Usage
This combination drug is prescribed for the relief of cough associated with mucus, particularly in conditions like bronchitis, bronchial asthma, emphysema, and COPD. It targets both the production and clearance of mucus and helps to dilate the airways.
- Pharmacological Classification: This combination includes a mucolytic (Ambroxol), an expectorant (Guaifenesin), a topical analgesic and decongestant (Levomenthol), and a bronchodilator (Terbutaline).
- Mechanism of Action: Ambroxol breaks down mucopolysaccharides, reducing mucus viscosity. Guaifenesin increases respiratory tract fluid secretions, thinning the mucus. Levomenthol provides a cooling sensation and mild decongestant effect. Terbutaline, a beta2-adrenergic agonist, relaxes bronchial smooth muscle, widening the airways.
Alternate Names
There’s no standard international nonproprietary name (INN) for this combination. It is marketed under various brand names such as Cold Care A Syrup, Instaryl-P Syrup, Kuffgic LS PD Syrup, and Kufica T Syrup.
How It Works
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Pharmacodynamics: Ambroxol stimulates surfactant synthesis and reduces mucus viscosity. Guaifenesin increases respiratory tract fluid secretions. Levomenthol activates TRPM8 receptors, causing a cooling sensation and mild decongestant effects. Terbutaline, a beta2-agonist, relaxes bronchial smooth muscle.
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Pharmacokinetics: Ambroxol is well-absorbed orally, metabolized in the liver, and excreted renally. Guaifenesin is readily absorbed orally and excreted renally. Levomenthol is absorbed through mucous membranes and skin. Terbutaline is metabolized by conjugation and excreted primarily in urine.
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Mode of Action: Ambroxol breaks down mucopolysaccharides. Guaifenesin increases respiratory tract fluid secretions. Levomenthol activates TRPM8 receptors. Terbutaline activates beta2-adrenergic receptors.
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Elimination Pathways: Ambroxol and Guaifenesin are primarily excreted renally. Terbutaline is excreted primarily in urine after conjugation. Levomenthol is partially metabolized and excreted through various pathways.
Dosage
Dosage varies depending on patient factors like age, weight, and medical condition. Always consult the manufacturer’s prescribing information.
Standard Dosage
Adults:
A common adult dose is 5-10 ml of syrup or one tablet three times daily. The exact dose and frequency depend on the specific product formulation.
Children:
Dosages for children are typically based on weight or age. For children between 6 months and 2 years, 1 ml (approximately 20 drops) twice daily or 0.5 ml (approximately 10 drops) three times daily is common. Avoid use in infants below 6 months due to limited safety data.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary depending on individual health and organ function. Close monitoring is recommended.
- Patients with Renal Impairment: Caution is advised, and dose reduction or increased dosing interval might be required due to potential metabolite accumulation.
- Patients with Hepatic Dysfunction: Caution is recommended. Dose adjustments may be needed.
- Patients with Comorbid Conditions: This medicine should be used with caution in patients with diabetes, hypertension, cardiovascular disease, hyperthyroidism, gastric ulcers, and seizure disorders.
Clinical Use Cases
Dosing in specific clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, and emergencies should be determined by the treating physician based on the patient’s individual needs.
Dosage Adjustments
Adjustments should be based on individual patient characteristics, including renal/hepatic impairment, metabolic disorders, and other relevant health factors.
Side Effects
Common Side Effects:
Nausea, vomiting, drowsiness, headache, dizziness, nervousness, tremors, palpitations, stomach upset, dry mouth, skin rash, hives, fast heartbeats, diarrhea, increased heart rate.
Rare but Serious Side Effects:
Allergic reactions (rash, itching, swelling), arrhythmias, hypotension, hyperglycemia, hypokalemia, and seizures.
Long-Term Effects:
Chronic complications are uncommon with short-term use. Long-term use of terbutaline can lead to tolerance and potentially cardiac dysfunction.
Adverse Drug Reactions (ADR):
Severe allergic reactions (anaphylaxis), severe cardiovascular events (e.g., myocardial infarction, stroke), and significant electrolyte imbalances.
Contraindications
Hypersensitivity to any component, severe cardiovascular disease (e.g., unstable angina, uncontrolled hypertension), hyperthyroidism, seizure disorders.
Drug Interactions
Beta-blockers, MAO inhibitors, sympathomimetic drugs, caffeine, digoxin, certain antidepressants, certain blood pressure medications, certain Parkinson’s disease medications, corticosteroids, and some respiratory medications may interact with this drug combination. Alcohol should be avoided or limited.
Pregnancy and Breastfeeding
Use with caution during pregnancy and breastfeeding. Terbutaline has been associated with potential adverse fetal effects. Consult a physician to assess risks and benefits. Breastfeeding should be temporarily stopped if this medication is necessary.
Drug Profile Summary
- Mechanism of Action: See “How It Works” section.
- Side Effects: See “Side Effects” section.
- Contraindications: See “Contraindications” section.
- Drug Interactions: See “Drug Interactions” section.
- Pregnancy & Breastfeeding: Use with caution. Consult a physician.
- Dosage: See “Dosage” section.
- Monitoring Parameters: Respiratory rate, oxygen saturation, blood pressure, heart rate, blood glucose, and potassium levels.
Popular Combinations
This combination itself contains four active ingredients. Adding other medications should be done cautiously and under the guidance of a physician.
Precautions
- General Precautions: Pre-screening for allergies and relevant medical conditions is essential.
- Specific Populations: See “Dosage - Special Cases” and “Pregnancy and Breastfeeding” sections.
- Lifestyle Considerations: Avoid alcohol and smoking. Caution while driving or operating machinery due to potential drowsiness or dizziness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ambroxol + Guaifenesin + Levomenthol + Terbutaline?
A: Dosage varies based on patient-specific factors. See the “Dosage” section for general guidelines and always consult the manufacturer’s prescribing information.
Q2: Can this combination be used in children?
A: It can be used in children over 6 months of age under strict medical supervision. Specific dosing guidelines for children are provided in the “Dosage” section.
Q3: What are the common side effects?
A: Common side effects include nausea, vomiting, dizziness, headache, and stomach upset.
Q4: Are there any serious side effects?
A: Rare but serious side effects include allergic reactions, cardiac arrhythmias, and hypotension.
Q5: Is this medication safe during pregnancy?
A: Use with caution during pregnancy and breastfeeding. Consult a physician.
Q6: Can I take this medication if I have diabetes?
A: Use with caution in diabetic patients and monitor blood sugar levels. Consult your physician.
Q7: What should I do if I experience side effects?
A: If side effects are mild, they usually resolve on their own. If side effects persist or worsen, consult a doctor immediately.
Q8: Can I drink alcohol while taking this medication?
A: Alcohol should be avoided or limited as it may exacerbate side effects like drowsiness and dizziness.
Q9: Does this combination interact with other medications?
A: Yes, it can interact with several medications. See the “Drug Interactions” section for details. Always inform your doctor about all other medications you are taking.
