Ammonium Chloride + Chlorpheniramine Maleate

Usage

Ammonium Chloride + Chlorpheniramine Maleate is prescribed for the relief of cough and cold symptoms, particularly those associated with allergies or respiratory infections. This combination targets multiple symptoms like cough, nasal congestion, runny nose, sneezing, and watery eyes.

• Pharmacological Classification:

  • Ammonium Chloride: Expectorant
  • Chlorpheniramine Maleate: Antihistamine

• Mechanism of Action: Ammonium chloride works by thinning and loosening mucus in the airways, making it easier to cough up. Chlorpheniramine maleate blocks the action of histamine, a substance released by the body during allergic reactions. This helps relieve allergy symptoms like sneezing, runny nose, and watery eyes.

Alternate Names

This combination medication doesn’t have a specific international nonproprietary name (INN). It is generally referred to by its constituent drug names. Several brand names exist depending on the manufacturer and specific formulation.

• Brand Names: (Note: Brand names vary regionally. This is not an exhaustive list)
  • Coscopin Linctus (when combined with Noscapine and Sodium Citrate)
  • Koflyn (when combined with Sodium Citrate)
  • Piriton Expectorant (when combined with Sodium Citrate)
  • Fedalis Expectorant (when combined with Sodium Citrate)

How It Works

• Pharmacodynamics: Ammonium chloride increases the water content of mucus, reducing its viscosity. Chlorpheniramine maleate competitively antagonizes histamine at H1 receptors, reducing the effects of histamine release during an allergic response.

• Pharmacokinetics:

  • Absorption: Both drugs are absorbed from the gastrointestinal tract.
  • Metabolism: Chlorpheniramine is primarily metabolized in the liver. Ammonium chloride is converted to urea and hydrochloric acid.
  • Elimination: Both drugs and their metabolites are primarily eliminated by the kidneys.

• Mode of Action: Ammonium chloride acts on the mucous membranes of the respiratory tract, irritating them and stimulating increased fluid secretion. Chlorpheniramine blocks the binding of histamine to H1 receptors, preventing the cascade of events that lead to allergic symptoms.

• Receptor binding, enzyme inhibition, or neurotransmitter modulation: Chlorpheniramine maleate binds to and blocks H1 histamine receptors.

• Elimination pathways: Primarily renal excretion for both drugs.

Dosage

Standard Dosage

Adults: 10ml every 4-6 hours as needed. Do not exceed 40 ml in 24 hours.

Children: Dosing varies depending on age and weight. It is typically recommended for children over 6 years of age. Consult a pediatrician for appropriate dosing guidelines and ensure the formulation is suitable for children.

Special Cases:

• Elderly Patients: Start with a lower dose and monitor closely for adverse effects. A dose reduction may be necessary.

• Patients with Renal Impairment: Dose adjustment is necessary. Consult a nephrologist for specific recommendations.

• Patients with Hepatic Dysfunction: Dose adjustment is necessary. Consult a hepatologist for specific recommendations.

• Patients with Comorbid Conditions: Use with caution in patients with asthma, glaucoma, prostate problems, cardiovascular disease, hypertension, or hyperthyroidism.

Clinical Use Cases

The Ammonium Chloride + Chlorpheniramine Maleate combination is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. It is primarily indicated for outpatient management of cough and cold symptoms related to the common cold or allergies.

Dosage Adjustments

Dose adjustments are based on patient factors such as age, renal function, and hepatic function. Consult specialist physicians (nephrologist, hepatologist, etc.) as needed for individualized dosing.

Side Effects

Common Side Effects

• Drowsiness
• Dizziness
• Dry mouth
• Nausea
• Constipation
• Blurred vision

Rare but Serious Side Effects

• Allergic reactions (skin rash, itching, swelling)
• Difficulty breathing
• Irregular heartbeat

Long-Term Effects

No specific long-term adverse effects have been identified.

Adverse Drug Reactions (ADR)

Severe allergic reactions (anaphylaxis, angioedema) require immediate medical attention.

Contraindications

• Hypersensitivity to ammonium chloride or chlorpheniramine maleate
• Severe liver or kidney disease
• Narrow-angle glaucoma
• Prostate enlargement causing urinary retention
• Concurrent use or within 14 days of MAOI therapy
• Newborns, premature infants, and children under 2

Drug Interactions

• Alcohol (increases drowsiness and dizziness)
• Other antihistamines (additive sedative effects)
• MAOIs (increased risk of serotonin syndrome)
• Sedatives (increased drowsiness)
• Phenytoin (decreased phenytoin metabolism)

Pregnancy and Breastfeeding

Use with caution during pregnancy and breastfeeding only if benefits outweigh risks. Consult a physician before use.

Drug Profile Summary

• Mechanism of Action: Ammonium chloride thins mucus; chlorpheniramine maleate blocks H1 receptors.
• Side Effects: Drowsiness, dizziness, dry mouth, nausea, blurred vision.
• Contraindications: Hypersensitivity, severe liver/kidney disease, MAOI use, newborns/infants.
• Drug Interactions: Alcohol, antihistamines, MAOIs, sedatives.
• Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
• Dosage: Adults: 10ml q4-6h (max 40ml/day), children: consult pediatrician.
• Monitoring Parameters: Respiratory status, allergy symptoms, side effects.

Popular Combinations

Often combined with other medications like dextromethorphan (cough suppressant), guaifenesin (expectorant), noscapine (cough suppressant), phenylephrine (decongestant), or sodium citrate (mucolytic) to address a broader range of cold and cough symptoms.

Precautions

• Pre-existing medical conditions (asthma, glaucoma, prostate problems, cardiovascular disease, etc.): Use with caution.
• Pregnant women: Consult a doctor before use.
• Breastfeeding mothers: Not recommended.
• Children and elderly: Dose adjustments needed, increased risk of side effects.
• Lifestyle considerations: Avoid alcohol, driving, and operating machinery if drowsiness occurs.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Ammonium Chloride + Chlorpheniramine Maleate?

A: Adults: 10ml every 4-6 hours, not to exceed 40ml in 24 hours. Children: Consult pediatrician.

Q2: Can this combination be used in patients with asthma?

A: Use with caution in asthmatic patients and under the guidance of a physician.

Q3: Can pregnant or breastfeeding women take this medicine?

A: Use with caution during pregnancy and breastfeeding only if clearly needed and under the supervision of a physician.

Q4: What are the common side effects?

A: Common side effects include drowsiness, dizziness, dry mouth, nausea, constipation, and blurred vision.

Q5: Does this medication interact with alcohol?

A: Yes, avoid alcohol while taking this medication, as it can increase drowsiness and dizziness.

Q6: Can I drive while taking this medicine?

A: This medicine may cause drowsiness. Avoid driving or operating machinery if you experience this side effect.

Q7: How long can I take this medication?

A: Use this medication for the duration advised by your physician. It’s typically used for short-term symptom relief.

Q8: What should I do if I miss a dose?

A: If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. Do not double the dose to catch up.

Q9: Is this medication addictive?

A: This medication is generally not considered addictive when used as directed. However, prolonged use should be avoided unless specifically advised by a physician.

Q10: Can this be used for a chronic cough?

A: This medication is not recommended for chronic cough, as it is designed for short-term symptom relief. Consult a doctor for the evaluation and management of a chronic cough.