Usage
- This combination medication is primarily prescribed for the symptomatic relief of cough associated with the common cold, allergies, and other respiratory tract infections. It helps relieve chest congestion, thin mucus, and suppress coughing.
- Pharmacological classification: This drug is a combination of an expectorant (ammonium chloride, guaifenesin), a mucolytic (bromhexine), and an antihistamine (diphenhydramine).
- Mechanism of action: Ammonium chloride and guaifenesin increase respiratory tract secretions, thinning the mucus. Bromhexine breaks down the mucus, reducing its viscosity. Diphenhydramine reduces allergic symptoms such as sneezing and runny nose, and also has a mild antitussive effect.
Alternate Names
- No widely recognized alternate names exist for this specific combination. The individual components, however, are known by their generic names: ammonium chloride, bromhexine hydrochloride, diphenhydramine hydrochloride, and guaifenesin.
- Several brand names exist depending on the manufacturer and region, including Col-Col syrup, Rexom Unizet, and Zeet expectorant.
How It Works
- Pharmacodynamics: Ammonium chloride and guaifenesin increase fluid production in the respiratory tract, thinning mucus. Bromhexine directly breaks down mucopolysaccharides, reducing mucus viscosity. Diphenhydramine blocks histamine H1 receptors, reducing allergy symptoms, and acts on the cough center in the brain to suppress cough.
- Pharmacokinetics:
- Absorption: All four components are readily absorbed from the gastrointestinal tract.
- Metabolism: Diphenhydramine is extensively metabolized in the liver by the CYP450 system, particularly CYP2D6. Bromhexine is also metabolized in the liver. Ammonium chloride is converted to urea in the liver. Guaifenesin is partially metabolized.
- Elimination: Diphenhydramine and bromhexine metabolites are primarily excreted in urine. Ammonium chloride is eliminated as urea in the urine and chloride ions through the kidneys. Guaifenesin is excreted both as unchanged drug and metabolites in urine.
- Mode of action: Ammonium chloride and guaifenesin irritate the respiratory mucosa, stimulating secretions. Bromhexine depolymerizes mucoproteins. Diphenhydramine competitively antagonizes histamine at H1 receptors.
Dosage
Standard Dosage
Adults: 10 mL (2 teaspoonfuls) orally every 4-6 hours as needed, not exceeding 6 doses in 24 hours.
Children: Dosage depends on age and weight and should be determined by a physician. Generally, children under 6 years should receive a lower dose (e.g. 2.5 - 5 mL) and those under 2 years old shouldn’t receive this medication. Children between 6 and 12 should receive 5 mL every 4-6 hours. Consult the specific product labeling or a healthcare professional for accurate pediatric dosing.
Special Cases: Dosage adjustments should be made in elderly patients and those with hepatic or renal impairment. Consult a physician.
Clinical Use Cases
The combination is not typically used in clinical settings like intubation, surgical procedures, or intensive care, where individual components or alternative agents may be preferred.
Side Effects
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Dizziness
- Drowsiness
- Headache
- Dry mouth
Rare but Serious Side Effects
- Allergic reactions (skin rash, itching, swelling)
- Difficulty breathing
- Severe dizziness
- Confusion
- Hallucinations
Adverse Drug Reactions (ADR)
Severe allergic reactions require immediate medical attention.
Contraindications
- Hypersensitivity to any of the components
- Severe respiratory compromise
- Severe liver or kidney disease
- Glaucoma
- Urinary retention
- MAOI use within the last 14 days
Drug Interactions
- Alcohol
- CNS depressants (e.g., sedatives, hypnotics, opioids)
- Anticholinergics (e.g., atropine)
- MAOIs
- Some antidepressants (e.g., duloxetine, fluoxetine)
Pregnancy and Breastfeeding
Consult a physician before use during pregnancy or breastfeeding. Diphenhydramine is generally considered safe during pregnancy but use during the third trimester is not advised due to potential neonatal effects. It is excreted in breast milk. Bromhexine and guaifenesin have limited data regarding pregnancy and breastfeeding safety. Ammonium chloride should be used with caution.
Drug Profile Summary
- Mechanism of Action: Expectorant, mucolytic, antihistamine
- Side Effects: Nausea, vomiting, diarrhea, dizziness, drowsiness, dry mouth, allergic reactions.
- Contraindications: Hypersensitivity, severe respiratory disease, hepatic or renal impairment, glaucoma, MAOI use.
- Drug Interactions: Alcohol, CNS depressants, anticholinergics, MAOIs, some antidepressants.
- Pregnancy & Breastfeeding: Consult a physician.
- Dosage: Adults: 10ml every 4-6 hours, not exceeding 6 doses in 24 hours. Children: consult a physician for safe dosing.
- Monitoring Parameters: Respiratory status, allergic reactions.
Popular Combinations
No data about popular combinations available.
Precautions
- Assess respiratory and allergy history
- Use with caution in patients with hepatic or renal impairment, glaucoma, or urinary retention.
- Avoid alcohol.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ammonium Chloride + Bromhexine + Diphenhydramine + Guaifenesin?
A: Adults: 10ml every 4-6 hours, not exceeding 6 doses/24 hrs. Children: Consult a physician.
Q2: Can this combination be used in patients with asthma?
A: Use with caution in patients with asthma, as it may worsen symptoms in some cases.
Q3: Can pregnant women use this combination?
A: Consult a physician before use during pregnancy or breastfeeding.
Q4: What are the common side effects?
A: Nausea, vomiting, diarrhea, dizziness, drowsiness, dry mouth.
Q5: What are the serious side effects?
A: Severe allergic reactions, breathing problems, severe dizziness, confusion, hallucinations.
Q6: What drugs interact with this combination?
A: Alcohol, CNS depressants, anticholinergics, MAOIs, some antidepressants.
Q7: Can this combination be used in children under 2 years?
A: No.
Q8: What conditions is this combination used for?
A: Cough and congestion associated with colds, allergies, and respiratory infections.
Q9: Can this combination be used if the patient has glaucoma?
A: No. This combination is contraindicated in patients with glaucoma.
