Tussionex Bead Count in 5mL
Tussionex is an extended-release suspension containing hydrocodone and chlorpheniramine in a bead formulation, but the exact number of beads per 5mL is not standardized or clinically relevant—what matters is that each 5mL delivers 10mg of hydrocodone and 8mg of chlorpheniramine in a suspension that must not be filtered or divided.
Critical Product Characteristics
- Tussionex is formulated as an extended-release suspension where the active ingredients are contained within polymer-coated beads suspended in liquid 1
- The bead count per volume is not specified by manufacturers because the therapeutic dose is determined by the total volume of suspension, not by counting individual beads 1
- Each 5mL of Tussionex suspension delivers a fixed dose of 10mg hydrocodone (equivalent to 10 MME) and 8mg chlorpheniramine, regardless of the number of beads present 2, 3
Why Bead Count Is Not Clinically Specified
- The suspension must be shaken well before each dose to ensure uniform distribution of beads throughout the liquid vehicle, making individual bead counting irrelevant to proper dosing 1
- Attempting to filter, separate, or count beads would destroy the extended-release mechanism and could lead to immediate release of the full opioid dose, creating overdose risk 3
- The polymer coating on beads provides the controlled-release properties over 12 hours—any manipulation compromises this safety feature 1
Proper Dosing Context
- Adult dosing is 5mL every 12 hours (delivering 10mg hydrocodone per dose, or 20 MME/day total), not to exceed 10mL in 24 hours 2, 4
- Tussionex is contraindicated in patients under 18 years of age due to unfavorable benefit-risk profile and lack of efficacy data in pediatric populations 3
- The extended-release formulation should never be used for acute breakthrough cough—it is designed for sustained symptom control over 12-hour intervals 2, 4
Common Pitfalls to Avoid
- Never attempt to divide, filter, or separate the beads from the suspension—this destroys the extended-release mechanism and creates immediate overdose risk 3, 1
- Do not prescribe Tussionex when non-opioid cough suppressants have not been tried first, as opioid antitussives should be reserved for severe cough significantly impairing quality of life 4
- Avoid exceeding 10mL (20mg hydrocodone/20 MME) in 24 hours without careful risk-benefit reassessment, as doses approaching 50 MME/day require heightened monitoring for respiratory depression 2, 4
- Do not use in elderly patients without dose reduction due to increased risk of respiratory depression 4