Don't play with Tussionex
Late last night, I kept coughing due to a passing cold. After taking several doses of other cough syrups during the evening, which had obviously not done their job, I decided to take some Tussionex — my ultimate weapon against coughing. I try to use it only when I absolutely need it, because it’s fairly expensive and it’s also hard to get (it can only be prescribed by a doctor). But after three days of coughing through the night and keeping my wife and myself awake, I figured the time had come. I took a teaspoon, waited a half hour, and nothing happened. I took another, waited another half hour, and still the coughing continued. I began to worry: had the syrup expired? Was my coughing so bad that I needed to take more? I took another teaspoon. Bad idea!
Soon after that, I started to feel the effects. Tussionex contains a codeine derivative, which means that, along with stopping my cough, it usually gives me a warm and fuzzy feeling that wears off in a couple of hours or so. This time, because I’d unwittingly (and stupidly) overdosed, the effect was very pronounced, and it was mixed with a sensation of nausea. I found it hard to sit up or stand up and went to bed, where I fell asleep immediately.
Here’s the full list of side effects for Tussionex, from the PDR (Physician’s Desk Reference):
“Anxiety, constipation, decreased mental and physical performance, difficulty breathing, difficulty urinating, dizziness, drowsiness, dry throat, emotional dependence, exaggerated feeling of depression, extreme calm (sedation), exaggerated sense of well-being, fear, itching, mental clouding, mood changes, nausea, rash, restlessness, sluggishness, tightness in chest, vomiting.”
I guess I should be thankful the only side effect I’d experienced before this was the “exaggerated sense of well-being”, along with a slight headache which occurred a few hours after taking the medication. Things were going to be very different now.
I woke up early in the morning, around 6 am, feeling rested and alert. I figured the effects of the overdose had worn off. They hadn’t. I got up to go about my business, and shortly after that, a general, overpowering feeling of nausea swept over me. I could not stand up. I couldn’t keep my balance at all. I felt sick, wasn’t seeing straight, I couldn’t control my movements and had trouble putting words together. It didn’t take long after that for me to experience a fuller spectrum of the side effects: decreased mental and physical performance, dizziness, drowsiness, mental clouding, nausea and finally, vomiting. That’s right, I did it again… I vomited more often in these past few months than in the past several years, and I don’t like it.
I’m still in bed as I write this. The moment I stand or sit upright, the nausea comes back, my face turns white, etc. I’ll be in bed for a while, hopefully not the whole day. All this fun gave me a chance to think about the situation. It’s clear that this wouldn’t have occurred if I hadn’t overdosed. The recommended dosage is one teaspoon every 12 hours. The PDR says: ”The usual dose is 1 teaspoonful (5 milliliters) every 12 hours. Do not take more than 2 teaspoonfuls in 24 hours.”
I took three teaspoons within 1 ½ hours. That was incredibly stupid and irresponsible of me, and truthfully, I should be thankful I’m still alive. Here’s what one should expect from a Tussionex overdose:
“Blue skin color due to lack of oxygen, cardiac arrest, cold and clammy skin, decreased or difficult breathing, extreme sleepiness leading to stupor or coma, low blood pressure, muscle flabbiness, slow heartbeat, temporary cessation of breathing”
There it is, in black and white: cardiac arrest, stupor or coma. Instead of getting up from my bed last night and doing a quick search for this info last night, I overdosed like a dummy. My wife could have woken up next to my corpse. Thank God that didn’t happen!
I found out this morning that the FDA, since 2008, is also cautioning healthcare providers, pharmacists and patients, to guard against Tussionex overdose. After my own accidental brush with death, I agree with them.
Still, I’m not sorry I took Tussionex. I’m definitely sorry I overdosed though. I’ve used many cough syrups over the years, and none stops my coughing like Tussionex. Here’s a sample of the stuff I tried in only the past few months:
Ketof is the only other cough syrup that helps me marginally. The rest are garbage, particularly that Coughend Sirop. I also used a syrup called Prospan (not pictured here) in the last few days, which I found did a good job at clearing my throat. It tastes great, but still, it doesn’t stop my coughing. And of course I tried plenty of American cough syrups over the years, none of which helped.
Don’t think I cough all the time, either. But I’m stubborn like a mule, and will often go outside when it’s cold and I’m not dressed adequately. So naturally, I catch colds, and when I do, I cough a lot.
This experience also got me thinking about drugs and their effects on the body. Our bodies, you see, are endowed with the capability to heal themselves. That capability works better or worse in people, depending on how well they take care of themselves (diet, exercise, regular sleep, etc.) Drugs will usually only mask the symptoms of a disease, not cure it. Even though I’m not coughing now, that doesn’t mean Tussionex cured my cough and sore throat. It only stopped my coughing. Here’s what the PDR says about it:
“Tussionex Extended-Release Suspension is a cough-suppressant/antihistamine combination used to relieve coughs and the upper respiratory symptoms of colds and allergies. Hydrocodone, a mild narcotic similar to codeine, is believed to work directly on the cough center. Chlorpheniramine, an antihistamine, reduces itching and swelling and dries up secretions from the eyes, nose, and throat.”
You see, it’s used to “relieve” coughs and other symptoms, not “cure” them. They’re not even sure how it works. They “believe” the codeine derivative in it works directly on the cough center. The human body’s internal chemistry is so complex that I don’t know if we’ll ever figure it out properly. Right now, we’re still just stabbing in the dark when it comes to medicating people. We give them a drug and then, oops, we realize the effect isn’t the desired one, or that it interacts with other drugs and causes undesirable side effects. The PDR says about Tussionex that its “side effects cannot be anticipated”. And there’s also a section dedicated to its possible food and drug interactions. Here’s what that says:
“Tussionex may increase the effects of alcohol. Do not drink alcohol while taking this medication. If Tussionex is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Tussionex with the following:
- Antispasmodic medications such as Bentyl and Cogentin
- Major tranquilizers such as Thorazine and Compazine
- MAO inhibitor drugs (antidepressant drugs such as Nardil and Parnate)
- Medications for anxiety such as Xanax and Valium
- Medications for depression such as Elavil and Prozac
- Other antihistamines such as Benadryl
- Other narcotics such as Percocet and Demerol”
You see, this is what medicine has become these days: the chemistry of drug interactions. Every physician that works in a field where they prescribe lots of medications has to know drug interactions perfectly, or they will put their patients’ lives at risk. Sadly, most do not know all they need to know, because the interactions are so complex.
My dad is a psychiatrist. He made it a point to know all the psychiatric drug interactions and those of common drugs administered by other doctors, such as primary care providers or internal medicine specialists. He studies them all the time and keeps up to date with all the latest medications. He meets plenty of other doctors who aren’t as well prepared as he is, and he’s told me often how shocked he is to find these people are prescribing drugs that readily conflict with others, creating undesired and potentially lethal side effects. The sad part is that when he tries to let them know about it, they usually brush him off. And then we wonder why so many patients do poorly in hospitals… Isn’t it to be expected when most doctors are ill-prepared to prescribe medications for their patients?
I think the takeaway lesson from all this is that prescription drugs can be very dangerous. They are not to be treated lightly, like I treated Tussionex — even though its nature is supposedly benign — it is, after all, “only” a cough syrup, right? A drug’s side effects and its interactions with other drugs need to be known not only by the doctor but also by the patient, so that each of us is aware of what we are putting inside our bodies. The consequences — if we don’t do this — can be fatal at times. I may not realize it fully right now, but I might not have been around today, and it was all because I self-medicated carelessly.
Updated 1/11/10: I’ve gotten a number of rude comments since I wrote this article, none of which were published, where dorm room heroes and couch potato experts called me all sorts of names, all because the dosage that I took was too low by their standards. They’d have been satisfied if I drank a whole bottle of Tussionex and woken up a month later out of a coma, or if I hadn’t woken up at all. What can I say, other than your mileage may vary. People react differently to different dosages. I suppose if my body had been addled by years of alcohol and prescription drug abuse, my tolerance level for the drug would have been higher, and three teaspoons wouldn’t have done much for me. However, when you lead a clean life and are in full possession of your senses, you tend to be much more sensitive to these situations. So please stop criticizing the article. I wrote it not to draw attention to myself, but to put up a warning sign about prescription drug abuse.
Glad you’re okay, Raoul. I had that stuff when I was in college. The doctor prescribed a combination of that and Dimetapp, which I think was only available by prescription at the time.
I got high. It was the only time I’ve ever been high, and it taught me to be very careful whenever I try a new med.
Thanks Julie! It’s not fun to feel your senses and motor movements spin out of control, I’m with you there. And it’s kind of scary to think there’s only a short distance between those sensations and a coma, or worse, death.
I am so glad you are okay. Two years ago my husband of 33 years did the same as you, but he did not wake up.
I did wake up, next to a corpse.
Jen, I’m so sorry to hear that. Please accept my condolences. I’ll consider myself blessed to still be alive.
Hey man. Taking more than the medication than perscribed does not necessarily mean an overdose. I have taken like 7X the dose cause I was being a dumbass and trying to get high. I mean it was the best high I ever had but then again it was dangerous as hell.
I’m currently on Tussionex, and I’ve had it many times before (it seems that I’m very susceptible to respiratory issues, and coughing is intense for me). It works fantastically, and yes–it does give that feeling of ‘well-being’, which I now jokingly refer to as being ‘high’. However, it works almost too well for me, and I find myself taking less than the prescribed dose (usually 1/2 teaspoon, twice a day).
That said, a year ago I had a terrible cough and was prescribed Tussionex. I didn’t think it worked well enough on my cough initially, so I almost always took a higher dosage than prescribed. Later, my doctors used it to treat my insomnia, since it also was the one thing that would make me sleep. I trust my physicians, and my own father is one of them…but looking back at the amount of Tussionex I would take for my coughing, I was probably putting myself in a dangerous situation. It was good to read this and see the risks! I’m going to be very careful with this med…
Good to hear you’re alright!
-Jen
I have taken Tussionex mostly becoause of bad coughing when I get a cold, sinusitis or allergy symptoms with wheezing. I am a nurse and I know for sure to look up all medications that are prescribed for myself and my family. However my PMD is very reluctant to prescribe this cough syrup and it is so far the only cough syrup that works for me. My husband is sooooooooo irritated when I cough all night long. I am sooooooo sick when I cough all night long. Headaches, throat pain, bloody sputum, laryngitis, you name it. Hopefully this is not too gross for some of you. Tussionex works but patients need to be aware that they should take it only as directed.
There is no way you overdosed on 3 teaspoons. I am a 19 year old male, I weigh about 120 lbs. and im about 5′ 5″ and I can handle half of an 8 oz. bottle at once. I’m not stupid enough to do that but I have done it on accident before… And I didn’t die.
Blake, as you go on with your college education and perhaps take a course in Physiology or Anatomy, you’ll understand that different people have varying thresholds of tolerance when it comes to drugs. I’m sure that you’ve already seen this in action with alcohol at your college. Some can hold their booze better than others. If you’re more resistant to Tussionex, one of two things can be happening: you’re not getting the same dosage I got (less active ingredients per same volume), or your tolerance for it is higher, which means you’ve either been born with it, or you’ve built it up through repeated use.
I’m surprised no one has mentioned the fact that Tussionex contains hydrocodone — the same synthetic opiate used in Vicodin and its many generic counterparts.
In fact, a teaspoon contains 10mg of hydrocodone, which is the same as taking two lower-dose pills or one higher-dose pill. That’s why you get that “exaggerated sense of well-being.” You’re not almost high, or kind of high — you ARE high.
So if you make it a habit to take Tussionex regularly for every night of coughing, or use it a sleep aid, you’re unknowingly developing an opiate habit. You might not realize it, but after using a cough syrup like this for anywhere from one to three weeks, if you suddenly stop using it you’re going to go into withdrawal. Most people will think they’ve come down with a bad cold or the flu, but in truth it’s withdrawal — the runny nose, the nausea, the restless leg (or back) syndrome, diarrhea, cold sweats, and even slight depression are all symptoms of withdrawal that could be mistaken for a bad cold, a virus or the flu.
I’m not saying this cough medicine shouldn’t be prescribed — on the contrary, I think many doctors are downright paranoid these days and are reluctant to prescribe medicine to patients who are genuinely suffering. That’s a shame. However, I do agree with the blog author’s point that many doctors are largely ignorant of drug interactions, and patients themselves aren’t particularly well-informed regarding what they’re taking, how it affects their bodies, and how it may interact with other medications. In fact, I think doctors and the pharmaceutical companies are almost single-handedly responsible for the epidemic of liver disease in this country, with all the APAP they stuff in every medication, but that’s a long discussion for another time.
I’m a retail Pharmacy Technician at CVS. While I can’t speak for hospital pharmacies, I can assure most people that, if you’re getting your prescriptions at your local pharmacy, your Pharmacist is very aware of any and all interactions between your medications, but for your sake keep a couple of things in mind: 1) get your medications ALL from one place; the more places you frequent, the more likely it is that one pharmacy will not be aware of other medications which can have potential interactions (luckily, most primary insurance providers track your prescriptions, and if you fill at another pharmacy on the same insurance, the pharmacist there is usually warned, assuming you’re not paying out-of-pocket); and 2) if you’re someone who gets lots of medication, or is frequently prescribed medication and/or prone to becoming ill, go to a pharmacy that has a full-time pharmacist on STAFF that you TRUST; I cannot stress how important that last part is. I have seen pharmacists who don’t give a damn and are only there for the money (usually they’re lazy, which is the reason they’re “floaters” and don’t have their own stores), and who won’t think twice about ignoring the big red flag on-screen that says “DRUG-DRUG INTERACTION.” More often than not, however, you’ll find a pharmacist who is at least professional enough to take care of you properly, or in my case, my Pharmacist-In-Charge is the most personable, friendly, helpful person I have ever met, and his patients love him, and consequently us technicians as well.
I’m sorry for straying from the subject of your blog, but because my perspective on the health care industry is totally different from an in-house perspective, I just wanted to inform people that, if you’re doing retail, your pharmacist is there to catch your doctor’s mistakes–and believe me, doctors can make some serious mistakes.
So appreciate CVS service. We use them and they have caught things just like this. I was on another med for shoulder surgery pain and then got the nasty bug going round here. Got the trusty tussionex as nobody in the house was sleeping due to my cough – not to mention every time I coughed my shoulder would jar and another sort of hell washed over me and apparently I was crying in my sort of sleep state.
CVS caught the combo and told me to stay away from the other med if I was going to take the syrup. I followed their directions to the letter and slept finally. And I think part of the med in the syrup was enough to help with the shoulder pain that I never needed that pain drug I was on again. two birds, one stone and safely. Glad CVS caught it otherwise I might have taken both not thinking or not reading the info included as I’ve used tussionex on several occasions. it really is the only cough med that works for my husband and me
I have the h1n1 flu right now and I was perscribed tussionex because my cough is killing me…I’ve been taking 4-6 teaspoons daily…however I also have a history of opiate abuse…mostly oxy and dilaudid so as stupid as that may be of me is that possibly the reason its not affecting me the same as it affected you? Because even after 6 teaspoons I feel no different at all.
I think you answered your own question, Kayla. Your previous opiate use increased your tolerance for Tussionex, so that’s why you don’t feel it. Perhaps you should talk to your doctor about this, to see if there’s something else he or she can prescribe.
I went to the doctor yesterday and got a bottle of Tussinex. I’ve had it before so I knew what i was in for. The guy who said he drank 4 ozs. and was ok I highly recommend against doing that again. The stuff works great if you take it as prescribed but there’s a couple things to keep in mind. First of all it’s time released so it takes a really long time to kick in… as in about an hour. It helps with the cough right away but as far as making you tired and able to sleep you have to give it time. If you keep taking it because you don’t think it’s working they you can really get yourself in trouble. Also, if you take too much you’ll really feel horrible. You’ll get the sweats and feel like your going to throw up. That brings me to my second point. If you get to that stage then you’re in for several hours of hell because it is time released so it lasts forever. Anyway, just a couple things to think about. More importantly, I am not a doctor so my thoughts are just my thoughts. You should in know way take my advice. If I were you I would listen to your doctor and take as prescribed. Tussionex is like any other medication. It works great until people start to abuse it. Good luck.
Wow! This is some great info! Glad you are OK, Raoul!
I am currently taking Tussionex for flu & upper respiratory infection-related symptoms, ie.. cough, etc… I can honestly say I have no clue how anyone that takes more than two TEASPOONS in a 24 hour period are able to walk & talk, much less type a response in this blog!
To Blake, the hotshot college student, you are playing with fire! You may be able to tolerate and “accidental” overdose of 4 ozs. now, but that doesn’t mean you will always be able to tolerate it. What you are doing is called “prescription medication abuse”. I would be very cautious if I were you, and follow your Doctor & pharmacist’s instructions.
I took my first teaspoon dose on an empty stomach, and although this wasn’t my intention, I was high as a kite. I have been prescribed this medication in the past, and it is the only medication that works for my cough, but I also know how potent it can be, and take it as prescribed. I didn’t even drink the occasional beer whilst taking it, for fear it would counteract & cause me problems.
Thank you , Raoul, for posting about your scary experience. Perhaps you have helped others from a similar or worse experience!
Best of health to everyone!
Thank you Cheryl. I’m glad to see you’re taking this seriously. Tussionex should be taken seriously. Get well soon!
I have been taking Tussionex for years and it has been my life saver. See the thing is every time I come back from overseas trip through my work, mostly to Asia I come back with uncontrollabe cough. None of the over the counter or perscrption strength cough syrup do a thing. But the Tussionex on the other hand works like a magic. You go from non stop cough to absolutley none for another 8 to 10 hours with 1 tea spoon which by the way rarely exceed. And yes the most awsome side effect of it is that you feel happy and elated. Not that I need it necessarily since I am fairly happy and otherwise healthy person. I think if there’s some side affect from taking some medicine why not it be a plesant one than a painful one. Another side affect (again a plus one for me) is that you sleep like a baby.
For me it also rejouvinates my taste buds making everthing taste better. So I always get a 8 oz bottle from doctor when I am coughing badly. By the way this stuff is $90 for 8 oz bottle and strictly dispensed only with hard prescrption copy. So my suggetion don’t overdose and abuse this wonderful medication.
Yeah, just wanted to say that Tussionex does not contain just any derivative of codeine, it contains hydrocodone, which is the narcotic commonly known as Vicodin and is much stronger than codeine. It is literally liquid vicodin in an extended release suspension. That funny feeling of well being, lightheadedness, nausea, or euphoria is how you experience being high on narcotics.
I just happened onto this website. Interesting….I have basically been taking any narcotic i can find, not paying for it or street drugs at all. But my mom gets them and I snatch them occasionally. So sue me. I feel that with my chronic back pain and lack of health insurance, its the only thing that helps me with getting anything done. I have two kids, and both small, and keeping up with them is hell and torturous. The small amount I take helps enough. I have no other recourse. I would be happy taking this amount everyday forever, but I doubt if I can find anything this regular. I have never tried Tussionex, but my point was about tolerances. I have taken no more than 1 10mg hydrocodone at once, but there is definitely a tolerance you get and it doesnt really go away. Even if it does, it goes back after a day or two. I never get nauseous with narcs, but some people do.
One thing, not related to the Tussionex… going out in the cold without bundling up does not cause you to catch a cold. I find myself arguing with old people about this all the time. Viruses cause colds – and the viruses don’t care how many layers of clothing you have on. You could play naked in a blizzard, and if there are no viruses, you will not catch a cold. You could also wrap up in thirty layers of clothing, and if you breathe in a virus, you will get a cold.
How long does it take to kick in? I took it 2 hours ago and I am still coughing up a lung and I am wide awake. Hopefully I’ll fall a sleep some time around 3am from just being exhausted.
It’s amazing how ignorant most adults are of prescription medications and their potential for abuse. And fyi hydrocodone is a codeine derivative, that produces a cleaner and more euphoric ’sense of well being’ than codeine itself, otherwise known as being HIGH. And also, an overdose is not simply taking more than the recommended dose. An actual O.D on tussionex would be similar to one on say, heroin, and would include a potentially fatal respiratory depression and intense vomiting. Your ‘overdose,’ is what many would call a high. Any opiates can be used to relieve coughs, because they slow down your respiratory system and make it harder for your body to produce a cough. People should really educate themselves about any substance they put in their body, prescribed or not. The internet is a great resource, and it’s scary that I can’t even vote and I’m still so much more informed on the potential benefits and drawbacks about prescription medications.
I know all about tolerance, and I’m well aware that through out my many years of taking Tussionex, I’ve built up a very large tolerance for hydrocodone. Still, I feel it may be a bit of an exaggeration to say that you’re lucky to still be alive after only taking three teaspoons. I’m 4′11″, 110lbs, and I have taken eight to ten TABLESPOONS full. Granted, I do have a tolerance, as I am prescribed the drug five or six times a year for my bronchitis. Still, tolerance or no tolerance, I don’t think three teaspoons would put you anywhere near death–not when a girl literally half your size can take three times the amount safely.
Let me just add:
I’m not condoning or suggesting that *anyone* try to take more than the prescribed dose. I do have a very high tolerance and it would not be safe for most people to try taking more than two teaspoons. However, I felt like suggesting that taking three teaspoons was a death-defying act seemed to put undue anxiety on the notion of taking the medicine. Tussionex has been one of my saving graces during the long, horrible nights of coughing. People shouldn’t fear the medicine. And if someone I knew took three teaspoons and complained of dizziness and nausea… I’d give them some toast and milk, not tell them to fear for their lives.
As I previously posted, my 56 year old husband died 2 1/2 years ago in his sleep after taking too much Tussionex. He too claimed he had a high tolerance and could handle it. He was also taking xanax, so his death was most likely due to multiple drug toxicity. Please be careful.
Raoul -
Thanks for this blog on Tussionex. I’ve taken it once before but went thru 4 bottles of Robitussin over the last month and a half before calling my Dr and asking for this again. We just switched insurance and an 8 oz bottle cost $75. I love the euphoria it gives you and I’m amazed at how my coughing eventually goes away throughout the “time released” day, however, I have to work every day and it is impossible for me to even take the full 1 tsp. at a time in order to be able to drive or fully function. I am calling my Pharmacist tomorrow to see if taking 1/2 tsp. every 6 hours instead of 1 tsp. every 12 hours will still help me with the unending cough. This stuff works great, but it is very POTENT! Be careful people!
About 2 years ago I had a cough and nothing over the counter worked. I have COPD and my lung Dr. gave me a subscription for Tussionex. I got such a small amount that I knew it had to be potent. I could take one tsp. twice a day. However when I took one at night I slept real good and didn’t even start coughing intil the next evening. I found if i took 1/2 tsp at night it worked. Every time I got the cough I would get another subscription and stretch it out until I got better. Now my Medicare and sublimental insurance won’t pay for tussionex. The last subscription which amounted to about 15 days cost me $150. It’s too bad some people are abusing this product and indangering their health and life. Now the insurance companies are refusing to pay for people that really need it. I wish I knew how to afford it if I need it in the future.
It is unbelievable how naive some of the people on this board are. Like a few others have said, this cough syrup contains hydrocodone. The exact same ingredient in Lortab and Vicodin (which are identical drugs made by different companies). It is HIGHLY addictive and is known as one of the most popular choices of “drug seeking” individuals in the U.S. It amazes me that even some Dr.’s prescribe this to patients sight unseen (although, said patient must pick up the script from the Dr’s office as it can no longer be called in to a pharmacy via phone/fax due to its change from the lower scheduled rating). Yes, people have different tolerances to different meds Raoul, but Tussionex only comes in one strength at this point in time and dosages are Rx’d by patient age and or weight. I would love to address Mr. Crew’s SuperHuman feat of downing “half of an 8 oz bottle” of Tussionex “without dying”. I can assure you 100% that u did not down half of an 8 oz bottle. First and foremost, it is illegal to dispense the syrup in amounts greater than 4 oz’s total. Now if you were simply mistaken about the size of your bottle and did in fact drink half of it, then that would have given you approximatly 30 adult sized doses. You are in fact correct that this amount would probably not kill you…..but BOY would I have loved to have had tickets to THAT show!!!! Your 120 massive man body pounds would have reacted to that much narcotic like a child on speed. Im not even sure where I am going with this anymore except to say that I know horse manure when I smell it. This is a cough syrup people….use it for a cold, and leave the abuse to the idiots!