Usage
- Ammonium Chloride + Diphenhydramine is prescribed for the relief of cough and cold symptoms, including runny nose, sneezing, watery eyes, and sore throat. It is particularly effective for dry, raspy coughs. It can also provide relief from allergies.
- Pharmacological Classification: Expectorant (Ammonium Chloride) and Antihistamine (Diphenhydramine). This combination belongs to the class of cough and cold products.
- Mechanism of Action: Ammonium Chloride works by thinning and loosening mucus in the airways, making it easier to cough up. Diphenhydramine blocks the action of histamine, a chemical mediator that causes allergic reactions. It also has antitussive (cough-suppressing) properties that act centrally in the brain.
Alternate Names
- No widely recognized alternate generic names exist for this specific combination product. The individual components may be referred to as diphenhydramine hydrochloride and ammonium chloride.
- Brand Names: Brand names vary depending on the region and manufacturer. Some examples include Benadryl Original, Biochemdryl, Stopkof, and Histalix, as well as other generic formulations like Bactidol Itchy Cough Relief.
How It Works
- Pharmacodynamics: Ammonium Chloride increases respiratory tract secretions, reducing mucus viscosity and facilitating expectoration. Diphenhydramine antagonizes histamine H1 receptors, mitigating allergic symptoms. It also acts centrally to suppress cough.
- Pharmacokinetics: Diphenhydramine is well-absorbed orally, reaching peak plasma concentration in 1-4 hours. It is metabolized extensively in the liver and excreted mainly in urine. Ammonium Chloride is absorbed from the gastrointestinal tract. Ammonium ions play a crucial role in acid-base balance, primarily through renal excretion.
- Mode of Action: Diphenhydramine competitively inhibits histamine at H1 receptors, thereby reducing the effects of histamine release in allergic responses. It also interacts with muscarinic cholinergic receptors, causing some anticholinergic effects.
- Receptor Binding/Enzyme Inhibition: Diphenhydramine competitively binds to H1 histamine receptors.
- Elimination Pathways: Diphenhydramine is primarily metabolized in the liver and excreted in urine. Ammonium Chloride is eliminated mainly through renal excretion.
Dosage
Standard Dosage
Adults:
- 10 mL (or as directed on product label) every 4-6 hours as needed. Do not exceed 6 doses in a 24 hour period.
Children:
- 6 to 12 years: 5 mL (or as directed on product label) every 4-6 hours as needed. Do not exceed 6 doses in a 24 hour period.
- Under 6 years: Not recommended for use in young children, especially those under 4. Consult a healthcare professional.
Special Cases:
- Elderly Patients: Use with caution due to increased risk of side effects, especially drowsiness, dizziness, and confusion. Dosage adjustment may be needed.
- Patients with Renal Impairment: Dose adjustment may be necessary depending on the degree of impairment. Closely monitor renal function.
- Patients with Hepatic Dysfunction: Dose adjustment may be required based on the severity of liver dysfunction. Monitor liver function tests.
- Patients with Comorbid Conditions: Use with caution in patients with asthma, glaucoma, prostatic hypertrophy, cardiovascular disease, hypertension, hyperthyroidism, and other chronic lung conditions.
Clinical Use Cases The medication is primarily indicated for cough and cold symptom relief and not typically used in the clinical settings mentioned below.
- Intubation: Not indicated.
- Surgical Procedures: Not indicated.
- Mechanical Ventilation: Not indicated.
- Intensive Care Unit (ICU) Use: Not indicated.
- Emergency Situations: Not indicated.
Dosage Adjustments Adjustments may be needed in elderly patients and those with renal or hepatic impairment as mentioned above.
Side Effects
Common Side Effects
- Drowsiness
- Dizziness
- Dry mouth
- Headache
- Stomach upset
- Blurred vision
- Constipation
- Thickening of mucus
Rare but Serious Side Effects
- Allergic reactions (difficulty breathing, swelling, rash, itching)
- Confusion
- Difficulty urinating
- Paradoxical CNS stimulation (excitability, nervousness, restlessness)
Long-Term Effects
- No specific long-term effects have been extensively documented, but prolonged use of antihistamines can lead to tolerance.
Adverse Drug Reactions (ADR)
- Severe allergic reactions (anaphylaxis)
- Seizures
- Cardiac arrhythmias
Contraindications
- Hypersensitivity to diphenhydramine or ammonium chloride
- Premature infants and neonates
- Narrow-angle glaucoma
- Asthma attack
- Stomach/duodenal ulcers
- Prostate/bladder problems
- Severe liver/kidney disease
- Concurrent or recent use of MAOIs
Drug Interactions
- MAOIs: Can intensify anticholinergic effects and cause very high blood pressure.
- CNS Depressants (alcohol, barbiturates, opioid analgesics): Enhanced sedation.
- Anticholinergics (tricyclic antidepressants): Increased anticholinergic effects.
- Beta Blockers (metoprolol): Potential potentiation of beta-blocker effects.
Pregnancy and Breastfeeding
- Pregnancy: Pregnancy Category A (Australia) or B (US). Consult a physician before use. Use only if the potential benefit outweighs the risk to the fetus.
- Breastfeeding: Diphenhydramine is excreted in breast milk and may have undesirable effects on a nursing infant. Not recommended during breastfeeding.
Drug Profile Summary
- Mechanism of Action: Ammonium Chloride: Expectorant; Diphenhydramine: Antihistamine and Antitussive.
- Side Effects: Drowsiness, dizziness, dry mouth, constipation, blurred vision.
- Contraindications: Hypersensitivity, newborns, glaucoma, MAOI use, severe liver/kidney disease.
- Drug Interactions: MAOIs, CNS depressants, anticholinergics, certain beta blockers.
- Pregnancy & Breastfeeding: Caution advised; not recommended during breastfeeding.
- Dosage: Adults: 10 mL every 4-6 hours; Children (6-12 yrs): 5 mL every 4-6 hours.
- Monitoring Parameters: Respiratory status, mental alertness, side effects.
Popular Combinations Ammonium chloride and diphenhydramine are often combined with other ingredients like sodium citrate and menthol in various cough and cold preparations.
Precautions
- General Precautions: Assess for allergies, pre-existing medical conditions, and concomitant medications.
- Specific Populations: As described in special cases section for dosage.
- Lifestyle Considerations: Avoid alcohol and activities requiring alertness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ammonium Chloride + Diphenhydramine?
A: Adults: 10 mL every 4-6 hours, not to exceed 6 doses in 24 hours. Children (6-12 years): 5 mL every 4-6 hours, not to exceed 6 doses in 24 hours. Not recommended for children under 6 years of age.
Q2: How does Ammonium Chloride + Diphenhydramine work?
A: Ammonium chloride works as an expectorant, thinning and loosening mucus. Diphenhydramine acts as an antihistamine, blocking allergic responses and suppressing coughs.
Q3: What are the common side effects?
A: Common side effects include drowsiness, dizziness, dry mouth, headache, and upset stomach.
Q4: Is it safe to take during pregnancy or breastfeeding?
A: Consult a physician before use during pregnancy. Not recommended while breastfeeding.
Q5: Can I operate machinery while taking this medication?
A: Use caution as it may cause drowsiness and impair alertness. Avoid activities requiring mental alertness until you know how it affects you.
Q6: What are the contraindications for this medication?
A: Contraindications include hypersensitivity, glaucoma, severe liver or kidney disease, asthma attack, and concomitant use of MAOIs.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is almost time for the next dose. Do not double the dose to catch up.
Q8: Are there any specific drug interactions I should be aware of?
A: Yes. Avoid concurrent use with MAOIs. It can also interact with alcohol, other CNS depressants, anticholinergics, and certain beta blockers.
Q9: What are the signs of an overdose?
A: Overdose symptoms can include severe drowsiness, confusion, hallucinations, seizures, and cardiovascular collapse. Seek immediate medical attention if overdose is suspected.
Q10: How should this medication be stored?
A: Store at room temperature (15-30°C) and protect from light and freezing. Keep out of reach of children.
