Usage
This combination medication is primarily prescribed for the symptomatic relief of cough and nasal congestion associated with the common cold, flu, allergies, or other respiratory illnesses. It is also used to relieve throat irritation and thin and loosen mucus in the airways.
Pharmacological Classification: This drug is a combination product and can be classified as an expectorant, antihistamine, antitussive, and mucolytic. More precisely:
- Ammonium chloride is an expectorant.
- Chloroform is an antitussive.
- Diphenhydramine is an antihistamine.
- Menthol is a counterirritant and local anesthetic with mild antitussive properties.
- Sodium citrate is a mucolytic and alkalizing agent.
Mechanism of Action: This combination targets different aspects of cough and congestion:
- Ammonium chloride works by irritating the gastric mucosa, stimulating reflex bronchial secretions, and making the mucus less viscous, easing its expulsion.
- Chloroform works as a local anesthetic and mild antitussive suppressing the cough reflex at the level of the central nervous system.
- Diphenhydramine, as an antihistamine, blocks the action of histamine, a substance responsible for allergic reactions that can trigger coughing, sneezing, and runny nose.
- Menthol acts as a counterirritant, creating a cooling sensation that soothes throat irritation.
- Sodium citrate helps thin and loosen phlegm (mucus) by making it less acidic.
Alternate Names
This specific combination medication does not have a universally recognized international nonproprietary name (INN). It is known primarily by its component ingredients. Brand names may vary depending on the manufacturer and region but some examples mentioned are: Benadryl Original, Coflax Cough Syrup, Bennatuss Expectorant, Difenacol, Abacoff, and Respidil.
How It Works
Pharmacodynamics: The combined effects of the ingredients lead to decreased cough frequency and intensity, reduced nasal and chest congestion, relief from throat irritation, and easier expectoration of mucus.
Pharmacokinetics:
- Absorption: Ammonium chloride, diphenhydramine, and sodium citrate are absorbed systemically after oral administration. Menthol is absorbed locally and through the gastrointestinal tract. Chloroform is absorbed rapidly through inhalation, ingestion, and dermal contact.
- Metabolism: Diphenhydramine is extensively metabolized in the liver, primarily by CYP2D6. Other ingredients are also subject to metabolic processes.
- Elimination: The metabolites of the drug, including diphenhydramine, are primarily excreted through urine. Some components may undergo biliary excretion.
Mode of Action (at cellular/molecular level):
- Ammonium chloride increases chloride secretion in the airways, leading to increased water flow into the bronchial lumen, hydrating and thinning the mucus.
- Chloroform depresses the central nervous system and reduces the sensitivity of cough receptors.
- Diphenhydramine competitively antagonizes the H1 histamine receptors, mitigating histamine-mediated allergic reactions.
- Sodium citrate reacts with bicarbonate in the body fluids to produce carbon dioxide, potentially causing mild bronchodilation, and also acts as a mucolytic by increasing the pH of the mucus.
Dosage
Dosage information for this specific combination, including chloroform, is limited in available sources. However, here’s some general guidance based on similar formulations without chloroform. It’s crucial to consult the specific product labeling and seek expert advice for proper dosing instructions, especially with chloroform as a component.
Standard Dosage
Adults: 5-10 ml every 4-6 hours. Do not exceed the maximum daily dose as indicated on the product packaging.
Children: Dosage should be based on the child’s age and weight. Consult a pediatrician for appropriate dosing instructions. This combination is generally not recommended for children under 2 years of age. Some sources restrict its use for children under 6.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary due to age-related decline in renal and hepatic function.
- Patients with Renal Impairment: Dose reduction is necessary.
- Patients with Hepatic Dysfunction: Dose adjustment is required due to impaired metabolism of diphenhydramine.
- Patients with Comorbid Conditions: Use with caution in patients with asthma, glaucoma, urinary retention, prostatic hypertrophy, cardiovascular disease, or other relevant conditions.
Clinical Use Cases
The available sources focus on the use of this medication for symptomatic relief of cough and cold symptoms and do not provide dosage information for other clinical settings like intubation, surgical procedures, mechanical ventilation, or ICU use. Such usage is generally outside the scope of this combination medication.
Dosage Adjustments
Dose modifications should be considered based on individual patient factors, including renal and hepatic function, and potential drug interactions.
Side Effects
Common Side Effects:
- Drowsiness
- Dizziness
- Dry mouth
- Headache
- Nausea
- Stomach upset
- Constipation
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling, difficulty breathing)
- Cardiac arrhythmias
- Seizures
- Severe drowsiness
Long-Term Effects:
Chronic use of this combination, especially with chloroform as a component, is not advised due to potential toxicity concerns, including liver and kidney damage.
Contraindications
- Hypersensitivity to any of the components
- Severe respiratory compromise
- Narrow-angle glaucoma
- Urinary retention
- Concurrent use of MAO inhibitors
Drug Interactions
- MAO inhibitors
- Alcohol
- CNS depressants (e.g., sedatives, opioids)
- Anticholinergics (e.g., tricyclic antidepressants)
Pregnancy and Breastfeeding
The safety of this combination, particularly with chloroform, during pregnancy and breastfeeding is not well established. Its use should be avoided or limited to situations where the potential benefits outweigh the risks. The use of chloroform during pregnancy or lactation is contraindicated due to its potential teratogenic effect and potential carcinogenicity. Consult with a physician before using this medication during pregnancy or while breastfeeding.
Drug Profile Summary
- Mechanism of Action: See above.
- Side Effects: Drowsiness, dizziness, dry mouth, headache, nausea, upset stomach. See above.
- Contraindications: Hypersensitivity, severe respiratory compromise, narrow-angle glaucoma, urinary retention, concurrent MAO inhibitor use. See above.
- Drug Interactions: MAO inhibitors, alcohol, CNS depressants, anticholinergics. See above.
- Pregnancy & Breastfeeding: Avoid use unless potential benefits outweigh risks. Chloroform is contraindicated. See above.
- Dosage: See above. Note that specific dosing depends on the product and its formulation. The provided information should not be used for actual dosing without consulting relevant product information and a medical professional.
- Monitoring Parameters: Respiratory status, mental status, blood pressure, heart rate.
Popular Combinations
While this specific combination with chloroform is unusual, combinations of ammonium chloride, diphenhydramine, menthol, and sodium citrate are commonly used with other medications for cough and cold such as decongestants or other antitussives.
Precautions
- Use with caution in patients with asthma, glaucoma, prostate problems, liver or kidney disease.
- Avoid alcohol consumption while taking this medication.
- May cause drowsiness; avoid driving or operating machinery.
- Drink plenty of fluids to help loosen mucus.
FAQs (Frequently Asked Questions)
A: Dosage information for this specific combination, particularly with chloroform, is scarce. Consult the product’s packaging and a doctor for precise dosage instructions.
Q2: Can I take this combination if I’m pregnant or breastfeeding?
A: The safety of this combination, especially with chloroform, during pregnancy and breastfeeding has not been clearly established. Its use is generally discouraged and should be avoided unless specifically recommended by a physician.
Q3: What are the common side effects of this medication?
A: Common side effects include drowsiness, dizziness, dry mouth, headache, nausea, and stomach discomfort.
Q4: Can I drink alcohol while taking this medication?
A: No, it is recommended to avoid alcohol consumption while taking this medication, as it can exacerbate drowsiness and dizziness.
Q5: Are there any drug interactions I should be aware of?
A: Yes, this combination may interact with MAO inhibitors, CNS depressants (like sedatives and opioids), and anticholinergics. Inform your doctor about all other medications you are taking.
Q6: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to catch up.
Q7: Can I drive or operate machinery after taking this medication?
A: This medication may cause drowsiness or dizziness. Avoid driving or operating heavy machinery until you know how it affects you.
Q8: What should I do if I experience severe side effects?
A: If you experience any severe or persistent side effects, stop taking the medication and consult your doctor immediately.
Q9: Is this medication safe for children?
A: This medication is typically not recommended for children under 2 years of age. Some sources extend this restriction to children under 6. Consult a pediatrician for appropriate dosage and safety information for children.
