Usage
This combination medication is prescribed for the relief of symptoms associated with the common cold, flu, and other respiratory tract infections with thick mucus. It is also used to treat allergic rhinitis (hay fever) characterized by sneezing, runny nose, watery eyes, itching, and congestion.
Pharmacological Classification:
This is a combination drug including components belonging to the following classes:
- Ambroxol: Mucolytic/Expectorant
- Guaifenesin: Expectorant
- Loratadine: Second-generation antihistamine
Mechanism of Action:
- Ambroxol breaks down the structure of thick mucus, making it less viscous and easier to cough up.
- Guaifenesin increases the volume of fluids in the airways, further thinning the mucus and facilitating its expulsion.
- Loratadine blocks the action of histamine, a substance released by the body during allergic reactions, thereby relieving allergy symptoms.
Alternate Names
This combination medication may not have a universally recognized International Nonproprietary Name (INN). It is typically referred to by the names of its constituents. Several brand names exist depending on the manufacturer and the region. Some examples as of today (2025-02-16) are:
How It Works
Pharmacodynamics:
Ambroxol acts on the serous and mucous glands in the respiratory tract, promoting the secretion of thinner, less viscous mucus. Guaifenesin irritates receptors in the gastric mucosa, which triggers a vagal reflex leading to increased respiratory tract fluid secretions, ultimately thinning the mucus. Loratadine is a selective inverse agonist of peripheral H1 receptors. It blocks the effects of histamine, reducing allergic symptoms like sneezing, itching, and runny nose.
Pharmacokinetics:
- Ambroxol is well-absorbed orally, reaching peak plasma concentrations in 1-3 hours. It is metabolized primarily in the liver and excreted mainly in the urine.
- Guaifenesin is also readily absorbed from the gastrointestinal tract. It is metabolized in the liver and excreted in the urine.
- Loratadine is rapidly absorbed after oral administration. It undergoes extensive first-pass metabolism in the liver, forming its active metabolite, desloratadine. Both loratadine and desloratadine are eliminated through urine and feces.
Elimination Pathways: Primarily renal excretion for all three components, with hepatic metabolism playing a significant role.
Dosage
The dosage will vary according to the patient’s age, overall health condition, and the severity of the symptoms.
Standard Dosage
Adults:
A typical adult dose for this combination (as per the sources) could include:
- Loratadine 10mg
- Guaifenesin 200-400mg
- Ambroxol 30mg
This can be administered every 8-12 hours or as directed by the physician. The maximum dosage limits should be adhered to as prescribed by the doctor. Note that this dosage is an example.
Children:
Pediatric dosing should be determined by a pediatrician, considering the child’s weight and age. Some source suggest the following:
- 2-6 years old: 5 mg Loratadine/ 50mg Guaifenesin/ 30 mg Ambroxol twice daily
- 6-12 years old: 10 mg Loratadine/ 100mg Guaifenesin/ 30 mg Ambroxol twice daily
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary based on kidney and liver function.
- Patients with Renal Impairment: Dose reduction or increased dosing intervals may be required depending on the severity of impairment.
- Patients with Hepatic Dysfunction: Similar adjustments as for renal impairment.
- Patients with Comorbid Conditions: Dosage modifications may be needed based on the specific comorbidity.
Clinical Use Cases
The combination is not usually indicated for specialized settings like intubation, surgical procedures, mechanical ventilation, or ICU use. These settings require individual medication adjustments based on the patient’s specific needs.
Dosage Adjustments
Adjustments are made based on renal or hepatic function, other medical conditions, drug interactions, and patient response.
Side Effects
Common Side Effects
Nausea, vomiting, diarrhea, stomach pain, dizziness, headache, drowsiness, dry mouth, rash.
Rare but Serious Side Effects
Severe allergic reactions (anaphylaxis), difficulty breathing, swelling of face, lips, tongue, or throat.
Long-Term Effects
Long-term use requires monitoring of liver and kidney function.
Adverse Drug Reactions (ADR)
Significant ADRs include severe allergic reactions and significant changes in liver or kidney function tests.
Contraindications
Hypersensitivity to any component of the drug, severe liver or kidney disease, acute porphyria. Pregnancy (use with caution), breastfeeding (generally avoided).
Drug Interactions
Other antihistamines, decongestants, cough suppressants, certain antibiotics (e.g., erythromycin, ketoconazole), alcohol, tricyclic antidepressants, beta-blockers, MAOIs.
Pregnancy and Breastfeeding
Pregnancy: Use with caution if benefits outweigh risks.
Breastfeeding: It is generally recommended to avoid this combination during breastfeeding.
Drug Profile Summary
- Mechanism of Action: See above
- Side Effects: See above
- Contraindications: See above
- Drug Interactions: See above
- Pregnancy & Breastfeeding: See above
- Dosage: See above
- Monitoring Parameters: Liver and kidney function tests.
Popular Combinations
This medication itself is a combination product, combining it with other medications requires careful consideration and is generally not recommended unless directed by a physician.
Precautions
Assess for allergies, renal/hepatic function, and drug interactions. Avoid alcohol. Exercise caution in patients with pre-existing medical conditions, especially those affecting the liver, kidneys, or heart.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ambroxol + Guaifenesin + Loratadine?
A: Refer to the detailed dosage section above. It is important to consult with a doctor for personalized dosage recommendations.
Q2: Can this combination be used in children?
A: Yes, but the dosage needs to be adjusted based on age and weight. Consult a pediatrician for specific recommendations. Sources suggest avoiding the medication in children under 2 years old.
Q3: Is it safe to take this medication during pregnancy or breastfeeding?
A: Consult a physician before using during pregnancy or while breastfeeding. The risks and benefits should be carefully evaluated.
Q4: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, stomach pain, dizziness, headache, and drowsiness.
Q5: Are there any serious side effects I should be aware of?
A: Although rare, serious side effects like severe allergic reactions (anaphylaxis) can occur.
Q6: Can I consume alcohol while taking this medication?
A: Alcohol should be avoided as it can worsen side effects like drowsiness and dizziness and interact with loratadine.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and continue with your regular dosing schedule.
Q8: What if my symptoms don’t improve after a few days?
A: Consult your doctor if your symptoms persist or worsen despite taking the medication.
Q9: Can this medication be used in elderly patients?
A: It can be used in the elderly, but with caution and possible dose adjustments based on kidney and liver function.
Q10: Are there any drug interactions I should be aware of?
A: Yes, please review the drug interactions section above.
It’s important to remember that the information provided here is for general knowledge and should not substitute professional medical advice. Always consult a qualified healthcare professional before starting any new medication or making changes to your treatment plan. This answer is valid as of today, 2025-02-16, and may change with new research or guidelines.
