Usage
- This combination medication is primarily prescribed for the relief of symptoms associated with the common cold, cough, and allergies, such as cough (dry or productive), runny nose, sneezing, nasal congestion, and chest congestion. It is specifically useful in cases of cough with mucus.
- Pharmacological Classification: This combination includes several drug classes: mucolytic (ambroxol), antihistamine (cetirizine), cough suppressant (dextromethorphan), expectorant (guaifenesin), decongestant (phenylephrine), and alkalinizing agent (sodium citrate).
- Mechanism of Action: Briefly, ambroxol breaks down mucus, cetirizine blocks histamine action, dextromethorphan suppresses the cough reflex, guaifenesin loosens mucus, phenylephrine reduces nasal congestion, and sodium citrate helps alkalinize the respiratory secretions.
Alternate Names
- No widely recognized alternate names exist for this specific six-ingredient combination. However, it’s crucial to note that different pharmaceutical companies market this combination under various brand names.
- Brand Names: While sources list brand names for other combinations, they do not list a specific brand name for this 6-ingredient combination. Brand names vary regionally.
How It Works
- Pharmacodynamics: Ambroxol stimulates the serous glands in the respiratory tract to produce less viscous secretions. Cetirizine antagonizes the H1 histamine receptor, reducing allergic symptoms. Dextromethorphan acts centrally on the cough center in the medulla. Guaifenesin increases respiratory tract fluid, reducing mucus viscosity. Phenylephrine acts as an α1-adrenergic receptor agonist, causing vasoconstriction in the nasal mucosa. Sodium citrate acts as an alkalinizing agent.
- Pharmacokinetics: All components are absorbed orally. Ambroxol is metabolized in the liver and excreted primarily in the urine. Cetirizine undergoes minimal metabolism and is excreted mostly unchanged in urine. Dextromethorphan is metabolized in the liver, and metabolites are excreted in urine. Guaifenesin is also metabolized in the liver and excreted in the urine. Phenylephrine undergoes first-pass metabolism and is excreted in urine. Sodium citrate is metabolized and excreted as carbon dioxide and sodium bicarbonate.
- Mode of Action/Receptor Binding/Enzyme Inhibition: Ambroxol’s precise mode of action beyond stimulating serous glands is not fully elucidated. Cetirizine is an H1 receptor antagonist. Dextromethorphan acts on sigma opioid receptors and NMDA receptors in the CNS. Guaifenesin might stimulate gastric vagal receptors. Phenylephrine activates α1-adrenergic receptors. Sodium citrate alkalinizes bodily fluids, including respiratory secretions.
- Elimination Pathways: Primarily renal excretion for all components, with varying degrees of hepatic metabolism.
Dosage
Standard Dosage
Adults:
- 5 to 10 ml of syrup three times daily.
Children:
- Dosage must be determined by a physician based on the child’s age and weight.
Special Cases:
- Elderly Patients: Dosage adjustment may be required depending on renal and hepatic function.
- Patients with Renal Impairment: Dose reduction may be necessary.
- Patients with Hepatic Dysfunction: Dose reduction may be necessary.
- Patients with Comorbid Conditions: Careful evaluation is needed, especially in patients with cardiovascular disease, diabetes, hyperthyroidism, or closed-angle glaucoma.
Clinical Use Cases
- The available source material does not provide specific dosage recommendations for specialized clinical scenarios such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. This combination is typically used for outpatient management of common cold and cough symptoms.
Dosage Adjustments:
Dosage adjustments are needed for patients with renal or hepatic impairment. Specific modifications should be based on individual patient characteristics and clinical judgment.
Side Effects
Common Side Effects:
- Nausea, vomiting, dizziness, drowsiness, headache, dry mouth, constipation.
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling), breathing difficulties, hallucinations, irregular heartbeat.
Long-Term Effects:
- Potential for tolerance to dextromethorphan with prolonged use.
Adverse Drug Reactions (ADR):
- Severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis.
Contraindications
- Hypersensitivity to any of the components.
- Severe respiratory depression.
- Narrow-angle glaucoma.
- Monoamine oxidase inhibitor (MAOI) therapy.
- Severe cardiovascular disease.
Drug Interactions
- MAOIs, alcohol, other CNS depressants, anticholinergics, beta-blockers, tricyclic antidepressants.
Pregnancy and Breastfeeding
- Consult with a physician before use during pregnancy or breastfeeding. Safety in pregnancy and lactation is not fully established.
Drug Profile Summary
Popular Combinations
- Not applicable, as this is already a combination product.
Precautions
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ambroxol + Cetirizine + Dextromethorphan Hydrobromide + Guaifenesin + Phenylephrine + Sodium Citrate?
A: The typical adult dosage is 5 to 10 ml of syrup three times a day. Pediatric dosages should be determined by a physician.
Q2: What are the common side effects?
A: Common side effects include nausea, vomiting, dizziness, drowsiness, dry mouth, and constipation.
Q3: Is this combination safe during pregnancy?
A: Consult a physician before use during pregnancy. The safety profile isn’t fully established.
Q4: Can this medicine be used in children?
A: It can be used in children, but the dosage must be adjusted based on the child’s weight and age, as determined by a physician.
Q5: Are there any serious drug interactions?
A: Yes, significant interactions exist with MAOIs, alcohol, and other CNS depressants.
Q6: What should I do if a patient experiences an allergic reaction?
A: Discontinue the medication immediately and seek emergency medical attention.
Q7: How does this combination work to relieve cough and cold symptoms?
A: It works through multiple mechanisms: thinning mucus, suppressing cough, reducing allergy symptoms, decongesting nasal passages, and alkalinizing respiratory secretions.
Q8: Can this combination be used for chronic cough?
A: While it can provide symptomatic relief, it’s important to identify and treat the underlying cause of a chronic cough. Long-term use of dextromethorphan may lead to tolerance.
Q9: What are the contraindications for this medication?
A: Contraindications include hypersensitivity, severe respiratory depression, narrow-angle glaucoma, MAOI therapy, and severe cardiovascular disease.
