Tussi-Pres Liquid
It is used to treat nose stuffiness.It is used to thin mucus so it can be taken from the body by coughing.It is used to relieve coughing.
Drug Class
Cough, Cold, and Allergy Preparation
Pharmacologic Class
Expectorant, Antitussive, Alpha-adrenergic Agonist
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medicine is a combination of three ingredients: an expectorant (guaifenesin) to help loosen mucus and make coughs more productive, a cough suppressant (dextromethorphan) to reduce the urge to cough, and a decongestant (phenylephrine) to relieve stuffy nose.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. You can take this medication with or without food, but if it causes stomach upset, take it with food. Drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
When measuring liquid doses, use the measuring device that comes with the medication. If one is not provided, ask your pharmacist for a suitable measuring device to ensure accurate dosing.
Storing and Disposing of Your Medication
Store this medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your doctor or pharmacist. If you have questions about disposal, consult your pharmacist, who may be aware of drug take-back programs in your area.
Missing a Dose
If you take this medication regularly and miss a dose, take it as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time or extra doses. If you take this medication as needed, do not take it more frequently than directed by your doctor.
To use this medication correctly, follow your doctor's instructions and read all the information provided. You can take this medication with or without food, but if it causes stomach upset, take it with food. Drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
When measuring liquid doses, use the measuring device that comes with the medication. If one is not provided, ask your pharmacist for a suitable measuring device to ensure accurate dosing.
Storing and Disposing of Your Medication
Store this medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your doctor or pharmacist. If you have questions about disposal, consult your pharmacist, who may be aware of drug take-back programs in your area.
Missing a Dose
If you take this medication regularly and miss a dose, take it as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time or extra doses. If you take this medication as needed, do not take it more frequently than directed by your doctor.
Lifestyle & Tips
- Drink plenty of fluids (water, juice) to help loosen mucus and make the expectorant work better.
- Avoid alcohol while taking this medication, as it can increase drowsiness.
- Avoid driving or operating heavy machinery until you know how this medication affects you, as it may cause dizziness or drowsiness.
- Do not take more than the recommended dose or for longer than 7 days without consulting a doctor.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
Refer to specific product label for concentration. Typical adult dose: 10-20 mL (containing Guaifenesin 200-400 mg, Dextromethorphan 10-20 mg, Phenylephrine 5-10 mg) every 4 hours as needed.
Condition-Specific Dosing:
maxDailyDose:
Do not exceed 6 doses in 24 hours.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established (generally not recommended for children under 2 years)
Child:
Refer to specific product label for age-appropriate dosing. Generally, for children 6-12 years: 5-10 mL every 4 hours. Not recommended for children under 4-6 years without physician consultation.
Adolescent:
Similar to adult dosing, refer to product label.
Dose Adjustments
Renal Impairment:
Mild:
Use with caution; dose adjustment may not be necessary but monitor for adverse effects.
Moderate:
Use with caution; consider dose reduction or extended dosing interval due to potential accumulation of metabolites.
Severe:
Contraindicated or use with extreme caution; significant dose reduction or avoidance may be necessary. Consult physician.
Dialysis:
Not well studied; avoid use or use with extreme caution and close monitoring.
Hepatic Impairment:
Mild:
Use with caution; monitor for adverse effects.
Moderate:
Use with caution; consider dose reduction due to impaired metabolism of Dextromethorphan and Phenylephrine.
Severe:
Contraindicated or use with extreme caution; significant dose reduction or avoidance may be necessary. Consult physician.
Pharmacology
Mechanism of Action
Guaifenesin acts as an expectorant by increasing the volume and decreasing the viscosity of respiratory tract secretions, facilitating their removal. Dextromethorphan is an antitussive that acts centrally on the cough center in the medulla to elevate the cough threshold. Phenylephrine is an alpha-1 adrenergic agonist that causes vasoconstriction in the nasal mucosa, reducing swelling and congestion.
Pharmacokinetics
Absorption:
Bioavailability:
Guaifenesin: Well absorbed. Dextromethorphan: Well absorbed. Phenylephrine: Low oral bioavailability (approx. 38%) due to extensive first-pass metabolism.
Tmax:
Guaifenesin: ~1 hour. Dextromethorphan: ~2 hours. Phenylephrine: ~0.75-2 hours.
FoodEffect:
Generally not significant for absorption.
Distribution:
Vd:
Guaifenesin: Not extensively studied. Dextromethorphan: Large (e.g., 5-6 L/kg). Phenylephrine: Not extensively studied.
ProteinBinding:
Guaifenesin: Not extensively bound. Dextromethorphan: ~60-70%. Phenylephrine: Not extensively bound.
CnssPenetration:
Guaifenesin: Limited. Dextromethorphan: Yes (central action). Phenylephrine: Limited (peripheral action).
Elimination:
HalfLife:
Guaifenesin: ~1 hour. Dextromethorphan: ~2-4 hours (parent drug), Dextrorphan: ~3-6 hours. Phenylephrine: ~2-3 hours.
Clearance:
Rate varies by individual and renal/hepatic function.
ExcretionRoute:
Primarily renal (urine).
Unchanged:
Guaifenesin: Negligible. Dextromethorphan: <1%. Phenylephrine: <16% (oral dose).
Pharmacodynamics
OnsetOfAction:
Guaifenesin: ~30 minutes. Dextromethorphan: ~15-30 minutes. Phenylephrine: ~15-30 minutes.
PeakEffect:
Guaifenesin: ~1 hour. Dextromethorphan: ~2 hours. Phenylephrine: ~1 hour.
DurationOfAction:
Guaifenesin: ~4-6 hours. Dextromethorphan: ~5-6 hours. Phenylephrine: ~4 hours.
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
If you experience any of the following symptoms, call your doctor immediately or seek emergency medical attention, as they may be signs of a severe and potentially life-threatening reaction:
- Signs of an allergic reaction, such as rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Other Possible Side Effects
Like all medications, this drug can cause side effects, although not everyone will experience them. Many people have either no side effects or only mild ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor for advice:
- Dizziness
- Feeling nervous and excitable
- Trouble sleeping
Important Note
This list does not include all possible side effects. If you have concerns about side effects, discuss them with your doctor. For medical advice about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
If you experience any of the following symptoms, call your doctor immediately or seek emergency medical attention, as they may be signs of a severe and potentially life-threatening reaction:
- Signs of an allergic reaction, such as rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Other Possible Side Effects
Like all medications, this drug can cause side effects, although not everyone will experience them. Many people have either no side effects or only mild ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor for advice:
- Dizziness
- Feeling nervous and excitable
- Trouble sleeping
Important Note
This list does not include all possible side effects. If you have concerns about side effects, discuss them with your doctor. For medical advice about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Worsening symptoms or new symptoms develop.
- Cough lasts more than 7 days or comes back.
- Fever, rash, or persistent headache occurs.
- Nervousness, dizziness, or sleeplessness occurs.
- Rapid heartbeat or palpitations occur.
- Signs of an allergic reaction (rash, itching, swelling, severe dizziness, trouble breathing).
- Signs of serotonin syndrome (agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, diarrhea) if taking other serotonergic drugs.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
If you have a cough that produces a significant amount of mucus, a chronic cough caused by smoking or exposure to smoke, or lung conditions like asthma or emphysema.
If you have taken certain medications for depression or Parkinson's disease within the last 14 days, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure.
If you are currently taking linezolid or methylene blue, as these medications can interact with this drug.
Additionally, it is crucial to provide your doctor and pharmacist with a comprehensive list of all your medications, including:
Prescription and over-the-counter (OTC) medications
Natural products
* Vitamins
You must also inform them about any existing health problems. This information will help your doctor determine whether it is safe for you to take this medication with your other medications and health conditions. Never start, stop, or change the dosage of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
If you have a cough that produces a significant amount of mucus, a chronic cough caused by smoking or exposure to smoke, or lung conditions like asthma or emphysema.
If you have taken certain medications for depression or Parkinson's disease within the last 14 days, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure.
If you are currently taking linezolid or methylene blue, as these medications can interact with this drug.
Additionally, it is crucial to provide your doctor and pharmacist with a comprehensive list of all your medications, including:
Prescription and over-the-counter (OTC) medications
Natural products
* Vitamins
You must also inform them about any existing health problems. This information will help your doctor determine whether it is safe for you to take this medication with your other medications and health conditions. Never start, stop, or change the dosage of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. To minimize the risk of severe side effects, do not exceed the dosage prescribed by your doctor. Adhering to the recommended treatment duration is also crucial; do not take this drug for longer than the period specified by your doctor.
If you are considering giving this medication to a child, it is important to consult with your doctor first, as different brands may be suitable for different age groups.
Additionally, if you are pregnant, planning to become pregnant, or are breastfeeding, you must discuss the potential benefits and risks of this medication with your doctor to ensure the well-being of both you and your baby.
If you are considering giving this medication to a child, it is important to consult with your doctor first, as different brands may be suitable for different age groups.
Additionally, if you are pregnant, planning to become pregnant, or are breastfeeding, you must discuss the potential benefits and risks of this medication with your doctor to ensure the well-being of both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe drowsiness or dizziness
- Nausea, vomiting, stomach pain
- Rapid or irregular heartbeat
- High blood pressure
- Nervousness, restlessness, tremors
- Hallucinations, confusion
- Seizures
- Difficulty breathing
- Urinary retention
What to Do:
Seek immediate medical attention or call Poison Control at 1-800-222-1222. Be prepared to provide the name of the medication, the amount taken, and the time it was taken.
Drug Interactions
Contraindicated Interactions
- Monoamine Oxidase Inhibitors (MAOIs) (concurrent use or within 14 days of stopping MAOIs due to risk of hypertensive crisis with Phenylephrine and serotonin syndrome with Dextromethorphan)
- Linezolid (MAOI activity)
Major Interactions
- Selective Serotonin Reuptake Inhibitors (SSRIs) (increased risk of serotonin syndrome with Dextromethorphan)
- Tricyclic Antidepressants (TCAs) (potentiate pressor effects of Phenylephrine)
- Other Sympathomimetics (e.g., decongestants, appetite suppressants, amphetamines) (additive cardiovascular effects)
- Beta-blockers (may increase pressor effects of Phenylephrine)
- Antihypertensive medications (Phenylephrine may reduce their effect)
- Alcohol and other CNS depressants (additive sedative effects with Dextromethorphan)
Moderate Interactions
- CYP2D6 inhibitors (e.g., Fluoxetine, Paroxetine, Quinidine) (may increase Dextromethorphan levels and adverse effects)
- Digoxin (Phenylephrine may increase risk of arrhythmias)
- Ergot alkaloids (additive vasoconstriction with Phenylephrine)
Minor Interactions
- Not specifically identified for this combination, but general caution with other OTC products containing similar ingredients.
Monitoring
Baseline Monitoring
Blood Pressure and Heart Rate
Rationale: Phenylephrine can increase blood pressure and heart rate, especially in susceptible individuals.
Timing: Prior to initiation, especially in patients with pre-existing cardiovascular conditions.
Routine Monitoring
Symptom Relief (cough, congestion, mucus)
Frequency: Daily, as needed
Target: Improvement in symptoms
Action Threshold: Lack of improvement after 7 days, or worsening symptoms, requires medical evaluation.
Adverse Effects (e.g., dizziness, insomnia, nervousness, nausea, elevated BP)
Frequency: Daily, as needed
Target: Absence or mild, tolerable effects
Action Threshold: Severe or persistent adverse effects warrant discontinuation and medical advice.
Symptom Monitoring
- Effectiveness of cough suppression and decongestion
- Changes in mucus consistency and ease of expectoration
- Signs of cardiovascular stimulation (palpitations, increased heart rate, elevated blood pressure)
- Central nervous system effects (dizziness, drowsiness, insomnia, nervousness, anxiety)
- Gastrointestinal upset (nausea, vomiting, constipation)
- Signs of serotonin syndrome (agitation, confusion, rapid heart rate, dilated pupils, muscle rigidity, sweating, diarrhea) if taken with serotonergic drugs.
Special Patient Groups
Pregnancy
Category C. Use only if the potential benefit justifies the potential risk to the fetus. Consult a healthcare provider before use.
Trimester-Specific Risks:
First Trimester:
Limited data, generally advised to avoid non-essential medications.
Second Trimester:
Use with caution, especially Phenylephrine due to potential vasoconstrictive effects.
Third Trimester:
Use with caution, Phenylephrine may reduce uterine blood flow. Dextromethorphan generally considered low risk but avoid near term if possible.
Lactation
L3 (Moderately Safe). Small amounts of components may pass into breast milk. Use with caution and monitor infant for drowsiness, irritability, or feeding difficulties. Consult a healthcare provider.
Infant Risk:
Low to moderate risk. Phenylephrine may cause irritability or sleep disturbances in infants. Dextromethorphan and Guaifenesin are generally considered low risk but monitor for sedation.
Pediatric Use
Not recommended for children under 4-6 years of age due to potential for serious side effects and lack of proven efficacy in this age group. Always use a dosing device and follow product-specific instructions carefully. Overdose is a significant risk.
Geriatric Use
Use with caution. Elderly patients may be more sensitive to the cardiovascular (Phenylephrine) and central nervous system (Dextromethorphan) effects, such as dizziness, sedation, and increased blood pressure. Start with the lowest effective dose and monitor closely.
Clinical Information
Clinical Pearls
- Advise patients to stay well-hydrated to maximize the expectorant effect of guaifenesin.
- Caution patients about potential for drowsiness or dizziness, especially when combined with alcohol or other CNS depressants.
- Emphasize the importance of checking other medications (prescription, OTC, herbal) for potential interactions, particularly with MAOIs, SSRIs, and other sympathomimetics.
- Educate patients that decongestants like phenylephrine can elevate blood pressure and heart rate, and should be used with caution in patients with hypertension, heart disease, or thyroid disorders.
- Remind patients that cough and cold medicines are for symptom relief and do not treat the underlying cause of infection.
Alternative Therapies
- Single-ingredient Guaifenesin (for expectorant effect)
- Single-ingredient Dextromethorphan (for cough suppression)
- Single-ingredient Phenylephrine or Pseudoephedrine (for decongestion)
- Saline nasal sprays (for congestion)
- Honey (for cough relief)
- Humidifiers (for respiratory comfort)
Cost & Coverage
Average Cost:
Varies widely, typically $5-$20 per bottle (e.g., 4 oz or 8 oz liquid)
Generic Available:
Yes
Insurance Coverage:
Often OTC, may be covered by some FSA/HSA plans or specific insurance plans with a prescription.
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may have additional patient information leaflets, so it is a good idea to consult with your pharmacist. If you have any questions or concerns about this medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide detailed information about the overdose, including the medication taken, the amount, and the time it occurred.