Ambroxol + Chlorpheniramine Maleate + Guaifenesin + Menthol + Phenylephrine

Usage

This combination medication is primarily prescribed for the symptomatic relief of cough associated with mucus and the common cold. It is also indicated for allergic rhinitis and other respiratory illnesses characterized by thick mucus secretions, nasal congestion, and cough. It addresses multiple cold and flu symptoms.

• Pharmacological Classification: This is a combination product with multiple classifications:

  • Ambroxol: Mucolytic agent
  • Chlorpheniramine Maleate: Antihistamine
  • Guaifenesin: Expectorant
  • Menthol: Topical analgesic and counterirritant
  • Phenylephrine: Decongestant

• Mechanism of Action:

  • Ambroxol breaks down mucopolysaccharides, reducing sputum viscosity.
  • Chlorpheniramine Maleate antagonizes histamine H1 receptors, mitigating allergic reactions.
  • Guaifenesin increases respiratory tract fluid, thinning mucus.
  • Menthol provides a cooling sensation and relieves throat irritation.
  • Phenylephrine acts as an alpha-adrenergic agonist, constricting nasal blood vessels and relieving congestion.

Alternate Names

There is no internationally recognized non-proprietary name for this specific combination. It’s referred to by its component drugs. Numerous brand names exist depending on the manufacturer and region.

How It Works

• Pharmacodynamics: This combination exerts its therapeutic effects through the combined actions of its individual components targeting different aspects of respiratory symptoms. Ambroxol acts as a mucolytic, Chlorpheniramine as an antihistamine, Guaifenesin as an expectorant, Menthol as a counterirritant, and Phenylephrine as a decongestant.

• Pharmacokinetics:

  • Absorption: All components are absorbed orally.
  • Metabolism: Primarily hepatic metabolism via CYP enzymes (especially for Ambroxol and Chlorpheniramine).
  • Elimination: Mainly renal excretion for all components, although some biliary excretion may occur.

• Mode of Action: Ambroxol acts on the mucus at the molecular level, breaking it down and reducing its viscosity. Chlorpheniramine competitively inhibits histamine H1 receptors blocking the allergic cascade. Guaifenesin stimulates secretions from the bronchial glands. Phenylephrine acts as an alpha-1 adrenergic agonist.

Dosage

Dosage guidelines are specific to each formulation and are available from the manufacturer. As of 2025-02-16, there are no globally standardized dosing recommendations across all formulations. Always refer to the specific product labeling.

Standard Dosage

Adults: Dosage can vary based on product formulation; generally 10ml syrup every 4-6 hours for adults and children above 12 years. Do not exceed recommended daily dose.

Children: This combination is generally not recommended for children under 12 years old. Refer to pediatric guidelines when available.

Special Cases: Dosage adjustments must be individualized by medical professionals, considering patient response and any potential contraindications.

Clinical Use Cases

Dosage in clinical settings like the ICU requires consultation with pulmonologists or anesthesiologists due to the lack of specific clinical trials for this particular fixed-dose combination in these contexts.

Dosage Adjustments

Adjustments should be based on patient-specific factors like renal/hepatic function and response to therapy. There is limited data available concerning dosage adjustments for hepatic/renal impairments for the specific combination. Consulting a specialist is recommended.

Side Effects

Common Side Effects:

Drowsiness, dizziness, headache, dry mouth, nausea, vomiting, gastrointestinal upset.

Rare but Serious Side Effects:

Allergic reactions (rash, itching, swelling), difficulty breathing, rapid heart rate, hallucinations, seizures.

Long-Term Effects: No specific long-term effects are known for the combination used as directed.

Adverse Drug Reactions (ADR):

Severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome (rare).

Contraindications

Hypersensitivity to any components. Severe hypertension, severe coronary artery disease, narrow-angle glaucoma, urinary retention, MAOI use within 14 days, hypersensitivity to any component.

Drug Interactions

MAOIs, antihistamines, antidepressants, blood pressure medications, sedatives, tranquilizers, alcohol. May interact with other cough and cold medications, beta-blockers, diuretics, antidepressants, and sedatives. Consult drug information resources for detailed interactions.

Pregnancy and Breastfeeding

Use only if clearly needed and benefits outweigh risks. Consult a physician. Generally considered unsafe for pregnant and breastfeeding women.

Drug Profile Summary

• Mechanism of Action: Multifaceted, addressing mucus, allergy, congestion.
• Side Effects: Drowsiness, dizziness, dry mouth, GI upset.
• Contraindications: Hypersensitivity, severe cardiovascular/respiratory disease, MAOI use.
• Drug Interactions: Numerous, see drug interaction resources.
• Pregnancy & Breastfeeding: Consult physician; generally avoided.
• Dosage: Varies with product formulation; see product literature.
• Monitoring Parameters: Respiratory rate, allergic reactions.

Popular Combinations

This combination is itself a common formulation. Additional medications may be added based on symptoms, such as analgesics like paracetamol.

Precautions

Evaluate for pre-existing contraindications. Monitor for adverse reactions. Exercise caution in patients with pre-existing conditions. Screen for allergies. Advise about potential drowsiness and avoid driving or operating machinery.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Ambroxol + Chlorpheniramine Maleate + Guaifenesin + Menthol + Phenylephrine?

A: The dosage is dependent on the specific formulation and patient factors. Refer to the manufacturer’s guidelines and/or consult a physician. This combination is often available in syrup form, with typical adult dosages of 10ml every 4-6 hours. Pediatric dosages should be determined by a physician, as this medication is generally not recommended for use in children under 12.

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

A: Primarily used to relieve symptoms of the common cold, flu, and allergies, including cough with mucus, nasal congestion, and runny nose.

Q3: Can this combination be used in children?

A: Generally not recommended for children under 12. Consult a pediatrician for appropriate alternatives.

Q4: What are the major contraindications for this medicine?

A: Hypersensitivity, severe cardiovascular disease, glaucoma, urinary retention, concurrent MAOI use.

Q5: Are there any significant drug interactions I should be aware of?

A: Yes, numerous. Refer to drug interaction resources for detailed information. Key interactions involve MAOIs, other antihistamines, antidepressants, and certain blood pressure medications.

Q6: Can this medicine be used during pregnancy or while breastfeeding?

A: Use with caution; consult a physician. It’s generally advisable to explore safer alternatives during pregnancy and breastfeeding.

Q7: What are the most common side effects?

A: Drowsiness, dizziness, dry mouth, nausea, gastrointestinal upset.

Q8: What should I do if a patient experiences an allergic reaction?

A: Discontinue the medication immediately and seek urgent medical assistance.

Q9: Does this medicine interact with alcohol?

A: It is best to avoid alcohol, as it may exacerbate potential side effects like drowsiness.

Q10: Can patients drive or operate heavy machinery after taking this medicine?

A: Advise patients to avoid such activities, especially initially, due to possible drowsiness and impaired cognitive function.