Usage
This combination medication is primarily prescribed for the relief of cough associated with the common cold, bronchitis, sinusitis, or other upper respiratory tract infections. It combines ingredients with expectorant, antihistamine, and mucolytic properties to address various aspects of cough and cold symptoms.
- Pharmacological Classifications: Expectorant, Antihistamine, Mucolytic.
- Mechanism of Action: Ammonium chloride and terpin hydrate act as expectorants by irritating the mucous membranes in the airways, stimulating the secretion of thinner mucus, making it easier to cough up. Chlorpheniramine maleate is an antihistamine that blocks the action of histamine, reducing allergic symptoms like runny nose, sneezing, and watery eyes, which can contribute to coughing. Sodium citrate acts as a mucolytic, further thinning and loosening the mucus, facilitating easier expectoration.
Alternate Names
This specific combination doesn’t have widely recognized alternate names. However, the individual components are sometimes known by other names:
- Ammonium Chloride: Sal Ammoniac, Amurol
- Chlorpheniramine Maleate: Chlor-Trimeton, Teldrin
- Sodium Citrate: Citrosoda, Bicitra
- Terpin Hydrate: Tussin
- Brand Names: Tercuff Expectorant (Note: Brand names can vary regionally. This is not an exhaustive list.)
How It Works
- Pharmacodynamics: This combination medication works by decreasing the viscosity of mucus, reducing airway irritation from histamine-mediated inflammation, and suppressing the cough reflex. The combined effect of expectorant, antihistamine, and mucolytic actions provides relief from cough and associated symptoms.
- Pharmacokinetics: The individual components are absorbed orally. Ammonium chloride is converted to ammonia and hydrochloric acid, which irritates the respiratory mucosa. Chlorpheniramine is metabolized in the liver, primarily by CYP450 enzymes. Sodium citrate becomes sodium bicarbonate in the body. Terpin hydrate is also metabolized in the liver. Excretion of the components and their metabolites primarily occurs through the kidneys. Specific combined product pharmacokinetic data are limited.
- Mode of Action:
- Ammonium chloride and terpin hydrate stimulate increased fluid secretion in the airways by irritating the mucous membranes, thus reducing mucus viscosity.
- Chlorpheniramine competitively antagonizes histamine H1 receptors, minimizing histamine’s effects, which include allergic reactions and cough.
- Sodium citrate alkalinizes respiratory secretions, aiding mucus thinning and improving expectoration.
- Elimination Pathways: Primarily renal excretion, with hepatic metabolism playing a role for some components.
Dosage
Standard Dosage
Adults:
- Syrup: 5-10 mL every 4-6 hours, not exceeding 60 mL in 24 hours. (Note: Always refer to specific product labeling as formulations may vary.)
Children:
Dosage should be determined based on the child’s weight or age and should be prescribed by a physician. Generally not recommended for children under 6 years of age without direct medical supervision.
Special Cases:
- Elderly Patients: Start with a lower dose due to potential age-related decline in kidney and liver function. Titrate upwards as needed and tolerated. Monitor closely for adverse effects.
- Patients with Renal Impairment: Dose reduction may be necessary. Consult current clinical guidelines for specific recommendations based on the degree of renal impairment.
- Patients with Hepatic Dysfunction: Use with caution and consider dose adjustment.
- Patients with Comorbid Conditions: Use with caution in patients with asthma, glaucoma, prostate enlargement, urinary retention, cardiovascular disease, hypertension, hyperthyroidism, and chronic lung diseases.
Clinical Use Cases
This combination medication is not typically indicated for use in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary use is for symptomatic relief of cough associated with common colds and other upper respiratory infections in outpatient settings.
Dosage Adjustments
Adjustments may be needed based on individual patient factors, such as renal or hepatic dysfunction, age, other medical conditions, and concomitant medications. Always consult current clinical guidelines and the specific product labeling for detailed recommendations.
Side Effects
Common Side Effects:
- Drowsiness
- Dizziness
- Dry mouth, nose, and throat
- Nausea
- Constipation
- Headache
- Blurred vision
- Upset stomach
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling, difficulty breathing)
- Difficulty urinating
- Rapid heart rate
- Seizures
- Confusion
Long-Term Effects:
Chronic use is generally not recommended due to the potential for dependence (especially with formulations containing codeine, though this is not the specific formulation discussed here), tolerance, and other potential long-term adverse effects.
Adverse Drug Reactions (ADR):
Any severe or persistent side effects, especially allergic reactions, should be considered clinically significant ADRs requiring immediate medical intervention.
Contraindications
- Hypersensitivity to any of the components
- Severe liver or kidney disease
- Asthma or other respiratory conditions where mucus plugging is a risk
- Glaucoma
- Prostate enlargement
- Urinary retention
Drug Interactions
- Alcohol: Increased drowsiness and dizziness
- Other antihistamines: Additive anticholinergic effects
- CNS depressants: Additive sedative effects
- Monoamine Oxidase Inhibitors (MAOIs): May prolong and intensify the effects of chlorpheniramine
- Anticonvulsants (e.g., phenytoin): Potential interactions
- Antidepressants (e.g., duloxetine): Potential interactions
- Anxiolytics (e.g., alprazolam): Potential interactions
Pregnancy and Breastfeeding
- Pregnancy: Use with caution only if benefits outweigh risks. Data are limited on this specific combination during pregnancy.
- Breastfeeding: Chlorpheniramine is excreted in breast milk. Use with caution. Small, infrequent doses are generally considered acceptable, but larger doses or prolonged use may cause infant drowsiness or decrease milk supply.
Drug Profile Summary
- Mechanism of Action: Expectorant, antihistamine, mucolytic
- Side Effects: Drowsiness, dizziness, dry mouth, nausea, constipation
- Contraindications: Hypersensitivity, severe liver/kidney disease, asthma, glaucoma, BPH
- Drug Interactions: Alcohol, other antihistamines, CNS depressants, MAOIs
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks
- Dosage: Refer to detailed section above.
- Monitoring Parameters: Respiratory status, alertness, side effects
Popular Combinations
This combination itself is a commonly used formulation. Individual components may be combined with other drugs like decongestants or analgesics. Always consider potential drug interactions.
Precautions
- Pre-existing medical conditions: Evaluate for respiratory, cardiovascular, hepatic, and renal dysfunction before prescribing.
- Pregnant women: Careful risk-benefit assessment.
- Breastfeeding mothers: Monitor infant for drowsiness and consider potential effects on milk supply.
- Children and elderly: Age-specific dosing and monitoring.
- Lifestyle: Avoid alcohol, as it can exacerbate drowsiness and dizziness. Caution with driving or operating machinery.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ammonium Chloride + Chlorpheniramine Maleate + Sodium Citrate + Terpin Hydrate?
A: Adults: Typically 5-10 mL syrup every 4-6 hours, not to exceed 60 mL in 24 hours. Children: Dosage should be determined by a physician based on weight or age.
Q2: What are the common side effects?
A: Drowsiness, dizziness, dry mouth, nausea, and constipation are common side effects.
Q3: Can this medication be used during pregnancy or breastfeeding?
A: Use with caution during pregnancy and breastfeeding only if the benefits outweigh the potential risks. Consult with a physician.
Q4: What are the contraindications?
A: Contraindications include hypersensitivity, severe liver or kidney disease, asthma, glaucoma, and prostate enlargement.
Q5: What are the potential drug interactions?
A: Potential interactions exist with alcohol, other antihistamines, CNS depressants, and MAOIs.
Q6: How does this medication work?
A: The combination of expectorant, antihistamine, and mucolytic actions thins mucus, reduces airway irritation, and facilitates easier coughing.
Q7: Is this medication safe for children?
A: Dosage in children should be determined by a physician. Generally not recommended for children under 6 years without direct medical supervision.
Q8: What should patients do if they experience side effects?
A: Patients should report any side effects to their physician, especially if they are severe or persistent.
Q9: Can this be used for a chronic cough?
A: It is generally not recommended for long-term use due to the potential for dependence and other chronic effects. Consult a doctor for chronic cough.
Q10: How long should a patient take this medication?
A: Take as directed by a physician. Typically, for short-term relief of cough associated with colds and other upper respiratory tract infections.
