Ammonium Chloride + Diphenhydramine + Menthol + Sodium Citrate

Usage

• This combination medication is primarily prescribed for the symptomatic relief of cough and nasal congestion associated with the common cold, flu, allergies, or other respiratory illnesses like bronchitis. It helps to loosen and thin mucus in the airways, making it easier to cough up. It also suppresses cough and soothes irritated throat tissues.
• Pharmacological Classification: Expectorant, antihistamine, antitussive, mucolytic, and demulcent.

Alternate Names

• No widely recognized alternate names exist for this specific four-component combination. However, each individual component has its own respective generic and brand names.
• Brand Names: Numerous brand names exist depending on the manufacturer and region (e.g., Benadryl Original (containing diphenhydramine and ammonium chloride), Abacoff, Stopkof, Histalix).

How It Works

• Pharmacodynamics: Ammonium chloride works as an expectorant by stimulating secretions in the respiratory tract, thinning the mucus. Diphenhydramine, an antihistamine, blocks the action of histamine, reducing allergy symptoms like coughing and sneezing. It also has a central nervous system depressant effect, providing a mild sedative and antitussive action. Menthol acts as a demulcent, soothing the throat. Sodium citrate acts as a mucolytic by making mucus less viscous and acidic.

• Pharmacokinetics: All components are absorbed orally. Diphenhydramine is metabolized primarily in the liver via the CYP2D6 enzyme system. Ammonium chloride is converted to ammonia and hydrochloric acid. The metabolic pathways for menthol and sodium citrate are less crucial for this combination’s clinical effects. Renal excretion plays a role in the elimination of all components and their metabolites.

Dosage

Standard Dosage

Adults: 5-10 ml every 4-6 hours, not exceeding 6 doses in 24 hours.

Children:

• 6-12 years: 2.5-5 ml every 4-6 hours.
• Under 6 years: Not recommended without a doctor’s advice. Some sources recommend against use in children under 2 years of age.

Special Cases:

• Elderly Patients: Use with caution due to increased risk of side effects like dizziness and drowsiness. Dose adjustments might be required.
• Patients with Renal Impairment: Caution advised; dose adjustment might be necessary.
• Patients with Hepatic Dysfunction: Use with caution; dose adjustment might be needed.
• Patients with Comorbid Conditions: Use cautiously in patients with asthma, glaucoma, urinary retention, prostate problems, or cardiovascular diseases.

Clinical Use Cases

The combination is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. Its primary use is for symptomatic relief of cough and congestion associated with common respiratory illnesses.

Side Effects

Common Side Effects

• Drowsiness
• Dizziness
• Dry mouth
• Nausea
• Headache
• Stomach upset
• Constipation
• Diarrhea

Rare but Serious Side Effects

• Allergic reactions (rash, itching, swelling)
• Difficulty breathing
• Hallucinations
• Confusion
• Palpitations
• Tachycardia
• Hypotension
• Blurred vision
• Difficulty urinating

Long-Term Effects

Limited information available on the long-term effects of this particular combination.

Contraindications

• Hypersensitivity to any of the components.
• Concurrent use of monoamine oxidase inhibitors (MAOIs).
• Children under 2 years (some sources say under 6).
• Severe liver or kidney disease.
• Asthma or glaucoma.

Drug Interactions

• Alcohol (increases drowsiness and dizziness)
• Other antihistamines or sedatives (additive sedative effects)
• MAOIs (may cause serious interactions)
• Tricyclic antidepressants
• Certain beta-blockers (e.g., metoprolol)
• Warfarin
• Chloramphenicol
• Propantheline
• Metoclopramide
• Pregabalin

Pregnancy and Breastfeeding

• Pregnancy: Use only if clearly needed and the potential benefits outweigh the risks.
• Breastfeeding: Diphenhydramine is excreted in breast milk. Not recommended unless the potential benefits outweigh the risks to the infant.

Drug Profile Summary

• Mechanism of Action: Expectorant, antihistamine, antitussive, mucolytic, demulcent.
• Side Effects: Drowsiness, dizziness, dry mouth, nausea, headache.
• Contraindications: Hypersensitivity, MAOI use, children under 2 (or 6), severe liver/kidney disease.
• Drug Interactions: Alcohol, other antihistamines, MAOIs, certain beta-blockers.
• Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
• Dosage: Adults: 5-10 ml every 4-6 hours; Children (6-12 years): 2.5-5 ml every 4-6 hours.
• Monitoring Parameters: Respiratory status, alertness, side effects.

Popular Combinations Not applicable, this is already a combination product.

Precautions

• Pre-existing medical conditions (asthma, glaucoma, etc.) should be evaluated.
• Pregnant Women: Avoid unless benefits outweigh risks.
• Breastfeeding Mothers: Not recommended.
• Children & Elderly: Use cautiously with appropriate dosage adjustments.
• Lifestyle Considerations: Avoid alcohol and activities requiring alertness.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Ammonium Chloride + Diphenhydramine + Menthol + Sodium Citrate?

A: Adults: 5-10 ml every 4-6 hours. Children (6-12 years): 2.5-5 ml every 4-6 hours. Not recommended for children under 6 (or 2, according to some sources) without a doctor’s advice.

Q2: What are the primary uses of this combination?

A: Symptomatic relief of cough and nasal congestion associated with colds, flu, allergies, and other respiratory illnesses.

Q3: How does diphenhydramine contribute to the effects of this medication?

A: Diphenhydramine is an antihistamine that blocks histamine action, relieving allergy symptoms and suppressing cough. It also has a sedative effect.

Q4: What is the role of ammonium chloride in this combination?

A: Ammonium chloride acts as an expectorant, thinning mucus and making it easier to cough up.

Q5: Are there any serious side effects I should be aware of?

A: While generally safe, rare but serious side effects can include allergic reactions, difficulty breathing, hallucinations, confusion, and cardiovascular effects (palpitations, tachycardia, hypotension).

Q6: Can this medication be used during pregnancy or breastfeeding?

A: Use with caution during pregnancy and breastfeeding only if the potential benefits outweigh the risks to the fetus or infant. Consult a physician before use.

Q7: What are the major drug interactions with this combination?

A: Avoid concurrent use of alcohol, MAOIs, other antihistamines or sedatives, and certain other medications (e.g., some beta-blockers). Consult a physician or pharmacist about specific drug interactions.

Q8: Can this medication be given to young children?

A: Not recommended for children under 6 years old (or 2, according to some sources) without a doctor’s advice.

Q9: What should patients do if they experience side effects?

A: Most side effects are mild and transient. If side effects are persistent or severe, patients should consult their doctor.

Q10: Can patients drive or operate machinery while taking this medicine?

A: This medication can cause drowsiness and dizziness. It is advisable to avoid driving or operating machinery until the effects of the medication are known.