also, some of the liquid medicines contain a large amount of alcohol.
  • Brain disease or injury or
  • Colitis or
  • Convulsions (seizures) (history of) or
  • Diarrhea or
  • Gallbladder disease or gallstones—These conditions may become worse if you are taking a combination medicine containing codeine, dihydrocodeine, hydrocodone, or hydromorphone
  • Diabetes mellitus (sugar diabetes)—Decongestants may put diabetic patients at greater risk of having heart or blood vessel disease.
  • Emphysema, asthma, or chronic lung disease (especially in children)—Salicylate-containing medicine may cause an allergic reaction in which breathing becomes difficult.
  • Enlarged prostate or
  • Urinary tract blockage or difficult urination—Some of the effects of anticholinergics (e.g., homatropine) or antihistamines may make urinary problems worse.
  • Glaucoma—A slight increase in inner eye pressure may occur with the use of anticholinergics (e.g., homatropine) or antihistamines, which may make the condition worse.
  • Heart or blood vessel disease or
  • High blood pressure—Decongestant-containing medicine may increase the blood pressure and speed up the heart rate; also, caffeine-containing medicine, if taken in large amounts, may speed up the heart rate.
  • Kidney disease—This condition may increase the chance of side effects of this medicine because the medicine may build up in the body.
  • Liver disease—Liver disease increases the chance of side effects because the medicine may build up in the body; also, if liver disease is severe, there is a greater chance that aspirin-containing medicine may cause bleeding.
  • Thyroid disease—If an overactive thyroid has caused a fast heart rate, the decongestant in this medicine may cause the heart rate to speed up further; also, if the medicine contains narcotic antitussives (e.g., codeine), iodides (e.g., iodinated glycerol), or salicylates, the thyroid problem may become worse.

PrecautionsTOP

If your cough has not improved after 7 days or if you have a high fever, skin rash, continuing headache, or sore throat with the cough, check with your doctor. These signs may mean that you have other medical problems.

For patients taking a codeine-containing medicine or any other narcotic analgesics (e.g., dihydrocodeine, hydrocodone, oxycodone, and pentazocine):

  • Contact your doctor immediately if you experience extreme sleepiness, confusion, or shallow breathing. These symptoms may indicate that you are an "ultra-rapid metabolizer of codeine". Ultra-rapid metabolizers change codeine to morphine more quickly and completely than other people. As a result, there is too much morphine in the body and more side effects of morphine than usual

For nursing mothers taking a codeine-containing medicine or any other narcotic cough medicine (dihydrocodeine, hydrocodone, or hydromorphone):

  • Call your doctor if you become extremely tired and have difficulty caring for your baby.
  • Your baby should generally nurse every two to three hours and should not sleep more than four hours at a time.
  • Check with your doctor or hospital emergency room immediately if your baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, difficulty breathing, or limpness. These may be symptoms of an overdose and need immediate medical attention .

For patients taking antihistamine-containing medicine:

  • Before you have any skin tests for allergies, tell the doctor in charge that you are taking this medicine. The results of the test may be affected by the antihistamine in this medicine.
  • This medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are taking this medicine.
  • This medicine may cause some people to become drowsy, dizzy, or less alert than they are normally.
  • Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert.
  • When taking antihistamines on a regular basis, make sure your doctor knows if you are taking large amounts of aspirin at the same time (as in arthritis or rheumatism). Effects of too much aspirin, such as ringing in the ears, may be covered up by the antihistamine.
  • Antihistamines may cause dryness of the mouth. For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

For patients taking decongestant-containing medicine:

  • This medicine may add to the central nervous system (CNS) stimulant effects of diet aids. Do not use medicines for diet or appetite control while taking this medicine unless you have checked with your doctor.
  • This medicine may cause some people to be nervous or restless or to have trouble in sleeping. If you have trouble in sleeping, take the last dose of this medicine for each day a few hours before bedtime. If you have any questions about this, check with your doctor.
  • Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine.

For patients taking narcotic antitussive (codeine, dihydrocodeine, hydrocodone, or hydromorphone)-containing medicine:

  • This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are taking this medicine.
  • This medicine may cause some people to become drowsy, dizzy, less alert than they are normally, or to feel a false sense of well-being. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert and clearheaded.
  • Nausea or vomiting may occur after taking a narcotic antitussive. This effect may go away if you lie down for a while. However, if nausea or vomiting continues, check with your doctor.
  • Dizziness, lightheadedness, or fainting may be especially likely to occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem.
  • Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine.

For patients taking iodide (calcium iodide, iodinated glycerol, or potassium iodide)-containing medicine:

  • Make sure your doctor knows if you are planning to have any future thyroid tests. The results of the thyroid test may be affected by the iodine in this medicine.

For patients taking analgesic-containing medicine:

  • Check the label of all nonprescription (over-the-counter [OTC]), and prescription medicines you now take. If any contain acetaminophen or aspirin or other salicylates, including diflunisal or bismuth subsalicylate, be especially careful. Taking them while taking a cough/cold combination medicine that already contains them may lead to overdose. If you have any questions about this, check with your health care professional.
  • Do not take aspirin-containing medicine for 5 days before any surgery, including dental surgery, unless otherwise directed by your medical doctor or dentist. Taking aspirin during this time may cause bleeding problems.

For diabetic patients taking aspirin- or sodium salicylate-containing medicine:

  • False urine sugar test results may occur:
    • If you take 8 or more 325-mg doses of aspirin every day for several days in a row.
    • If you take 8 or more 325-mg or 4 or more 500-mg doses of sodium salicylate.
  • Smaller doses or occasional use of aspirin or sodium salicylate usually will not affect urine sugar tests. If you have any questions about this, check with your health care professional, especially if your diabetes is not well controlled.

For patients taking homatropine-containing medicine:

  • This medicine may make you sweat less, causing your body temperature to increase. Use extra care not to become overheated during exercise or hot weather while you are taking this medicine since overheating may result in heat stroke. Also, hot baths or saunas may make you feel dizzy or faint while you are taking this medicine.
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