Zerotuss

Chlorpheniramine Maleate (4mg) + Codeine (10mg) + Menthol (1.5mg/5ml)
Price: ₹65 - ₹105 for 100ml bottle
Mfr: Aristo Pharmaceuticals Pvt. Ltd. | Form: Syrup

📋 Clinical Overview

A fixed-dose combination antitussive and antihistaminic syrup used for the symptomatic relief of dry, non-productive cough associated with allergic conditions like allergic rhinitis or the common cold. Chlorpheniramine is a first-generation alkylamine H1-antihistamine, Codeine is a centrally-acting opioid antitussive, and Menthol provides local soothing and decongestant effects.

💊 Dosage & Administration

Adult: 10 ml (2 teaspoonfuls) three to four times daily. Maximum: 40 ml per day.

Note: To be taken orally. Use the measuring cup/spoon provided. Can be taken with or without food. Do not drive or operate machinery after intake. Avoid alcohol.

⚠️ Contraindications

  • Hypersensitivity to any component
  • Respiratory depression, acute asthma
  • Paralytic ileus
  • Concurrent use of MAOIs or within 14 days
  • Children below 6 years of age
  • Known CYP2D6 ultra-rapid metabolizers (risk of life-threatening morphine toxicity)

🔬 Mechanism of Action

The combination acts synergistically. Chlorpheniramine antagonizes histamine at H1 receptors, reducing allergic symptoms and providing mild sedative effects. Codeine, an opioid agonist, suppresses the cough reflex by direct action on the cough center in the medulla oblongata. Menthol acts as a topical cooling/soothing agent on irritated pharyngeal mucosa, providing symptomatic relief and a sensation of easier breathing.

🤕 Side Effects

  • Drowsiness, sedation
  • Dry mouth, nose, or throat
  • Dizziness
  • Gastrointestinal upset, constipation
  • Blurred vision

🤰 Special Populations

Pregnancy: Category C (US FDA). Avoid, especially in third trimester (risk of neonatal withdrawal syndrome and respiratory depression in newborn). Use only if potential benefit justifies potential fetal risk.

Driving: IMPAIRMENT ALERT: May cause drowsiness, dizziness, and blurred vision. Patients should not drive or operate heavy machinery until their response is known.

🔄 Drug Interactions

Alcohol, Benzodiazepines, BarbituratesPotentiated CNS and respiratory depressionMajor
MAO Inhibitors (Phenelzine, Tranylcypromine)Risk of hypertensive crisis, hyperpyrexiaMajor
Other Opioids (Morphine, Tramadol)Additive CNS depression, respiratory depression, constipationMajor
SSRIs/SNRIs (Fluoxetine, Paroxetine), TCAsIncreased codeine effect (CYP2D6 inhibition), risk of serotonin syndromeModerate
CNS Depressants (Antipsychotics, Skeletal Muscle Relaxants)Increased sedation and respiratory depressionModerate
Anticholinergics (Atropine, Oxybutynin, TCAs)Potentiated anticholinergic side effects (dry mouth, urinary retention, confusion)Moderate
Rifampicin, Carbamazepine, PhenytoinReduced codeine efficacy (CYP3A4 induction)Moderate

🔁 Alternatives to Zerotuss

Same composition (Chlorpheniramine Maleate (4mg) + Codeine (10mg) + Menthol (1.5mg/5ml)), different brands:

Tixylix Codistar Chericof