Usage
- This combination medication is prescribed for the relief of cough and cold symptoms, including productive and dry coughs, nasal and chest congestion, sneezing, runny nose, and itchy, watery eyes. It is also used to alleviate allergy symptoms such as hay fever and other upper respiratory allergies.
- Pharmacological Classification: This is a combination drug containing expectorants (ammonium chloride, guaifenesin), mucolytic (bromhexine), antihistamine (diphenhydramine), and a topical anesthetic/cooling agent (menthol).
- Mechanism of Action: This combination works by thinning and loosening mucus (ammonium chloride, guaifenesin, bromhexine), suppressing the cough reflex (diphenhydramine), and providing a cooling and soothing effect on irritated airways (menthol).
Alternate Names
- No internationally recognized non-proprietary name exists for this specific five-component combination. Each ingredient has its own international non-proprietary name (INN): Ammonium Chloride, Bromhexine, Diphenhydramine, Guaifenesin, and Menthol.
- Brand Names: Bendyl, Rexom Unizet and Tutolin, among others. Brand names can vary regionally.
How It Works
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Pharmacodynamics: Ammonium chloride and guaifenesin increase respiratory tract secretions, making the mucus thinner and easier to expectorate. Bromhexine breaks down the structure of mucus, further reducing its viscosity. Diphenhydramine acts as an antihistamine, blocking the effects of histamine which reduces allergic symptoms like sneezing and runny nose. It also has antitussive effects, suppressing the cough reflex. Menthol provides a cooling sensation and acts as a mild local anesthetic, soothing irritated airways.
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Pharmacokinetics:
- Ammonium Chloride: Absorbed from the gastrointestinal tract. Some systemic absorption.
- Bromhexine: Well-absorbed orally and undergoes extensive metabolism in the liver.
- Diphenhydramine: Well-absorbed orally with significant first-pass metabolism in the liver. It is widely distributed and crosses the blood-brain barrier.
- Guaifenesin: Rapidly absorbed from the gastrointestinal tract.
- Menthol: Absorbed through mucous membranes and distributed locally.
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Mode of Action: Ammonium chloride and guaifenesin increase bronchial secretions, making the mucus watery. Bromhexine directly breaks down mucopolysaccharides in mucus. Diphenhydramine competitively inhibits the effects of histamine at H1 receptors. Menthol activates TRPM8 receptors, leading to a cooling sensation.
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Elimination Pathways: Primarily renal and hepatic.
Dosage
Standard Dosage
Adults: One to two 5ml (one to two medicine measures) every three to four hours. Maximum four doses/day.
Children: Consult a doctor before giving to children below 12. Children 6-12: 2.5-5ml every four hours. Should not be used in children under 6.
Special Cases:
- Elderly Patients: Start with a lower dose and titrate as needed, monitoring for side effects.
- Patients with Renal Impairment: Use with caution. Dose adjustment may be necessary.
- Patients with Hepatic Dysfunction: Use with caution. Dose adjustment may be necessary.
- Patients with Comorbid Conditions: Use cautiously in patients with asthma, COPD, glaucoma, peptic ulcer disease, epilepsy, diabetes, cardiovascular disease, or prostatic hypertrophy.
Clinical Use Cases Dosages for these specific settings have not been described.
Dosage Adjustments Adjust based on patient-specific factors and clinical response.
Side Effects
Common Side Effects
Nausea, diarrhea, indigestion, headache, stomach pain, dizziness, drowsiness, dry mouth, blurred vision, skin rash, constipation.
Rare but Serious Side Effects
Allergic reactions (e.g., rash, hives, angioedema), difficulty breathing, seizures, hallucinations, irregular heartbeat, urinary retention, paradoxical excitation.
Long-Term Effects
Potential for tolerance with prolonged use of diphenhydramine, leading to decreased effectiveness.
Adverse Drug Reactions (ADR)
Severe allergic reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, agranulocytosis.
Contraindications
- Hypersensitivity to any of the components.
- Patients on MAOI therapy within the past 14 days.
- Premature infants and neonates.
Drug Interactions
- Alcohol: Increased dizziness and drowsiness.
- Antihistamines: Additive anticholinergic effects.
- Antidepressants (MAOIs): Potential for serotonin syndrome; additive sedative effects with other antidepressants.
- Anxiolytics: Increased sedation.
- Anticonvulsants: Altered drug levels.
- Opioids: Additive sedative effects.
- Other CNS depressants: Additive effects.
Pregnancy and Breastfeeding
Consult a physician before use during pregnancy or breastfeeding. Limited data available.
Drug Profile Summary
- Mechanism of Action: See “Usage”.
- Side Effects: See “Side Effects”.
- Contraindications: See “Contraindications”.
- Drug Interactions: See “Drug Interactions”.
- Pregnancy & Breastfeeding: Consult a physician.
- Dosage: See “Dosage”.
- Monitoring Parameters: Respiratory status, CNS effects, allergic reactions.
Popular Combinations
No specific popular combinations for this exact five-drug formulation are widely described.
Precautions
See “Special Cases” under “Dosage” and “Drug Interactions”. Avoid activities requiring alertness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ammonium Chloride + Bromhexine + Diphenhydramine + Guaifenesin + Menthol?
A: See “Standard Dosage” above.
Q2: Can this combination be used in children?
A: Consult a doctor before giving to children under 12. Contraindicated for children under 6.
Q3: What are the common side effects?
A: See “Common Side Effects” above.
Q4: Are there any serious side effects to be aware of?
A: See “Rare but Serious Side Effects” above.
Q5: Can this medicine be taken with alcohol?
A: No, alcohol should be avoided as it can increase dizziness and drowsiness.
Q6: What should I do if a patient experiences an allergic reaction?
A: Discontinue use immediately and seek medical attention if necessary.
Q7: Can pregnant or breastfeeding women take this medication?
A: Consult a physician before use during pregnancy or breastfeeding.
Q8: How should this medication be stored?
A: Store in a cool and dry place away from sunlight.
Q9: Can I take this with other cold and cough medications?
A: Consult a doctor before combining with other medications, especially those containing antihistamines, antidepressants, or other CNS depressants. Avoid use with MAO inhibitors.
Q10: What are the contraindications?
A: See “Contraindications” above.
