Usage
- This combination medication is primarily prescribed for the symptomatic relief of cough associated with the common cold, bronchitis, and other upper respiratory tract infections. It helps to loosen and thin mucus (expectorant), suppress cough (antitussive), and alleviate allergy symptoms (antihistamine).
- Pharmacological Classification: Expectorant, Antitussive, Antihistamine, Mucolytic, Topical Anesthetic.
Alternate Names
- This specific combination may not have a universally recognized alternate name. However, each ingredient has its own generic name as noted above. Many regional variations of the name may exist in cough syrup.
- Brand Names: Several brand names exist depending upon the region. Some example include Histalix, Abacoff, Benadryl Original, Difenacol, Diphal Expectorant and Stopkof.
How It Works
- Pharmacodynamics: Ammonium chloride acts as an expectorant by stimulating secretions and reducing mucus viscosity. Diphenhydramine is a first-generation antihistamine that blocks histamine H1 receptors, reducing allergic symptoms like runny nose, sneezing, and watery eyes. It also has antitussive and sedative properties. Menthol provides a cooling sensation and acts as a mild local anesthetic and decongestant.
- Pharmacokinetics:
- Absorption: Diphenhydramine and menthol are well absorbed from the gastrointestinal tract. Ammonium chloride is absorbed quickly into the bloodstream and converted to ammonia and hydrochloric acid in the liver. Sodium citrate gets absorbed into the bloodstream from the gut.
- Metabolism: Diphenhydramine is metabolized primarily in the liver via CYP2D6. Menthol is metabolized in the liver. Ammonium chloride gets converted to ammonia and hydrochloric acid. Sodium Citrate gets metabolized to sodium bicarbonate.
- Elimination: Diphenhydramine and its metabolites are primarily excreted in the urine. Menthol is excreted in the urine and bile. Ammonium chloride is primarily eliminated through the kidneys. Sodium citrate is primarily eliminated by the kidneys.
Dosage
Standard Dosage
Adults:
- 5-10 ml every 4-6 hours.
- Maximum daily dose: 40 ml.
Children:
- 1-5 years: 2.5 ml every 4 hours.
- 6-12 years: 2.5-5 ml every 4 hours.
- Not recommended for children under 1 year of age. Always consult a physician before giving the medicine to children below 6 years.
Special Cases:
- Elderly Patients: Start with a lower dose and titrate up as needed due to potential increased sensitivity.
- Patients with Renal Impairment: Dose adjustments may be necessary depending on the degree of impairment.
- Patients with Hepatic Dysfunction: Dose reduction may be necessary.
- Patients with Comorbid Conditions: Caution in patients with asthma, glaucoma, prostate enlargement, urinary retention, hypertension, hyperthyroidism, cardiovascular disease, and liver or kidney disease. Dosage adjustment must be individualized.
Clinical Use Cases
The combination is typically used for the relief of cough and cold symptoms in outpatient settings and is generally not indicated for specific clinical situations like intubation, surgical procedures, mechanical ventilation, or ICU use. For such cases, specific medications targeted towards the underlying condition are preferred.
Side Effects
Common Side Effects:
- Drowsiness, dizziness, dry mouth, headache, blurred vision, nausea, vomiting, constipation, or diarrhea.
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling), difficulty breathing, hallucinations, confusion, irregular heartbeat, and difficulty urinating.
Long-Term Effects:
- Chronic use of diphenhydramine can lead to tolerance and dependence.
Contraindications
- Hypersensitivity to any of the ingredients.
- Narrow-angle glaucoma.
- Urinary retention.
- Severe asthma or chronic bronchitis.
- MAO inhibitor therapy within the previous 14 days.
- Children under 1 year of age.
Drug Interactions
- Alcohol.
- MAOIs (e.g., phenelzine, tranylcypromine).
- Tricyclic antidepressants.
- CNS depressants (e.g., barbiturates, opioids, benzodiazepines).
- Anticholinergics.
- Certain beta-blockers (e.g., metoprolol).
Pregnancy and Breastfeeding
- Pregnancy: Use with caution only if potential benefit outweighs risk. Consult with a physician.
- Breastfeeding: Diphenhydramine is excreted in breast milk. Use with caution and consult with a physician.
Drug Profile Summary
- Mechanism of Action: Expectorant, antitussive, and antihistaminic.
- Side Effects: Drowsiness, dizziness, dry mouth, blurred vision, gastrointestinal upset.
- Contraindications: Hypersensitivity, glaucoma, urinary retention, MAOI use.
- Drug Interactions: Alcohol, CNS depressants, anticholinergics.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: See dosage section.
- Monitoring Parameters: Respiratory status, cough frequency, and severity of symptoms.
Popular Combinations
- Often combined with other cough and cold medications, including decongestants and analgesics. These must be prescribed by a physician on a case-to-case basis.
Precautions
- Caution in patients with pre-existing medical conditions (asthma, glaucoma, prostate problems, liver or kidney disease).
- Driving restrictions due to potential drowsiness.
- Avoid alcohol.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ammonium Chloride + Diphenhydramine + Menthol?
A: See dosage section.
Q2: What are the common side effects?
A: Drowsiness, dizziness, dry mouth, and blurred vision.
Q3: Can I take this medication during pregnancy?
A: Consult a physician. Use with caution only if the benefits outweigh the risks.
Q4: What are the potential drug interactions?
A: Avoid alcohol and consult about potential interactions with other medications like MAOIs and CNS depressants.
Q5: Can this medication be used in children?
A: It can be used in children older than 1 year but should be given under the supervision of a doctor. Check dosing information as it varies for different age groups. Avoid usage in children below one year.
Q6: How does this combination medication work?
A: Ammonium chloride thins mucus, diphenhydramine suppresses cough and allergy symptoms, and menthol provides a cooling effect.
Q7: When should I avoid taking this medication?
A: If you have hypersensitivity to any of the ingredients, narrow-angle glaucoma, urinary retention, or are currently taking MAO inhibitors.
Q8: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is close to the time for your next dose. Do not double the dose.
Q9: Are there any long-term effects associated with this combination?
A: Prolonged use of diphenhydramine may lead to tolerance and dependence.
