Alcohol + Ephedrine + Guaifenesin + Piperazine

Usage

This combination, often marketed as Cadiphylate Elixir, is primarily prescribed for cough and congestion relief. It is classified as a combination drug containing a bronchodilator (piperazine), a sympathomimetic agonist (ephedrine), an expectorant (guaifenesin), and alcohol.

Alternate Names

Cadiphylate Elixir

How It Works

Pharmacodynamics:

• Piperazine: Relaxes the airway smooth muscle, leading to bronchodilation.
• Ephedrine: Acts as a sympathomimetic agonist, increasing blood flow to the heart and lungs, further contributing to bronchodilation.
• Guaifenesin: Thins and loosens mucus, facilitating expectoration.
• Alcohol: Serves as a solvent and may contribute to a mild sedative effect.

Pharmacokinetics:

The precise pharmacokinetic parameters (absorption, distribution, metabolism, and elimination) of this combination product are not well-defined in available resources. Each individual component has its own profile, which might be affected by co-administration. Ephedrine is known to be metabolized to norephedrine and primarily excreted renally. Guaifenesin is also primarily excreted renally. Piperazine is also renally excreted. The alcohol component is metabolized primarily by the liver.

Mode of Action:

• Ephedrine acts on alpha and beta-adrenergic receptors, mimicking the effects of adrenaline.
• Piperazine’s bronchodilatory mechanism is not entirely clear, but it is believed to be related to calcium channel blockade and potassium channel activation.
• Guaifenesin is thought to increase respiratory tract fluid secretions, making mucus less viscous and easier to expectorate.

Dosage

Dosage information for this specific combination is limited. Always consult a healthcare professional and the specific product labeling.

Standard Dosage

Adults:

Specific adult dosage recommendations are lacking; however, general guidance for similar cough syrups is often 5-10ml every 4-6 hours as needed.

Children:

Pediatric dosage is not clearly defined. Similar syrups are dosed based on weight or age, but pediatric use requires careful consideration due to potential adverse effects, particularly from ephedrine. Expert consultation is essential.

Special Cases:

• Elderly Patients: Dose adjustments may be needed due to age-related physiological changes.
• Patients with Renal Impairment: Dose modification may be necessary.
• Patients with Hepatic Dysfunction: Dose adjustments are likely needed.
• Patients with Comorbid Conditions: Caution is advised in patients with cardiovascular diseases, diabetes, hyperthyroidism, and prostatic hypertrophy due to potential exacerbations.

Clinical Use Cases

Specific dosage recommendations for clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations are not available.

Dosage Adjustments

Adjustments should be based on patient-specific factors, including renal and hepatic function, comorbidities, and drug interactions.

Side Effects

Common Side Effects

Headache, nausea, vomiting, upset stomach, restlessness, increased heart rate, insomnia.

Rare but Serious Side Effects

Seizures, tremors, difficulty breathing, allergic reactions (rash, itching, swelling, shortness of breath), significant changes in blood pressure and heart rate, cardiac arrhythmias.

Long-Term Effects

Not well documented.

Adverse Drug Reactions (ADR)

Severe allergic reactions, significant changes in blood pressure, cardiac arrhythmias, neurological effects (seizures, tremors).

Contraindications

Hypersensitivity to any component, severe heart or lung conditions, uncontrolled hypertension, hyperthyroidism, pregnancy, breastfeeding, concurrent use of MAO inhibitors.

Drug Interactions

MAO inhibitors, caffeine, other sympathomimetics, antidepressants. Alcohol can potentiate the sedative effects and should be avoided.

Pregnancy and Breastfeeding

Contraindicated. Ephedrine and alcohol may adversely affect fetal development and can pass into breast milk.

Drug Profile Summary

• Mechanism of Action: Bronchodilation, expectorant action, increased blood flow.
• Side Effects: Headache, nausea, vomiting, restlessness, increased heart rate, insomnia. Serious: seizures, tremors, breathing difficulties.
• Contraindications: Hypersensitivity, severe cardiopulmonary disease, uncontrolled hypertension, hyperthyroidism, pregnancy, breastfeeding, MAOI use.
• Drug Interactions: MAOIs, caffeine, other sympathomimetics, antidepressants, alcohol.
• Pregnancy & Breastfeeding: Contraindicated.
• Dosage: Consult a healthcare professional and product labeling.
• Monitoring Parameters: Blood pressure, heart rate, respiratory status.

Popular Combinations

Information not available.

Precautions

• General Precautions: Pre-screening for allergies, metabolic disorders, organ dysfunction.
• Specific Populations: Avoid use in pregnant and breastfeeding women, exercise caution in the elderly and children.
• Lifestyle Considerations: Limit alcohol consumption.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Alcohol + Ephedrine + Guaifenesin + Piperazine?

A: Consult a healthcare professional and the specific product labeling for dosage guidance, as it varies depending on several factors, including age, weight, and medical conditions. There is no standardized dosage for this specific combination.

Q2: What are the primary uses of this combination drug?

A: Primarily used for symptomatic relief of cough and congestion associated with respiratory illnesses like bronchitis.

Q3: What are the potential drug interactions I should be aware of?

A: Avoid co-administration with MAO inhibitors. Be cautious with caffeine, other sympathomimetics, and antidepressants. Alcohol should also be avoided due to potential additive effects and interactions with ephedrine.

Q4: Is this combination safe for pregnant or breastfeeding women?

A: No, it is contraindicated in both pregnancy and breastfeeding due to potential risks to the fetus or neonate.

Q5: Are there any specific monitoring parameters for patients on this medication?

A: Monitor blood pressure, heart rate, and respiratory status, especially in patients with pre-existing cardiovascular conditions.

Q6: What is the mechanism of action of each component in this mixture?

A: Piperazine acts as a bronchodilator, ephedrine as a sympathomimetic and bronchodilator, guaifenesin as an expectorant, and alcohol as a solvent with potential mild sedative effects.

Q7: What are the most common side effects patients might experience?

A: Common side effects include headache, nausea, vomiting, restlessness, increased heart rate, and insomnia.

Q8: Are there any serious adverse effects that warrant immediate attention?

A: Yes, serious side effects like seizures, tremors, difficulty breathing, and allergic reactions require immediate medical intervention. Significant changes in blood pressure and heart rate should also be closely monitored.

Q9: What precautions should I take before prescribing this combination?

A: Assess for pre-existing medical conditions such as cardiovascular diseases, renal or hepatic impairment, diabetes, and hyperthyroidism. Screen for allergies to any of the components. Exercise caution in elderly patients and children. Advise patients to limit alcohol consumption.