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codeine / guaifenesin / pseudoephedrine

Generic Virtussin Dac
Used for Nasal Congestion, Cold Symptoms, Cough
Used for Nasal Congestion, Cold Symptoms, Cough

Virtussin Dac is a combination of three medications: codeine (an opioid), guaifenesin (an expectorant), and pseudoephedrine (a decongestant). It's used to treat symptoms of the common cold in adults and children, like cough and stuffy nose. But it's not a recommended medication for children younger than 12 years old because of the higher risk of serious side effects. Virtussin Dac is a liquid that's taken by mouth every 4 hours. Side effects include constipation, dizziness, and sleepiness or restlessness. Because Virtussin Dac contains codeine, it's considered a controlled substance.

Please note: Virtussin Dac has been discontinued and is no longer available in the United States. Talk to your care team about alternative options to treat your symptoms.

Reviewed by:
reviewer
Robert Chad Hakim, PharmD, BCCCP
reviewer
Kristianne Hannemann, PharmD
Last reviewed on July 31, 2024
BasicsWarningsSide effectsPros & consPharmacist tipsFAQsDosageInteractionsContraindicationsAlternativesReferencesPricesMedicare
Virtussin Dac 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 Virtussin Dac?

What is Virtussin Dac used for?

Temporary relief of common cold symptoms, including:

  • Cough from minor throat irritations

  • Stuffy nose (nasal congestion)

  • Chest congestion

How Virtussin Dac works

Virtussin Dac is a combination of three medications that work together to relieve symptoms caused by the common cold.

  • Codeine is an opioid medication. It eases cough by attaching to opioid receptors in the brain that control the urge to cough.

  • Guaifenesin is an expectorant that loosens mucus in your airways by making it thinner. This makes it easier to cough out mucus and help clear chest congestion.

  • Pseudoephedrine is a decongestant, which works to relieve stuffy nose. It makes the blood vessels around your nose more narrow, which eases nasal swelling and pressure. This allows you to breathe more freely and to have better sinus drainage.

Are you looking for information on Robitussin AC (codeine / guaifenesin) or Histex-AC (codeine / phenylephrine / triprolidine) instead?

Drug Facts

Common BrandsVirtussin DAC (branded generic), Tusnel C
Drug ClassOpioid / Expectorant / Decongestant
Controlled Substance ClassificationSchedule V
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
warings-icon

What are the risks and warnings for Virtussin Dac?

Virtussin Dac 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 and misuse

  • Risk factors: Personal or family history of alcohol or substance use disorder | Personal or family history of mental health problems

    Codeine in Virtussin Dac is a controlled substance because it has a risk for addiction and misuse. Take the medication exactly as prescribed. Doing so can raise the risk for serious and possibly life-threatening side effects, such as dangerously slow breathing, inability to stay awake, and opioid overdose. Your healthcare professional (HCP) will prescribe the lowest amount of Virtussin Dac that's necessary to manage your symptoms for the shortest period of time possible.

    Because of the risk for misuse and dependency, Virtussin Dac is only available through a Risk Evaluation and Mitigation Strategy (REMS) program called the Opioid Analgesic REMS program. The FDA-required REMS program for Virtussin Dac helps make sure the medication is distributed and used in a safe manner. Your HCP must register with the program and receive training on proper medication use. Under this program, they'll discuss with you about safe and responsible storage, use, and disposal of Virtussin Dac.

    risk-warning

    Dangerously slow breathing (respiratory depression)

    • Risk factors: Taking medications that can cause slow breathing | Drinking alcohol | Older age | Being frail | Medical conditions that cause breathing problems (e.g., COPD, asthma, head injury) | Taking too much Virtussin Dac

      Codeine in Virtussin Dac can cause dangerously slow breathing, which can be life-threatening. This can happen to anyone, but the risk is greatest when you first start treatment or if your prescriber raises the dose. Don't take Virtussin Dac with alcohol or other medications that slow your body down (e.g., benzodiazepines, other opioids, muscle relaxants). Doing so puts you at higher risk of extremely slowed breathing. If you or your loved one notices that you have trouble breathing or have bluish-colored lips, fingers, or toes, call 911 to get medical help right away.

      risk-warning

      Opioid overdose

      • Risk factors: History of opioid use disorder | Previous opioid overdose | Taking high doses of Virtussin Dac | Taking more opioids than prescribed | Alcohol use

        Take Virtussin Dac exactly as prescribed. Taking too much Virtussin Dac or taking it more often than prescribed can lead to an accidental overdose. Symptoms of an opioid overdose include not responding to sound or touch, extremely slowed breathing, extreme sleepiness, slow heartbeat, and cold or clammy skin.

        Be sure you and your loved ones know how to recognize an overdose. Naloxone is a medication that can treat an opioid overdose. Your HCP might ask you to carry naloxone with you at all times in case you experience an overdose. Call 911 right away if this happens. Store your medication out of reach from children, pets, or visitors to prevent accidental exposure or overdose.

        risk-warning

        Difficulty concentrating and extreme sleepiness

        • Risk factors: Taking high doses of Virtussin Dac | Age 65 years or older | Younger than 18 years old | Drinking alcohol | Taking other medications that can cause sleepiness

          Codeine in Virtussin Dac can cause extreme sleepiness and lower your ability to think, react, and focus. Don't drink alcohol or take other medications that can cause sleepiness or "brain fog" (e.g., benzodiazepines, muscle relaxants, sleep medications) with Virtussin Dac. Doing so can worsen these side effects. Make sure you know how Virtussin Dac affects you before driving a car or doing activities that require your concentration. Talk to your HCP away if you feel too sleepy from taking Virtussin Dac.

          risk-warning

          Dangerous interactions

          Codeine in Virtussin Dac interacts with a lot of common medications. Some medications can raise Virtussin Dac levels in your body, which can raise your risk for side effects and even potentially life-threatening slowed breathing. These medications include erythromycin, ketoconazole, and ritonavir (Norvir).

          Other medications, such as rifampin (Rifadin) and carbamazepine (Tegretol), can lower the levels of Virtussin Dac in your body. This can cause Virtussin Dac to not work as well. These interactions might also cause withdrawal symptoms.

          If you're already taking stable doses of Virtussin Dac together with one of these other medications, don't stop taking them suddenly without first talking with your prescriber. Doing so can also lead to unsafe Virtussin Dac levels. Let your prescriber or pharmacist know what other medications you're taking before starting Virtussin Dac to make sure your medications are safe for you to take.

          risk-warning

          Harm to newborn babies

          If you're pregnant or thinking of becoming pregnant, talk with your HCP before taking Virtussin Dac. This medication isn't recommended in pregnancy because there's chance that pseudoephedrine and codeine in Virtussin Dac can cause harm to unborn babies. If you have cold symptoms during pregnancy, your HCP can talk with you about safer options.

          risk-warning

          Low blood pressure

          Codeine in Virtussin Dac can cause extremely low blood pressure. Your blood pressure might drop suddenly when you stand from a sitting or lying down position. This can lead to dizziness and fainting. To avoid falling, get up slowly if you've been sitting or lying down. If dizziness or lightheadedness doesn't go away, talk to your healthcare team.

          risk-warning

          Seizures

          • Risk factors: History of seizure conditions

            If you've had a seizure in the past, opioids like codeine in Virtussin Dac can raise the risk of having seizures more often. Virtussin Dac can also raise your risk of seizures in certain situations. Get medical help immediately if you have a seizure while taking Virtussin Dac.

            basics-icon

            What are the side effects of Virtussin Dac?

            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

            • Sleepiness
            • Dizziness
            • Constipation
            • Nausea
            • Sweating

            Other Side Effects

            • Nervousness
            • Headache
            • Shakiness

            Serious Side Effects

            Contact your healthcare provider immediately if you experience any of the following.
            • Dangerously slow breathing: trouble breathing; bluish-colored lips, fingers, or toes
            • Accidentally taking too much (overdose): not responding to sound or touch, slowed breathing, extreme sleepiness, slow heartbeat, cold or clammy skin
            • Opioid withdrawal: anxiety, suicidal thoughts, irritability, restlessness, runny nose, yawning, sweating, chills, wide pupils
            • Serious allergic reaction: itchy, red rash (hives); difficulty breathing; chest tightness; swelling of lips, tongue, throat, face, or eyes

            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 Virtussin Dac

            thumbs-up

            Pros

            Can treat a wide variety of symptoms for common cold

            Combines three medications into one liquid for convenience

            Available as a liquid

            Can take with or without food

            thumbs-down

            Cons

            Effects last about 4 hours

            Has potential for misuse

            Can cause constipation

            Not for long-term use

            pharmacist-tips

            Pharmacist tips for Virtussin Dac

            pharmacist

            • You can take Virtussin Dac with or without food. If it upsets your stomach, taking it with food might help.

              • When measuring your dose of Virtussin Dac, use the medication dose cup or oral syringe provided by your pharmacy. Don't use household spoons, because they aren't accurate and might cause you to take the wrong dose.

                • If Virtussin Dac is making you sleepy or dizzy during the day, it can affect your ability to focus, think, or react. Don't drive until you know how this medication affects you. Also, avoid alcohol while taking this medication because it can make sleepiness worse.

                  • Stop using Virtussin Dac and contact your primary care provider if your symptoms last more than a week or come back after clearing up. Also tell them if you have a rash, fever, or headache along with your cough or stuffy nose. These might be signs that you need more medical attention.

                    • Tell your care team about all the medications you're taking to make sure Virtussin Dac is safe for you. Don't start any new medications while taking Virtussin Dac, especially other medications with opioids, expectorants, or decongestants, without talking to your care team first. Doing so can raise your risk of overdose and severe side effects, including slowed breathing, dizziness, and sleepiness.

                      • Store Virtussin Dac out of reach from children, pets, or visitors. If you don't need to take Virtussin Dac anymore, choose a medication take-back option to get rid of it safely. This lowers the risk of accidental overdose and helps prevent medication misuse.

                        faqs

                        Frequently asked questions about Virtussin Dac

                        Is Virtussin Dac still available?
                        No, Virtussin Dac is no longer available. It's not clear why Virtussin Dac was discontinued and removed from the market.
                        Does Virtussin Dac make you sleepy?
                        Yes, it's possible to feel sleepy after you take Virtussin Dac because it contains codeine. However, Virtussin Dac also contains pseudoephedrine, which can have the opposite effect and make you stay awake. Pay attention to how Virtussin Dac affects your sleep. Contact your primary care provider to discuss better options for you if it's making you too sleepy or interrupting your sleep and affecting your daily activities.
                        Does Virtussin Dac cause constipation?
                        Yes. Virtussin Dac contains codeine, which is an opioid. This class of medication is known to cause constipation as a side effect. You might be constipated if you pass a bowel movement less than 3 times a week. To ease constipation, drink water to stay hydrated and eat fiber-rich foods. If these lifestyle changes aren't enough, ask your primary care provider about constipation medications that might help or a change to your treatment plan.
                        Is Virtussin Dac a controlled substance?
                        Yes. Virtussin Dac is a schedule V controlled substance because it contains codeine, which is an opioid. Opioids are controlled substances because they have higher potential for causing addiction or being abused. There are state and federal laws around controlled substances that limit how much medication can be prescribed or dispensed within a certain time frame. Talk with your healthcare professional (HCP) if you have concerns about Virtussin Dac.
                        Can I use Virtussin Dac only when I need it?
                        Yes, Virtussin Dac is typically prescribed as needed when you have symptoms. Usually, the HCP will ask you to take the lowest dose for the shortest amount of time to avoid side effects like constipation and to lower the risk of dependence. You don't need to take Virtussin Dac is your symptoms are going away.
                        Can I take Virtussin Dac if I'm pregnant or breastfeeding?
                        If you're pregnant or breastfeeding, ask your obstetrician-gynecologist (OB-GYN) whether you can take Virtussin Dac. Codeine and pseudoephedrine in Virtussin Dac aren't recommended during pregnancy because they can cause harm to the growing baby. They're also not recommended during nursing because codeine can pass into breastmilk and affect nursing babies, while pseudoephedrine can dry up breastmilk. Ask your OB-GYN about safer ways to treat cold symptoms during pregnancy and nursing.
                        Why can't children younger than 6 years old take Virtussin Dac?
                        Children younger than 6 years old can't take Virtussin Dac because their risk for overdose and side effects is higher. The codeine component of Virtussin Dac can cause serious life-threatening breathing problems, especially in children younger than 12 years old. If your young child is having common cold or cough symptoms, ask your child's care team about other treatment options.
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                        dosage

                        Virtussin Dac dosage forms

                        Typical dosing for Virtussin Dac

                        Each 5 mL of Virtussin DAC contains 10 mg of codeine, 100 mg of guaifenesin, and 30 mg of pseudoephedrine.

                        • Adults and children 12 years or older: The typical dose is 2 teaspoonfuls (10 mL) by mouth every 4 hours.

                        • Children ages 6 to 11 years old: The typical dose is 1 teaspoonful (5 mL) by mouth every 4 hours, or as directe by a HCP.

                        • Children under 6 years old: Ask your child's pediatrician.

                        interactions

                        Interactions between Virtussin Dac and other drugs

                        Virtussin Dac 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 Virtussin Dac. 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.

                        contraindications-icon

                        Virtussin Dac 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 Virtussin Dac will not be safe for you to take.

                        • Children younger than 2 years old

                        • Severely slowed breathing (respiratory depression)

                        • Severe asthma or other breathing conditions

                        • Currently take or have taken an monoamine oxidase inhibitor (MAOI) in the last 2 weeks

                        alternatives

                        What are alternatives to Virtussin Dac?

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

                        Temporary relief of common cold symptoms, including:

                        • Cough from minor throat irritations

                        • Stuffy nose (nasal congestion)

                        • Chest congestion

                        View Prices
                        Deconex DMX
                        Used for:

                        • Loosen phlegm (mucus) in the lungs to make it easier to cough up

                        • Short-term relief of cough and stuffy nose (nasal congestion)

                        $12.64 Lowest GoodRx priceView Prices
                        Capmist DM
                        Used for:

                        • Chest congestion

                        • Sinus congestion and pressure

                        • Stuffy nose

                        • Cough

                        $14.12 Lowest GoodRx priceView Prices

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                        References

                        Best studies we found

                        Fiedorowicz, J. G., et al. (2004). The role of monoamine oxidase inhibitors in current psychiatric practice. Journal of Psychiatric Practice.

                        Johnson, D. A., et al. (1993). The pharmacology of alpha-adrenergic decongestants. Pharmacotherapy.

                        Lannett Company, Inc. (2019). Codeine sulfate- codeine sulfate tablet [package insert]. DailyMed.

                        View All References (6)

                        Peechakara, B. V., et al. (2024). Codeine. StatPearls.

                        U.S. Food and Drug Administration. (2022). Drug disposal: Drug take back locations.

                        U.S. Food and Drug Administration. (2023). FDA Drug Safety Communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women.

                        U.S. Food and Drug Administration. (2023). Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS).

                        United States Drug Enforcement Administration. (n.d.). The Controlled Substances Act.

                        Virtus Pharmaceuticals. (2022). Virtussin DAC- codeine phosphate, guaifenesin, and pseudoephedrine hydrochloride liquid [package insert]. DailyMed.

                        GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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