Usage
- This combination medication is primarily prescribed for the symptomatic relief of cough due to minor throat and bronchial irritation, often associated with the common cold or inhaled irritants. It also provides symptomatic relief from allergic conditions like allergic rhinitis.
- Pharmacological Classification: Expectorant, antihistamine, and mucolytic agent.
- Mechanism of Action: Ammonium chloride acts as an expectorant by increasing water in the airways, thinning mucus secretions, and making coughs more productive. Chlorpheniramine maleate is an antihistamine that blocks histamine, reducing allergy symptoms like runny nose, watery eyes, itching, and sneezing. Sodium citrate acts as a mucolytic by thinning and loosening mucus in the respiratory tract, facilitating easier expectoration.
Alternate Names
- No widely recognized alternate names exist for this specific combination. However, the individual components have other names. Ammonium chloride may also be called sal ammoniac or ammonium muriate. Chlorpheniramine maleate may also be called chlorphenamine maleate. Sodium citrate may also be referred to as trisodium citrate.
- Brand Names: This combination is marketed under various brand names like Piriton Expectorant and Cofex depending on the region and the manufacturer. Different brands might contain slightly differing amounts of each component.
How It Works
- Pharmacodynamics: Ammonium chloride increases respiratory tract secretions, chlorpheniramine maleate antagonizes H1 histamine receptors, and sodium citrate reduces mucus viscosity.
- Pharmacokinetics: All three components are readily absorbed from the gastrointestinal tract. Ammonium chloride is metabolized in the liver, with chloride excreted by the kidneys. Chlorpheniramine maleate is also metabolized in the liver and excreted in urine. Sodium citrate is metabolized to bicarbonate.
- Mode of Action: Ammonium chloride stimulates bronchial glands to produce more watery mucus, while chlorpheniramine maleate competitively inhibits histamine at H1 receptors, decreasing capillary permeability and reducing edema. Sodium citrate alters the pH and ionic strength of mucus, making it less viscous.
- Elimination Pathways: Primarily renal excretion for all three components, following hepatic metabolism for ammonium chloride and chlorpheniramine maleate.
Dosage
Standard Dosage
Adults: 10ml (one tablespoonful) every four to six hours, as needed. The daily dose shouldn’t exceed more than four doses a day or the maximum dose recommended by the specific manufacturer.
Children:
- 3 months – 1 year: 2.5ml three times daily.
- 2 – 5 years: 5ml three times daily.
- 6-12 years: 5 – 10ml three times daily.
- This medicine isn’t recommended for children under 2 years old.
Special Cases:
- Elderly Patients: Lower doses may be necessary due to potential age-related decline in organ function.
- Patients with Renal Impairment: Dose reduction is required based on the degree of impairment.
- Patients with Hepatic Dysfunction: Dose adjustment is necessary due to altered metabolism.
- Patients with Comorbid Conditions: Caution is advised in patients with asthma, glaucoma, prostatic hypertrophy, cardiovascular diseases or hypertension. Dose individualization based on the specific comorbidity is essential.
Clinical Use Cases
This specific drug combination is not typically used in the context of intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its usage is generally limited to symptomatic relief of cough and allergy symptoms in outpatient settings.
Dosage Adjustments
Dosage adjustments are crucial in patients with renal or hepatic impairment, elderly individuals, and those with comorbid conditions. Always assess organ function and other relevant clinical factors before determining the appropriate dosage. Genetic polymorphisms affecting drug metabolism might also necessitate adjustments.
Side Effects
Common Side Effects:
- Drowsiness
- Dry mouth, nose, and throat
- Dizziness
- Nausea
- Constipation
- Headache
- Blurred Vision
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling, severe dizziness, trouble breathing)
- Difficulty breathing
- Chest tightness
- Irregular heartbeat
Long-Term Effects:
- With prolonged use, some individuals might develop tolerance to the antihistamine component, requiring a higher dose for effectiveness.
- Prolonged use of ammonium chloride might cause metabolic acidosis.
Adverse Drug Reactions (ADR):
- Severe allergic reactions like anaphylaxis and angioedema
Contraindications
- Hypersensitivity to any components of the medication.
- Newborns and premature infants.
- Severe liver or kidney disease.
- Acute asthma attacks.
- Patients on Monoamine Oxidase Inhibitors (MAOIs) or within 14 days of stopping MAOI therapy.
Drug Interactions
- MAOIs
- CNS depressants (e.g., alcohol, barbiturates, benzodiazepines)
- Antihypertensives
- Anticoagulants
- Antacids containing aluminum or magnesium
- Potassium-depleting drugs (e.g., diuretics)
- Anticholinergics (may potentiate antimuscarinic effects)
Pregnancy and Breastfeeding
- This combination should be used during pregnancy and lactation only if the potential benefits to the mother outweigh the potential risks to the fetus or infant.
- Chlorpheniramine may inhibit lactation and is secreted in breast milk.
Drug Profile Summary
- Mechanism of Action: Expectorant, antihistamine, and mucolytic action.
- Side Effects: Drowsiness, dry mouth, dizziness, nausea, constipation.
- Contraindications: Hypersensitivity, newborns, severe liver/kidney disease, acute asthma, MAOI use.
- Drug Interactions: MAOIs, CNS depressants, antihypertensives, anticoagulants, antacids.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
- Dosage: Adults: 10ml every 4-6 hours; Children: age and weight dependent.
- Monitoring Parameters: Respiratory status, allergy symptoms, and potential side effects.
Popular Combinations
This particular combination is itself a common formulation. Combining it with other cough and cold medications is generally not recommended due to potential overlapping effects and increased risk of adverse reactions. It’s crucial to consult with a physician before combining any other medications with the already existing combination.
Precautions
- General Precautions: Assess for allergies, metabolic disorders, and organ dysfunction.
- Specific Populations:
- Pregnant Women: Consult a physician regarding benefits and risks before using the combination.
- Breastfeeding Mothers: Consider the risk of neonatal exposure through breast milk. If use is necessary, monitor the neonate carefully.
- Children & Elderly: Age-specific dose adjustments. Children under 2 years should not take it. For elderly, lower doses are recommended.
- Menstruating Individuals: No specific precautions related to menstruation.
- Lifestyle Considerations: Avoid alcohol. Driving or operating machinery should be avoided due to potential drowsiness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ammonium Chloride + Chlorpheniramine Maleate + Sodium Citrate?
A: Adults: typically 10ml every 4-6 hours, not exceeding four doses per day. Children’s dosage varies based on age and weight; consult a pediatrician or refer to the packaging.
Q2: Can this medication be used in patients with asthma?
A: Use with caution in asthmatic patients due to potential bronchospasm. Close monitoring is essential.
Q3: Is it safe to use this combination during pregnancy?
A: Consult a physician before using during pregnancy. Use only if the potential benefit outweighs the risk to the fetus.
Q4: What are the common side effects?
A: Drowsiness, dry mouth, dizziness, nausea, and constipation are common side effects.
Q5: Can I take this medication with alcohol?
A: Avoid alcohol as it can exacerbate drowsiness and other side effects.
Q6: Can this combination be used for chronic cough?
A: No, it’s indicated for acute cough associated with common cold or inhaled irritants, not for chronic cough.
Q7: Are there any drug interactions I should be aware of?
A: Yes, it interacts with MAOIs, CNS depressants, antihypertensives, and certain other medications. Always inform your doctor about all the other medications you are currently taking.
Q8: What should I do if I experience severe side effects?
A: Discontinue use and seek immediate medical attention if severe side effects occur.
Q9: Can I operate machinery after taking this medication?
A: Avoid operating machinery or driving as the medication may cause drowsiness and impair cognitive function.
Q10: Is this combination suitable for infants?
A: Not recommended for infants under 2 years of age. Consult a pediatrician for appropriate cough and cold remedies for young children.
