Ammonium Chloride + Chlorpheniramine Maleate + Menthol + Paracetamol + Phenylephrine + Sodium Citrate

Usage

This combination medication is primarily prescribed for the symptomatic relief of the common cold and flu-like symptoms, including cough, nasal and sinus congestion, headache, fever, and aches and pains. It is also used to alleviate allergy symptoms such as runny nose, sneezing, and watery eyes.

Pharmacological Classification: This drug is a combination of several pharmacological classes:

• Analgesic and Antipyretic: Paracetamol
• Decongestant: Phenylephrine
• Antihistamine: Chlorpheniramine maleate
• Expectorant: Ammonium chloride
• Mucolytic: Sodium Citrate
• Counterirritant: Menthol

Mechanism of Action: This combination drug targets different symptoms simultaneously. Paracetamol reduces fever and pain. Phenylephrine relieves nasal congestion by constricting blood vessels in the nasal passages. Chlorpheniramine maleate combats allergy symptoms by blocking histamine action. Ammonium chloride thins mucus, aiding its expulsion. Sodium citrate also helps to loosen and thin mucus in the airways, while menthol soothes throat irritation and provides a cooling sensation.

Alternate Names

There are no officially recognized alternate names for this specific six-component combination. However, it may be referred to by various descriptive terms such as “cold and flu relief medication” or “cough and cold syrup”. Brand names may vary regionally. Some potential brand names, though not exhaustive, might include variations of “Cold-Q” or “Flu-Q Plus,” though confirming local brand names is essential.

How It Works

Pharmacodynamics: Paracetamol acts on the hypothalamic heat-regulating center to reduce fever and inhibits prostaglandin synthesis to alleviate pain. Phenylephrine acts as an alpha-adrenergic agonist, causing vasoconstriction in the nasal mucosa, reducing congestion. Chlorpheniramine is an H1-receptor antagonist, counteracting the effects of histamine release. Ammonium chloride and sodium citrate increase respiratory tract fluid, thinning mucus, while menthol acts as a counterirritant, stimulating cold receptors.

Pharmacokinetics: Paracetamol is rapidly absorbed from the gastrointestinal tract. Peak plasma concentrations are reached within 30-60 minutes. It is primarily metabolized in the liver and excreted in the urine. Phenylephrine has low bioavailability due to extensive first-pass metabolism. Chlorpheniramine is well-absorbed orally. Ammonium chloride and sodium citrate are also absorbed through the gastrointestinal tract. Menthol is absorbed through mucous membranes. Elimination pathways primarily involve renal and hepatic routes.

Dosage

Dosage recommendations are based on the available sources and may vary based on specific product formulations. It’s crucial to consult the specific product’s packaging and prescribing information.

Standard Dosage

Adults: The typical adult dose is 10ml of the suspension, taken up to four times daily.

Children: The typical dose for children between 6 to 12 years of age is 5 ml of suspension, taken up to four times daily. This medication is not recommended for children below six years of age.

Special Cases:

• Elderly Patients: Dosage adjustments may be required due to potential age-related decline in hepatic and renal function. A lower daily dose is often recommended.

• Patients with Renal Impairment: Exercise caution. Dose modifications should be made in patients with moderate to severe renal impairment.

• Patients with Hepatic Dysfunction: Use with caution. Dose adjustments might be needed.

• Patients with Comorbid Conditions: Caution is advisable in patients with cardiovascular disease, hypertension, hyperthyroidism, diabetes mellitus, glaucoma, or epilepsy.

Clinical Use Cases

The combination isn’t typically used in specific clinical settings like intubation, surgical procedures, mechanical ventilation, or the ICU. It is primarily intended for the symptomatic relief of common cold and flu symptoms in outpatient settings.

Dosage Adjustments

Always adjust the dose according to the patient’s age, weight, and renal/hepatic function. Monitor for adverse effects and consider drug interactions.

Side Effects

Common Side Effects:

• Drowsiness
• Dizziness
• Dry mouth, nose, and throat
• Nausea and vomiting
• Constipation
• Headache
• Blurred vision
• Restlessness

Rare but Serious Side Effects:

• Allergic reactions (e.g., skin rash, itching, swelling)
• Liver damage (with paracetamol overdose)
• Increased blood pressure (with phenylephrine)
• Difficulty breathing

Long-Term Effects:

Long-term use of this combination is generally not recommended due to potential dependence (especially to ammonium chloride) and other chronic effects.

Adverse Drug Reactions (ADR):

Any signs of an allergic reaction, such as swelling, rash, or difficulty breathing, require immediate medical attention. Similarly, any indication of liver damage, such as jaundice or abdominal pain, necessitates immediate discontinuation and medical assessment.

Contraindications

• Hypersensitivity to any of the components.
• Patients currently taking or within 14 days of stopping MAO inhibitors.
• Severe hypertension or coronary artery disease.
• Narrow-angle glaucoma.
• Severe liver or kidney disease.

Drug Interactions

• Alcohol: Increases the risk of drowsiness and liver damage.
• Other CNS depressants (e.g., sedatives, hypnotics): Additive sedative effects.
• Antihypertensives: Phenylephrine may counteract their effects.
• MAO inhibitors: May cause a hypertensive crisis.
• Tricyclic antidepressants: May enhance the anticholinergic effects of chlorpheniramine.
• Other medications containing paracetamol: Increased risk of liver damage if the total daily dose of paracetamol exceeds 4000mg.

Pregnancy and Breastfeeding

The safety of this combination during pregnancy and breastfeeding has not been fully established. Consult a physician before using this medication in these situations. The benefits of the medication should outweigh the potential risks to the fetus or nursing infant. Consider alternative medications if deemed safer.

Drug Profile Summary

• Mechanism of Action: See “How It Works” section.
• Side Effects: See “Side Effects” section.
• Contraindications: See “Contraindications” section.
• Drug Interactions: See “Drug Interactions” section.
• Pregnancy & Breastfeeding: Use with caution under medical supervision; assess risk/benefit ratio.
• Dosage: See “Dosage” section.
• Monitoring Parameters: Liver function tests (for prolonged use or high doses of paracetamol), blood pressure (for patients with hypertension or taking phenylephrine).

Popular Combinations

This formulation itself is a popular combination addressing various cold and flu symptoms. While it is not recommended to combine this with similar OTC products due to the risk of exceeding paracetamol dosage, a doctor might prescribe other medications in conjunction for symptoms not adequately addressed by this medication. Always consult a doctor before combining this drug with other medicines.

Precautions

• Screen for pre-existing conditions such as liver/kidney disease, hypertension, glaucoma, and allergy to any of the components.
• Pregnant/breastfeeding women: Use only if potential benefits outweigh risks.
• Children and elderly: Dose adjustments may be necessary.
• Avoid alcohol during treatment.
• May impair ability to drive or operate machinery.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Ammonium Chloride + Chlorpheniramine Maleate + Menthol + Paracetamol + Phenylephrine + Sodium Citrate?

A: See “Dosage” section above. Dosage is dependent on the specific product formulation, patient’s age and condition, and other factors. Always consult product information and a physician before administering this medication.

Q2: Can this combination be used in children under 6 years of age?

A: This combination is not generally recommended for use in children under six years of age.

Q3: Can pregnant or breastfeeding women take this medication?

A: The safety in pregnancy and lactation is not fully established. Use only under medical supervision after assessing the potential benefits and risks.

Q4: What are the common side effects?

A: See “Side Effects” section.

Q5: Can I drink alcohol while taking this medicine?

A: No, alcohol should be avoided as it can increase the risk of drowsiness, dizziness, and liver damage.

Q6: What should I do if I experience an allergic reaction?

A: Discontinue use immediately and seek medical attention.

Q7: Can I take this medication with other cold and flu remedies?

A: Avoid concurrent use with other medications containing paracetamol or similar ingredients to prevent accidental overdose. Consult a physician before combining this drug with any other medications, including OTC drugs and supplements.

Q8: Can this combination be used for chronic cough?

A: No, this medication is intended for the relief of cough associated with the common cold or inhaled irritants. It’s not recommended for chronic cough.

Q9: How does this medication work to relieve nasal congestion?

A: Phenylephrine, a component of this combination, acts as a decongestant by narrowing blood vessels in the nasal passages, reducing swelling and congestion.

Q10: What is the role of sodium citrate in this combination?

A: Sodium citrate acts as a mucolytic agent, helping to thin and loosen mucus in the airways, facilitating its removal and easing cough.