Tussi-Pres Pediatric 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 and Cold Preparation
Pharmacologic Class
Expectorant; Antitussive; Alpha-1 Adrenergic Agonist
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medicine is used to help relieve cough and nasal congestion. Guaifenesin helps thin and loosen mucus in your lungs, making it easier to cough up. Dextromethorphan helps calm your cough. Phenylephrine helps clear up a stuffy nose by shrinking blood vessels in the nasal passages.
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 disposing of your medication, 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 is 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 take 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 disposing of your medication, 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 is 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 take 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, clear broths) to help thin mucus and stay hydrated.
- Get adequate rest.
- Avoid irritants like smoke, dust, and allergens.
- Use a humidifier to help soothe irritated airways.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
Dosage varies by product concentration. Typically, 10-20 mL every 4 hours as needed, not to exceed 6 doses in 24 hours.
Dose Range:
10 - 20 mg
Condition-Specific Dosing:
general:
Based on typical OTC concentrations (e.g., Guaifenesin 100 mg/5mL, Dextromethorphan 10 mg/5mL, Phenylephrine 5 mg/5mL). Always refer to specific product label.
Pediatric Dosing
Neonatal:
Not established; generally contraindicated.
Infant:
Not established; generally contraindicated for children under 2 years of age. Consult a physician for children under 4 years.
Child:
Dosage varies by product concentration and age/weight. For children 6 to under 12 years: Typically 5-10 mL every 4 hours as needed, not to exceed 6 doses in 24 hours. For children 4 to under 6 years: Consult a physician; if used, typically 2.5-5 mL every 4 hours. Not recommended for children under 4 years without medical advice.
Adolescent:
For children 12 years and older: Typically 10-20 mL every 4 hours as needed, not to exceed 6 doses in 24 hours.
Dose Adjustments
Renal Impairment:
Mild:
No specific dose adjustment generally recommended for short-term OTC use.
Moderate:
Use with caution. Consider reduced frequency or dose if renal function is significantly impaired, especially for phenylephrine.
Severe:
Use with caution. Avoid if possible. Consult a physician.
Dialysis:
Not well studied for combination. Individual components may have considerations. Consult a physician.
Hepatic Impairment:
Mild:
No specific dose adjustment generally recommended for short-term OTC use.
Moderate:
Use with caution, especially for dextromethorphan (metabolized by CYP2D6) and phenylephrine (extensive first-pass metabolism).
Severe:
Use with caution. Avoid if possible. Consult a physician.
Pharmacology
Mechanism of Action
Guaifenesin acts as an expectorant by increasing the volume and decreasing the viscosity of respiratory tract secretions, thereby facilitating their removal by ciliary action and coughing. Dextromethorphan is an antitussive that acts centrally on the cough center in the medulla to elevate the cough threshold. Phenylephrine is a direct-acting sympathomimetic amine that primarily acts on alpha-1 adrenergic receptors in the arterioles of the nasal mucosa, causing vasoconstriction and reducing nasal congestion.
Pharmacokinetics
Absorption:
Bioavailability:
Guaifenesin: Rapidly absorbed. Dextromethorphan: Rapidly absorbed. Phenylephrine: Poor oral bioavailability (approx. 38%) due to extensive first-pass metabolism.
Tmax:
Guaifenesin: ~1 hour. Dextromethorphan: ~2 hours. Phenylephrine: ~1-2 hours.
FoodEffect:
Generally not significant for absorption of these components.
Distribution:
Vd:
Guaifenesin: Not well characterized. Dextromethorphan: Large Vd (5-6 L/kg). Phenylephrine: Not well characterized.
ProteinBinding:
Guaifenesin: Not significant. Dextromethorphan: ~60-70%. Phenylephrine: Not significant.
CnssPenetration:
Guaifenesin: Limited. Dextromethorphan: Yes (central action). Phenylephrine: Limited.
Elimination:
HalfLife:
Guaifenesin: ~1 hour. Dextromethorphan: ~2-4 hours (parent drug), ~10-20 hours (dextrorphan). Phenylephrine: ~2-3 hours.
Clearance:
Not well characterized for combination.
ExcretionRoute:
Guaifenesin: Renal (as metabolites). Dextromethorphan: Renal (as parent drug and metabolites). Phenylephrine: Renal (as metabolites).
Unchanged:
Guaifenesin: <1%. Dextromethorphan: <1% (parent drug). Phenylephrine: <2.6% (oral).
Pharmacodynamics
OnsetOfAction:
Guaifenesin: ~30 minutes. Dextromethorphan: ~15-30 minutes. Phenylephrine: ~15-30 minutes.
PeakEffect:
Guaifenesin: ~1 hour. Dextromethorphan: ~2 hours. Phenylephrine: ~1-2 hours.
DurationOfAction:
Guaifenesin: ~4-6 hours. Dextromethorphan: ~5-6 hours. Phenylephrine: ~4 hours.
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
If you experience any of the following symptoms, call your doctor or seek medical attention immediately, 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
Most medications can cause side effects, but many people either do not experience them or have only mild symptoms. 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, consult your doctor. For medical advice regarding 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 or seek medical attention immediately, 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
Most medications can cause side effects, but many people either do not experience them or have only mild symptoms. 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, consult your doctor. For medical advice regarding 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:
- Cough that lasts more than 7 days or comes back.
- Cough with fever, rash, or persistent headache.
- Nasal congestion that lasts more than 7 days.
- Difficulty breathing or shortness of breath.
- Chest pain.
- Signs of allergic reaction (e.g., rash, itching, swelling of face/tongue/throat, severe dizziness, trouble breathing).
- Severe dizziness, nervousness, or insomnia.
- Rapid or irregular heartbeat.
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 you experienced, including any symptoms that occurred.
Respiratory issues, including:
+ A cough that produces a significant amount of mucus
+ A chronic cough caused by smoking or exposure to smoke
+ Lung conditions like asthma or emphysema
Use of certain medications for depression or Parkinson's disease within the last 14 days, such as:
+ Isocarboxazid
+ Phenelzine
+ Tranylcypromine
+ Selegiline
+ Rasagiline
Note: Combining these medications with this drug may lead to severely high blood pressure.
Concurrent use of:
+ Linezolid
+ Methylene blue
Note: This is not an exhaustive list of interacting medications; it is crucial to discuss all medications and health conditions with your doctor.
To ensure safe treatment, it is vital to inform your doctor and pharmacist about:
All prescription and over-the-counter medications you are taking
Any natural products or vitamins you are using
Existing health problems
Any potential interactions between this medication and your other medications or health conditions
Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor to confirm the safety of such changes.
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 you experienced, including any symptoms that occurred.
Respiratory issues, including:
+ A cough that produces a significant amount of mucus
+ A chronic cough caused by smoking or exposure to smoke
+ Lung conditions like asthma or emphysema
Use of certain medications for depression or Parkinson's disease within the last 14 days, such as:
+ Isocarboxazid
+ Phenelzine
+ Tranylcypromine
+ Selegiline
+ Rasagiline
Note: Combining these medications with this drug may lead to severely high blood pressure.
Concurrent use of:
+ Linezolid
+ Methylene blue
Note: This is not an exhaustive list of interacting medications; it is crucial to discuss all medications and health conditions with your doctor.
To ensure safe treatment, it is vital to inform your doctor and pharmacist about:
All prescription and over-the-counter medications you are taking
Any natural products or vitamins you are using
Existing health problems
Any potential interactions between this medication and your other medications or health conditions
Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor to confirm the safety of such changes.
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.
When considering administration to children, note that different brands of this medication may be approved for use in various age groups. Therefore, it is crucial to consult with your doctor before giving this drug to a child to ensure the appropriate brand and dosage are used.
If you are pregnant, planning to become pregnant, or are breastfeeding, it is vital to discuss your situation with your doctor. This conversation will help you understand the benefits and risks associated with taking this medication during these periods, allowing you to make an informed decision regarding your health and the health of your baby.
When considering administration to children, note that different brands of this medication may be approved for use in various age groups. Therefore, it is crucial to consult with your doctor before giving this drug to a child to ensure the appropriate brand and dosage are used.
If you are pregnant, planning to become pregnant, or are breastfeeding, it is vital to discuss your situation with your doctor. This conversation will help you understand the benefits and risks associated with taking this medication during these periods, allowing you to make an informed decision regarding your health and the health of your baby.
Overdose Information
Overdose Symptoms:
- Nausea, vomiting, stomach pain
- Dizziness, drowsiness, confusion
- Nervousness, restlessness, irritability
- Hallucinations, agitation, seizures (especially with dextromethorphan)
- Rapid heart rate, palpitations, high blood pressure (with phenylephrine)
- Difficulty breathing
- Urinary retention
What to Do:
Seek immediate medical attention or call Poison Control at 1-800-222-1222. Bring the product packaging with you.
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)
Major Interactions
- Other sympathomimetics (e.g., pseudoephedrine, ephedrine, amphetamines) - increased risk of cardiovascular effects.
- Tricyclic antidepressants (TCAs) - may potentiate pressor effects of phenylephrine.
- Beta-blockers (non-selective) - may increase pressor effects of phenylephrine and lead to hypertension.
- Serotonergic drugs (e.g., SSRIs, SNRIs, triptans) - increased risk of serotonin syndrome with dextromethorphan.
Moderate Interactions
- Antihypertensive drugs - phenylephrine may reduce the effect of antihypertensives.
- Digoxin - increased risk of arrhythmias with phenylephrine.
- Alcohol and other CNS depressants - increased sedation with dextromethorphan.
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) - may increase dextromethorphan levels and adverse effects.
Minor Interactions
- None specifically for guaifenesin.
Monitoring
Symptom Monitoring
- Effectiveness in reducing cough frequency and severity
- Effectiveness in reducing nasal congestion
- Changes in mucus consistency and ease of expectoration
- Presence of adverse effects (e.g., dizziness, nervousness, insomnia, nausea, vomiting, headache, increased blood pressure, palpitations)
- Signs of allergic reaction (rash, itching, swelling)
- Worsening of symptoms or development of new symptoms (e.g., high fever, persistent headache, rash, difficulty breathing)
Special Patient Groups
Pregnancy
Use with caution during pregnancy, especially during the first trimester. Consult a healthcare provider before use. While individual components are generally considered low risk for short-term use, combination products should be used only if clearly needed.
Trimester-Specific Risks:
First Trimester:
Phenylephrine: Potential for vascular disruption; generally avoided. Dextromethorphan/Guaifenesin: Limited data, generally considered low risk but caution advised.
Second Trimester:
Generally considered safer than first trimester, but still use with caution and only if necessary.
Third Trimester:
Phenylephrine: May cause uterine vasoconstriction; caution advised. Dextromethorphan/Guaifenesin: Generally considered low risk for short-term use.
Lactation
Use with caution during breastfeeding. Consult a healthcare provider before use. Small amounts of components may pass into breast milk. Monitor infant for drowsiness or irritability.
Infant Risk:
L3 (Moderate risk). Phenylephrine may reduce milk supply. Dextromethorphan and guaifenesin are generally considered compatible with breastfeeding for short-term use, but monitor infant for sedation or gastrointestinal upset.
Pediatric Use
Not recommended for children under 4 years of age without consulting a healthcare professional due to potential for serious side effects and lack of proven efficacy. For children 4-6 years, use only under medical guidance. Always use a dosing device provided with the product and follow age-specific dosing instructions carefully. Accidental overdose in young children is a significant concern.
Geriatric Use
Use with caution in elderly patients, especially those with pre-existing conditions such as hypertension, heart disease, glaucoma, prostate enlargement (BPH), or diabetes, due to the phenylephrine component. Start with the lowest effective dose and monitor for adverse effects like increased blood pressure, insomnia, or urinary retention.
Clinical Information
Clinical Pearls
- This product is for symptomatic relief of cough and congestion, not a cure for the underlying cause.
- Encourage adequate hydration to maximize the expectorant effect of guaifenesin.
- Advise patients not to exceed recommended doses or use with other products containing similar ingredients (e.g., other cough/cold medicines, decongestants) to avoid accidental overdose.
- Counsel patients on the importance of reading the specific product label for exact dosing instructions and warnings, as concentrations can vary between brands.
- If cough persists for more than 7 days, or is accompanied by high fever, rash, or persistent headache, advise seeking medical attention.
Alternative Therapies
- Single-ingredient Guaifenesin (expectorant)
- Single-ingredient Dextromethorphan (antitussive)
- Single-ingredient Phenylephrine (decongestant)
- Saline nasal sprays (for congestion)
- Humidifiers
- Honey (for cough, in children >1 year)
- Non-pharmacological measures (rest, fluids)
Cost & Coverage
Average Cost:
$10 - $30 per 4 oz (120 mL) bottle
Generic Available:
Yes
Insurance Coverage:
Generally OTC, not typically covered by insurance unless prescribed or through FSA/HSA.
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't 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 details about the medication taken, the amount, and the time it happened.