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MAXI-TUSS CD (chlorpheniramine maleate/phenylephrine HCl/codeine phosphate)
- Cold symptoms
- Cough
- Rhinorrhea
- Allergic rhinitis
- Nasal congestion
4 mg-10 mg-10 mg/5 mL oral liquid
- 5 milliliters by oral route every 4 hours as needed, not to exceed 30 ml in 24 hours
Allergic rhinitis
- 5 milliliters by oral route every 4 hours as needed, not to exceed 30 ml in 24 hours
- 5 milliliters by oral route every 4 hours not to exceed 30 ml in24Hrs
Cold symptoms
- 5 milliliters by oral route every 4 hours as needed, not to exceed 30 ml in 24 hours
- 5 milliliters by oral route every 4 hours not to exceed 30 ml in24Hrs
Cough
- 5 milliliters by oral route every 4 hours as needed, not to exceed 30 ml in 24 hours
- 5 milliliters by oral route every 4 hours not to exceed 30 ml in24Hrs
Nasal congestion
- 5 milliliters by oral route every 4 hours as needed, not to exceed 30 ml in 24 hours
- 5 milliliters by oral route every 4 hours not to exceed 30 ml in24Hrs
Rhinorrhea
- 5 milliliters by oral route every 4 hours as needed, not to exceed 30 ml in 24 hours
- 5 milliliters by oral route every 4 hours not to exceed 30 ml in24Hrs
- Azilect
- Depade
- Eldepryl
- isocarboxazid
- linezolid
- Marplan
- Matulane
- methylene blue (antidote)
- naltrexone
- naltrexone microspheres
- Nardil
- Parnate
- phenelzine
- procarbazine
- rasagiline
- Revia
- selegiline HCl
- tranylcypromine
- Vivitrol
- Zelapar
- Zyvox
Contraindicated
- bromocriptine
- cabergoline
- Cafergot
- Compound 347
- Cycloset
- D.h.e.45
- dihydroergotamine
- enflurane
- ergoloid
- Ergomar
- ergotamine tartrate
- ergotamine-caffeine
- Forane
- isoflurane
- methylergonovine
- Migergot
- Migranal
- Parlodel
- sevoflurane
- Sojourn
- Terrell
- Ultane
Severe
Moderate
- Aplenzin
- Brisdelle
- Buprenex
- buprenorphine
- buprenorphine-naloxone
- Buproban
- bupropion HBr
- bupropion HCl
- butorphanol tartrate
- Butrans
- dextromethorphan-quinidine
- Fanatrex
- fluoxetine
- Forfivo Xl
- gabapentin
- gabapentin enacarbil
- Gralise
- Gralise 30-day Starter Pack
- Horizant
- methyldopa
- methyldopa-hydrochlorothiazide
- methyldopate
- nalbuphine
- Neurontin
- Nuedexta
- olanzapine-fluoxetine
- paroxetine HCl
- paroxetine mesylate
- Paxil
- Paxil Cr
- Pexeva
- Prozac
- Prozac Weekly
- quinidine gluconate
- quinidine sulfate
- reserpine
- Sarafem
- Suboxone
- Symbyax
- Wellbutrin
- Wellbutrin Sr
- Wellbutrin Xl
- Zubsolv
- Zyban
- Acute myocardial infarction
- Adenoidectomy in pediatric patient
- Arterial thrombosis
- Lactating mother
- Respiratory depression
- Severe uncontrolled hypertension
- Sleep apnea
- Tonsillectomy in pediatric patient
- Ventricular tachycardia
Contraindicated
- Acute asthma attack
- Acute hepatitis
- Acute pancreatitis
- Angle-closure glaucoma
- Asthma
- Benign prostatic hyperplasia
- Bladder outflow obstruction
- Bradycardia
- Chronic idiopathic constipation
- Chronic obstructive pulmonary disease
- Coronary artery disease
- CYp2d6 poor metabolizer
- CYp2d6 ultrarapid metabolizer
- Drug abuse
- Gastrointestinal obstruction
- History of opioid overdose
- Hypertension
- Hyperthyroidism
- Incomplete AV heart block
- Intracranial hypertension
- Kidney disease with likely reduction in GFR
- Obstructive sleep apnea syndrome
- Severe arteriosclerotic vascular disease
- Shock
- Stenosing peptic ulcer
- Systemic mastocytosis
- Urinary retention
Severe
Moderate
- Acidosis
- Adrenal cortical insufficiency
- Alcohol intoxication
- Biliary tract disorder
- Chronic heart failure
- Chronic obstructive pulmonary disease
- Constipation
- Cor pulmonale
- Debilitation
- Hypertension
- Hyperthyroidism
- Hypotension
- Hypoxia
- Seizure disorder
- Severe hepatic disease
- Untreated hypothyroidism
- Urinary retention
MAXI-TUSS CD (chlorpheniramine maleate/phenylephrine HCl/codeine phosphate)
- Cold symptoms
- Cough
- Rhinorrhea
- Allergic rhinitis
- Nasal congestion
- None
- Abdominal pain with cramps
- Constipation
- Dizziness
- Drowsy
- Nausea
- Sedation
- Thick bronchial secretions
More Frequent
Severe
Less Severe
- Atelectasis
- CNS depression
- Dyspnea
- Orthostatic hypotension
- Respiratory depression
- Acute confusion
- Anorexia
- Dizziness
- Dysphoric mood
- General weakness
- Headache disorder
- Hyperhidrosis
- Hypotension
- Nervousness
- Oliguria
- Palpitations
- Pruritus of skin
- Sedation
- Skin rash
- Syncope
- Urticaria
- Visual changes
- Vomiting
- Xerostomia
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Acute respiratory insufficiency
- Adrenal cortical insufficiency
- Anaphylaxis
- Androgen deficiency
- Blood dyscrasias
- Bradycardia
- Cardiac arrest
- Cardiac arrhythmia
- Circulatory depression
- Dizziness
- Extrasystoles
- Hallucinations
- Headache disorder
- Hemolytic anemia
- Hyperhidrosis
- Hypotension
- Ileus
- Insomnia
- Nervousness
- Opioid dependence
- Pallor
- Pancreatitis
- Seizure disorder
- Shock
- Sleep apnea
- Tachycardia
- Tremor
Less Severe
- Abdominal distension
- Acute abdominal pain
- Acute confusion
- Anorexia
- Ataxia
- Biliary spasm
- Blurred vision
- Chest discomfort
- Chills
- Constipation
- Diarrhea
- Diplopia
- Dry nose
- Dry throat
- Dyspnea
- Dysuria
- Erectile dysfunction
- Euphoria
- Excitement
- Fatigue
- Flushing
- Gastrointestinal irritation
- Headache disorder
- Hyperhidrosis
- Infertility
- Insomnia
- Irritability
- Libido changes
- Maculopapular rash
- Malaise
- Migraine
- Nervousness
- Nightmares
- Palpitations
- Paresthesia
- Pruritus of skin
- Skin photosensitivity
- Skin rash
- Symptoms of anxiety
- Tachycardia
- Tinnitus
- Tremor
- Urinary retention
- Urticaria
- Vertigo
- Visual changes
- Wheezing
- Xerostomia
Contraindicated
None
Severe Precaution
None
Management or Monitoring Precaution
None
Chlorpheniramine
- Severity Level:
2
- Additional Notes: Insufficient data available; neonate risk of seizures;avoid during 3rd trimester
Codeine
- Severity Level:
C
- Additional Notes: Neonatal withdrawal/resp.depress. w/chronic or high dose; small teratogenic risk
Phenylephrine
- Severity Level:
2
- Additional Notes: Insufficient human data available.
Contraindicated
Codeine
Cns/respiratory depression,apnea possible;Caution w/ fast cyp2D6 metabolizer
| General | Excretion Potential | Effect on Infant | Notes |
| Drug should not be given to breast feeding mothers | Excreted | Drug shown to have adverse effect | Cns/respiratory depression,apnea possible;Caution w/ fast cyp2D6 metabolizer |
Precaution Exists
Chlorpheniramine
Insufficient data available; may cause sedation and inhibit lactation
Oral bioavailability low; infant exposure may be minimal
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Unknown | Not known; no or inclusive data | Insufficient data available; may cause sedation and inhibit lactation |
Phenylephrine
Insufficient data available; may cause sedation and inhibit lactation
Oral bioavailability low; infant exposure may be minimal
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Excreted | Not known; no or inclusive data | Oral bioavailability low; infant exposure may be minimal |
No Known Risk
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Contraindicated
None
Precaution Exists
Chlorpheniramine
Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Non-sedating antihistamine preferred. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.
General-Consider adding naloxone Rx. Pulmonary-Life threatening respiratory depression risk with high doses, cachexia, or debilitation due to altered pharmacokinetics (poor fat stores, muscle wasting, or altered clearance). Monitor closely at initiation and dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
Cardiovascular-Elderly are more sensitive to tachycardia and hypertensive effects. May exacerbate symptomatic coronary insufficiency. Genitourinary-May cause urinary retention. Neuro/Psych-May worsen cognitive impairment in some elderly with dementia. Insomnia risk.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | N | N | N | Y | N | N |
BEERS: Y HEDIS: Y STOPP: Y
Codeine
Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Non-sedating antihistamine preferred. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.
General-Consider adding naloxone Rx. Pulmonary-Life threatening respiratory depression risk with high doses, cachexia, or debilitation due to altered pharmacokinetics (poor fat stores, muscle wasting, or altered clearance). Monitor closely at initiation and dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
Cardiovascular-Elderly are more sensitive to tachycardia and hypertensive effects. May exacerbate symptomatic coronary insufficiency. Genitourinary-May cause urinary retention. Neuro/Psych-May worsen cognitive impairment in some elderly with dementia. Insomnia risk.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | N | Y | Y | Y | Y | N |
BEERS: Y HEDIS: N STOPP: Y
Phenylephrine
Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Non-sedating antihistamine preferred. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.
General-Consider adding naloxone Rx. Pulmonary-Life threatening respiratory depression risk with high doses, cachexia, or debilitation due to altered pharmacokinetics (poor fat stores, muscle wasting, or altered clearance). Monitor closely at initiation and dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
Cardiovascular-Elderly are more sensitive to tachycardia and hypertensive effects. May exacerbate symptomatic coronary insufficiency. Genitourinary-May cause urinary retention. Neuro/Psych-May worsen cognitive impairment in some elderly with dementia. Insomnia risk.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | N | N | Y | Y | N | N |
BEERS: N HEDIS: N STOPP: N
No Known Risk
None
- This medication has a risk for abuse and addiction, which can lead to overdose and death. This medication may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose that works, and take it for the shortest possible time.<br /><br />See also How to Use section for more information about addiction. The risk for severe breathing problems is higher when you start this medication, or if you take the wrong dose or take more of this medication than prescribed. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death.<br /><br /> Also, other medications can affect the removal of this product from your body, which may affect how it works. Be sure you know how to take this product and what other drugs you should avoid taking with it. See also Drug Interactions section.<br /><br />Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up. Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away.<br /><br /> Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or think you may be pregnant. During pregnancy, this medication is not recommended.<br /><br />It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time.<br /><br />Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn't stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.
| Allergic rhinitis | |
| J30.1 | Allergic rhinitis due to pollen |
| J30.2 | Other seasonal allergic rhinitis |
| J30.5 | Allergic rhinitis due to food |
| J30.8 | Other allergic rhinitis |
| J30.81 | Allergic rhinitis due to animal (cat) (dog) hair and dander |
| J30.89 | Other allergic rhinitis |
| J30.9 | Allergic rhinitis, unspecified |
| Cold symptoms | |
| J00 | Acute nasopharyngitis [common cold] |
| Cough | |
| R05 | Cough |
| Nasal congestion | |
| R09.81 | Nasal congestion |
| Rhinorrhea | |
| R09.82 | Postnasal drip |
| 0-9 | A-Z |
|---|---|
| J00 | Acute nasopharyngitis [common cold] |
| J30.1 | Allergic rhinitis due to pollen |
| J30.2 | Other seasonal allergic rhinitis |
| J30.5 | Allergic rhinitis due to food |
| J30.8 | Other allergic rhinitis |
| J30.81 | Allergic rhinitis due to animal (cat) (dog) hair and dander |
| J30.89 | Other allergic rhinitis |
| J30.9 | Allergic rhinitis, unspecified |
| R05 | Cough |
| R09.81 | Nasal congestion |
| R09.82 | Postnasal drip |
Formulary Reference Tool