Dosing and uses of Histussin (hydrocodone/chlorpheniramine/phenylephrine)
Adult dosage forms and strengths
hydrocodone/chlorpheniramine/phenylephrine
oral liquid: Schedule III
- (2.5mg/2mg/5mg)/5mL
- (2.5mg/4mg/10mg)/5mL
- (3.25mg/2.5mg/8mg)/5mL
- (3.5mg/4mg/10mg)/5mL
- (5mg/3mg/7.5mg)/5mL
- (6mg/2mg/5mg)/5mL
- (6mg/2mg/12mg)/5mL
- (10mg/12mg/30mg)/5mL
Cough with Congestion
Temporary relief of nasal congestion and cough associated with respiratory tract infections and related conditions
5-10 mL PO q4-6hr PRN, not to exceed maximum dosage limits
Recommended maximum dosage limits
- Hydrocodone: 30 mg PO in 24 hr
- Chlorpheniramine: 24 mg PO in 24 hr
- Phenylephrine: 60 mg PO in 24 hr
Other Information
Administer with special measuring device for accurate dose
Administer with food if GI upset occurs
Use caution when dosing due to multiple strengths available
Pediatric dosage forms and strengths
hydrocodone/chlorpheniramine/phenylephrine
oral liquid: Schedule III
- (2.5mg/2mg/5mg)/5mL
- (2.5mg/4mg/10mg)/5mL
- (3.25mg/2.5mg/8mg)/5mL
- (3.5mg/4mg/10mg)/5mL
- (5mg/3mg/7.5mg)/5mL
- (6mg/2mg/5mg)/5mL
- (6mg/2mg/12mg)/5mL
- (10mg/12mg/30mg)/5mL
Cough with Congestion
<6 years: safety and efficacy not established
6-12 years: 2.5-5 mL PO q4-6hr PRN, not to exceed maximum dosage limits
6-12 years: Recommended maximum dosage limits
- Hydrocodone: 0.6 mg/kg PO, up to 20 mg in 24 hr
- Chlorpheniramine: 12 mg PO in 24 hr
- Phenylephrine: 30mg PO in 24 hr
Histussin (hydrocodone/chlorpheniramine/phenylephrine) adverse (side) effects
Frequency not defined
Hydrocodone
- Bradycardia, anticholinergic effects (dry mouth, palpitation, tachycardia)
- Angina, arrhythmias, cardiac arrest, myocardial infarction, QT-interval prolongation, pectoris, syncope, severe cardiac ST segment elevation, ventricular tachycardia
- Agitation, coma, dizziness, mental clouding/depression, dysphoria, euphoria, faintness, restlessness, nervousness, weakness, sedation, seizures, visual disturbances
- Flushing, sweating, pruritus, urticaria, warmness of the face/neck/upper thorax
- Constipation, nausea, vomiting
- Urinary retention, oliguria
- Respiratory/circulatory depression, respiratory arrest, shock, cardiac arrest
Chlorpheniramine
- Anticholinergic side effects
- Somnolence
- Constipation, diarrhea, nausea, vomiting
- Blurred vision
Phenylephrine
- Hypertension, reflex bardycardia
- Anxiety, headache
- Extravasation
- Burning, rebound congestion, sneezing
- Pulmonary edema
Warnings
Contraindications
Hydrocodone
- Absolute: acute abdominal condition, diarrhea associated with toxins, paralytic ileus, pseudomembranous colitis, respiratory depression
- Relative: asthma (acute), cardiac arrhythmia, cardiac disease, congestive heart failure, coronary artery DX, bladder outlet obstruction, GI tract obstruction, glaucoma (open & closed), hemorrhage, hiatal hernia, inflammatory bowel disease, intestinal atony, mitral valve stenosis, myasthenia gravis, obstructive uropathy, prostatic hypertrophy, reflux esophagitis, respiratory impairment, tachycardia, ulcerative colitis, urinary retention
Chlorpheniramine
- Acute asthma, sleep apnea
Phenylephrine
- Hypersensitivity to phenylephrine or sulfites; severe HTN, VTach, closed angle glaucoma
- See Interactions below
Pregnancy and lactation
Pregnancy category: C
Lactation: hydrocodone, chlorpheniramine and phenylephrine excreted into breast milk; nursing not recommended
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Histussin (hydrocodone/chlorpheniramine/phenylephrine)
Hydrocodone
Half-life: 3.3-4.4 hr
Duration: 4-8 hr
Peak PlasmaTime: 1.3 hr
Metabolism: liver (O-demethylation, N-demethylation, 6-keto reduction); hepatic P450 enzyme CYP2D6
Excretion: urine (mainly)
Chlorpheniramine
Half-Life: 12-43 hr
Duration: 24 hr
Onset: 6 hr
Peak Plasma Time: 2-6 hr
Protein Bound: 69-72%
Vd: 2.5-3.2 L/kg
Metabolism: GI mucosa, liver
Metabolites: monodesmethylchlorpheniramine, didesmethylchlorpheniramine
Excretion: urine
Sedative effect: low
Antihistamine activity: moderate
Anticholinergic acitivity: moderate
Phenylephrine
Duration: 2-4 hr
Onset: 15-20 min
Metabolism: liver & intestine by MAO
Excretion: urine
