Chlorpheniramine and Codeine Polistirex (Oral)

As a narcotic cough suppressant, Chlorpheniramine and Codeine Polistirex is beneficial in the treatment of coughing and other respiratory symptoms associated with colds and allergies.

Overview

As a combination medication, Chlorpheniramine and Codeine Polistirex can be used to relieve coughing and other symptoms associated with common cold or upper respiratory allergies. It is a single product which contains two standalone medicines: Chlorpheniramine, an antihistamine, and Codeine, an opiate.

Chlorpheniramine functions by treating the symptoms of allergies, such as itchy eyes/nose/skin/throat, rash, cough, sneezing, runny nose and watery eyes. It blocks a naturally occurring substance, histamine, which the body produces during allergic reactions. By blocking histamine and another substances (acetylcholine), Chlorpheniramine helps to dry up body fluids and reduce certain allergic reactions. Its sedative effects are reasonably weak compared to alternative first-generation antihistamines, making it a popular choice for patients who want a "non-drowsy"remedy to cough and common cold.

Codeine is an opioid medication which is used to treat moderate to severe pain and is found in many common over the counter and prescription cough medicines. It is a fast-acting analgesic and typically begins to work half an hour after ingestion, lasting for up to six hours in total. It has been used as a mainstream painkiller for nearly 200 years and is the most commonly taken opiate in the world. It is currently listed by the World Health Organization (WHO) as an essential medicine.

When combined, Chlorpheniramine and Codeine are often marketed in the US as Tuzistra XR. In some instances, this combination of medicines may also be used for undocumented purposes, also known as "off-label"use, at the discretion of the prescribing doctor.

Conditions treated

Type of medicine

  • Combined antihistamine and analgesic

Side effects

Along with the required effects, Chlorpheniramine and Codeine Polistirex can also cause various unwanted side effects. The most common side effects reported by patients undergoing treatment with this medicine include: anxiety, bloating, belching, chills, blurry vision, clammy skin, cold sweats, dark colored urine, confusion, depression, difficulty urinating, diarrhea, disturbed color perception, dizziness or light-headedness when getting up suddenly from a prone position, dryness in the throat, a feeling of movement, fever, headache, seeing halos around lights, increased hunger, heartburn, indigestion, loss of appetite, irregular breathing, nausea, night-blindness, nervousness, overbright appearance of lights, pressure in the stomach, pale or blue lips, pain or discomfot in the chest, seizures, shakiness, drowsiness or sleepiness, slurred speech, sweating, stomach discomfort, tunnel vision, vomiting, yellow skin or eyes.

Most (if not all) of these side effects should lessen over time as the patient continues to take Chlorpheniramine and Codeine Polistirex as prescribed. If any effects persist over a prolonged period or get worse over time, the patient is advised to inform his or her doctor immediately. In some instances, a doctor or healthcare professional may be able to advise the patient on how to alleviate some side effects, such as drinking water or sucking on sugar-free rock candy to reduce the sensation of a dry throat, for example.

Other side effects which are experienced rarely, albeit often enough to warrant mentioning, include: blistering of the skin, continuous ringing or buzzing in the ears, early menstrual periods, warm-to-the-touch face, loss of hearing, hiccups, increased sexual desire, loss of strength, skin rash, hives, difficulty sleeping, twitching, uncontrolled repetitive movements of the tongue/face/legs/arms, irritability. Patients who experience any of these effects to the point of discomfort are advised to seek medical attention.

Because Chlorpheniramine and Codeine Polistirex can potentially affect the mood and psychology of the patient (confusion, depression), and the vision of the patient (blurred vision, seeing halos around lights, increased sensitivity to light), those who take this medication are therefore advised not to drive or operate heavy machinery while undergoing treatment with medication. This is because patients with confusion or decreased motor skills and vision could potentially put themselves or other road users at risk. Patients with a history of mental illness should be prescribed this medication with caution, as it may exacerbate existing or pre-existing mental conditions such as depression or bipolar disorder (mania).

Dosage

As with all medicines, it is incredibly important for patients to only take Chlorpheniramine and Codeine Polistirex as prescribed by a qualified physician. This means that patients should not take any more of this medicine than advised, either in size of dose or frequency of dose. In addition to this, patients should stop taking Chlorpheniramine and Codeine Polistirex if advised to do so by their doctor, even if they still have a supply of the medication remaining.

This medicine stimulates opiate receptors in the central nervous system and causes peripheral vasodilation, respiratory depression, constipation, stimulation of receptors which cause vomiting, suppression of the cough reflex, increased bladder tone and the competitive agonizing of histamine at H1 receptor sites.

Adults and children of 12 years of age and older should take 2 teaspoons (5mL) of Chlorpheniramine and Codeine Polistirex every 12 hours, and should not exceed more than 4 teaspoons (20mL) of the medicine within a 24 hour period.

Children between the ages of 6 and 12 years of age should take 1 teaspoon (5mL) of Chlorpheniramine and Codeine Polistirex every 12 hours, and should not exceed more than two teaspoons (10mL) of this medication within a 24-hour period.

Chlorpheniramine and Codeine Polistirex is not suitable for children under the age of 6. Infants and young children suffering from cough medicine should take another cough medication specifically designed for pediatric administration. A doctor will be able to advise further on a suitable treatment.

The cough suspension should be shaken well prior to measuring the dose. This is because some of the contents of the medication can settle in the bottle when it has been left on a shelf for a prolonged period. The dose should then be measured and administered using a dosing spoon, cup or syringe for accuracy. Chlorpheniramine and Codeine Polistirex should not be diluted with other fluids or mixed with other medicines. This medicine can be taken with or without food, however, if stomach upset occurs after taking it on an empty stomach, it should be administered with food from then on to avoid further gastro-intestinal upset.

Patients are advised against taking double doses. If the patient misses a dose and realizes shortly after the designated dose time, they may take the missed dose and continue with treatment as normal. However, if it is nearer the time of the next allotted dose, the patient should skip the missed dose and resume normal dose frequency with the next dose.

Patients who experience any signs of overdose - which include an extremely slow or fast heartbeat, difficulty breathing, unconsciousness, severe loss of co-ordination, seizures or flushed skin - may require immediate medical attention. In this instance, the patient or their caregiver should contact their local poison control center on 1800-222-1222 or emergency services on 911. Alternatively, they may visit their local ER.

Interactions

All drugs have the potential to interact with other chemicals or drugs within the body. These interactions can cause the effects of one or more medications to change, rendering them ineffective or in some instances even causing dangerous or potentially fatal side effects. Because of this, patients are advised to keep a full and detailed list of all medicines they are currently taking, including the dosage and frequency of each drug. This applies to complementary medicines, over the counter remedies, vitamins, and herbal supplements.

Below is a list of medicines known to have interacted negatively with Chlorpheniramine and Codeine Polistirex. Patients who are currently taking one or more of these medicines should notify their doctor prior to taking the first dose of Chlorpheniramine and Codeine Polistirex cough medication:

  • Amobarbital
  • Amoxapine
  • Anileridine
  • Aripiprazole
  • Asenapine
  • Baclofen
  • Carbinoxamine
  • Cariprazine
  • Carisoprodol
  • Carphenazine
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlorpromazine
  • Acepromazine
  • Alfentanil
  • Almotriptan
  • Alprazolam
  • Amisulpride
  • Amitriptyline
  • Benperidol
  • Bromazepam
  • Bromopride
  • Buprenorphine
  • Bupropion
  • Buspirone
  • Butabarbital
  • Butalbital
  • Butorphanol
  • Chlorzoxazone
  • Clobazam
  • Clonazepam
  • Clorazepate
  • Codeine
  • Conivaptan
  • Cyclobenzaprine
  • Dantrolene
  • Diphenoxylate
  • Darunavir
  • Desvenlafaxine
  • Dezocine
  • Doxylamine
  • Dichloralphenazone
  • Diacetylmorphine
  • Diazepam
  • Difenoxin
  • Diphenhydramine
  • Dolasetron
  • Dihydrocodeine
  • Droperidol
  • Enflurane
  • Estazolam
  • Eszopiclone
  • Ethchlorvynol
  • Ethopropazine
  • Ethylmorphine
  • Fentanyl
  • Flibanserin
  • Flunitrazepam
  • Donepezil
  • Fluoxetine
  • Fluphenazine
  • Flurazepam
  • Fospropofol
  • Granisetron
  • Halazepam
  • Haloperidol
  • Halothane
  • Hexobarbital
  • Hydrocodone
  • Hydromorphone
  • Hydroxytryptophan
  • Hydroxyzine
  • Iloperidone
  • Isoflurane
  • Ketamine
  • Ketazolam
  • Ketobemidone
  • Levomilnacipran
  • Levorphanol
  • Lorazepam
  • Lorcaserin
  • Lormetazepam
  • Lurasidone
  • Meclizine
  • Medazepam
  • Melperone
  • Meperidine
  • Mephenesin
  • Mephobarbital
  • Meprobamate
  • Meptazinol
  • Mesoridazine
  • Metaxalone
  • Methadone
  • Methdilazine
  • Methocarbamol
  • Methohexital
  • Methotrimeprazine
  • Methylene Blue
  • Midazolam
  • Mirtazapine
  • Molindone
  • Moricizine
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Nicomorphine
  • Nitrazepam
  • Nitrous Oxide
  • Olanzapine
  • Opium
  • Opium Alkaloids
  • Orphenadrine
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Paliperidone
  • Palonosetron
  • Papaveretum
  • Paregoric
  • Paroxetine
  • Pentazocine
  • Pentobarbital
  • Perampanel
  • Perazine
  • Periciazine
  • Perphenazine
  • Phenobarbital
  • Pimavanserin
  • Pimozide
  • Piperacetazine
  • Pipotiazine
  • Piritramide
  • Prazepam
  • Primidone
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propofol
  • Propoxyphene
  • Quazepam
  • Quetiapine
  • Ramelteon
  • Remifentanil
  • Remoxipride
  • Risperidone
  • Secobarbital
  • Sertindole
  • Sodium Oxybate
  • Sufentanil
  • Sulpiride
  • Suvorexant
  • Tapentadol
  • Zolpidem
  • Temazepam
  • Thiethylperazine
  • Thiopental
  • Thiopropazate
  • Thioridazine
  • Thiothixene
  • Tilidine
  • Tiotropium
  • Tizanidine
  • Tolonium Chloride
  • Topiramate
  • Trifluoperazine
  • Tramadol
  • Trazodone
  • Triazolam
  • Trifluperidol
  • Trimeprazine
  • Zaleplon
  • Vortioxetine
  • Triflupromazine
  • Ziprasidone
  • Vilazodone
  • Zopiclone
  • Zotepine

In addition to avoiding these medicines, certain foods and recreational substances should not be eaten or taken when undergoing treatment with Chlorpheniramine and Codeine Polistirex as they may interact with the medication. Alcohol, for example, should be avoided as it could potentiate some of the central nervous system effects of Chlorpheniramine and Codeine Polistirex. Combining the two could result in impairment of judgment, impairment of motor skills and depression of the CNS. Patients should, therefore, avoid using alcohol with Chlorpheniramine and Codeine Polistirex and to notify their doctor if they are taking any other recreational substances which may interfere with this medicine.

Warnings

Chlorpheniramine and Codeine Polistirex may not be suitable for patients being treated for certain conditions. Pregnant women should consult with their doctor prior to using this medication. Although Chlorpheniramine and Codeine is classed as a pregnancy category C medicine by the FDA it may still pose a risk to certain women. There are currently no adequate studies which suggest any risk for nursing infants who receive the medication via excreted breastmilk.

Patients being treated by for the following conditions may need to adjust their dose of Chlorpheniramine and Codeine Polistirex, or potentially avoid treatment with the medication altogether:

  • Inflammatory bowel disease: because opioid analgesic agents increase the smoothness of muscle tone in the gastrointestinal tract while simultaneously decreasing peristalsis, this can lead to muscle spasm, intraluminal pressure, and constipation during prolonged use. Patients with intestinal or gastrointestinal issues should exercise caution when using this medicine.
  • Liver disease: narcotic opioids are metabolized extensively by the liver, and many of them (codeine included) contain active metabolites which are further converted to inactive substances. Serum concentrations of such agents may be increased in patients with impaired liver function. Treatment with Chlorpheniramine and Codeine Polistirex should, therefore, be cautiously administered at started at a reduced dosage in patients with liver issues. Subsequent doses can be adjusted based on the response of the patient as opposed to a fixed schedule.
  • Renal dysfunction: Despite the fact that narcotic analgesic agents are metabolized by the liver, kidney impairment can affect the elimination of certain agents and their metabolites, resulting in accumulation of the drug to the point of potentially toxic levels. Therapy with Chlorpheniramine and Codeine Polistirex should, therefore, be administered cautiously and at reduced doses in patients with kidney impairment. Subsequent doses may be increased based on the individual response of the patient.
  • Low blood pressure: certain opiate agonists (Codeine included) can cause vasodilation and hypotension when delivered in high doses, leading to shock and cardiac arrest. At therapeutic doses, Chlorpheniramine and Codeine Polistirex could potentially induce dizziness and other effects associated with hypotension. It should therefore be administered with caution.
  • Brain tumor and/or head injury: opiates can induce intracranial pressure as a result of the induction of cerebral hypoxia and vasodilation. Unless mechanical ventilation is available in a clinical setting, extreme caution is advised when administering opiate agonists to patients suffering from a serious head injury.
  • Respiratory depression: patients with pulmonary impairment or cerebral vascular disorder may experience apnea when being treated with Chlorpheniramine and Codeine Polistirex, which can affect respiratory drive and airway resistance. Clinical monitoring of patients undergoing treatment with Chlorpheniramine and Codeine Polistirex is recommended in order to avoid significant respiratory depression.
  • Chronic obstructive pulmonary disease: antihistamines like Chlorpheniramine can potentially cause thickening of bronchial secretions, which can result in obstruction of the respiratory tract. Many drug manufacturers and clinicians, therefore, recommend that treatment with medications containing antihistamines should be administered with great caution in patients who have chronic obstructive pulmonary disease.
  • Cardiovascular issues: Antihistamines are known to occasionally cause adverse cardiovascular effects including (but not limited to) tachycardia, ECG changes, arrhythmia, hypotension, and palpitation. While these conditions are typically limited to incidences of overdose, they can occur at standard doses in certain patients. Therefore, caution is advised when administering cough treatments like Chlorpheniramine and Codeine Polistirex to patients with documented cardiovascular problems.
  • Addison's disease: Patients with this condition are at an increased risk of CNS depression and respiratory depression associated with the use of opioids. Conversely, such agents may potentiate adrenal insufficiency. Reduced doses of Chlorpheniramine and Codeine Polistirex are therefore recommended in patients with Addison's disease until it has been observed that little or no risk is posed.

Storage

Chlorpheniramine and Codeine Polistirex should be stored in the container it was shipped in, with the outer packaging kept intact to protect it from natural light. It should be stored out of the reach of children and pets, at room temperature not exceeding 77F. This medicine should be kept away from moisture and is therefore not suitable for storage in a bathroom cabinet. Instead, it should be kept in a dedicated, locked medicine cabinet if possible.

If the patient no longer requires this medication, or it has reached the end of its shelf life, it should be disposed of in a safe and hygienic manner. It should not be poured down a toilet or drain. Many local pharmacies operate takeback schemes where they will dispose of unwanted or unused medications free-of-charge, and patients in possession of unwanted medicines are advised to contact their local pharmacy or waste disposal department for further advice.

Summary

Chlorpheniramine and Codeine Polistirex is an effective twelve-hour treatment for cough and respiratory symptoms associated with allergies and common cold. It is used in the majority of Western countries as a simple yet effective cough suppressant and anti-allergenic, however, patients should be advised that there are risks associated with taking this medication.

When Chlorpheniramine and Codeine Polistirex is used for a prolonged period of time, it may become habit-forming. This means that the patient could be at risk of physical or mental dependence on the medication which can lead to withdrawal effects if treatment is stopped suddenly.

Patients with certain medical conditions are advised to avoid using Chlorpheniramine and Codeine Polistirex or to use it with caution at an adjusted dose. This is because this medicine has the propensity to interact with a large number of other medications.

In order to get the best out of this medicine, doctor and patient should work together to discuss whether this medication is suitable for the patient, and what dose will be the most effective at treating their condition.

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Last Reviewed:
December 24, 2017
Last Updated:
April 05, 2018
Content Source: