Usage
- This combination medication is primarily prescribed for the symptomatic relief of cough associated with upper respiratory tract infections, such as the common cold, bronchitis, and sinusitis. It helps to loosen and thin mucus, making it easier to cough up. It can also provide relief from allergy symptoms like runny nose and sneezing.
- Pharmacological Classification: Expectorant, antihistamine, and alkalizing agent.
- Mechanism of Action: Ammonium chloride acts as an expectorant by increasing the water content in the airways, thinning the mucus. Diphenhydramine is an antihistamine that blocks the effects of histamine, reducing allergic symptoms and also inducing mild sedation. Sodium citrate alkalizes the urine and blood, helping maintain pH balance.
Alternate Names
- No widely recognized alternate generic names. Regional variations may exist.
- Brand Names: Numerous brand names exist depending on the manufacturer and region. Examples include (Note: brand names may vary regionally): Benadryl Cough Formula, Codolin Expectorant, Deleased Chesty Cough Syrup, Diphal Expectorant, Nesdryl Expectorant, Stopkof syrup.
How It Works
- Pharmacodynamics: Ammonium chloride increases respiratory secretions, making them less viscous. Diphenhydramine blocks H1 histamine receptors, reducing allergy symptoms and causing drowsiness. Sodium citrate is metabolized to sodium bicarbonate, which increases blood and urine pH.
- Pharmacokinetics:
- Absorption: All three components are absorbed orally.
- Metabolism: Diphenhydramine is metabolized primarily in the liver by the CYP450 system. Ammonium chloride is metabolized in the liver to form ammonia and hydrochloric acid. Sodium citrate is metabolized to sodium bicarbonate.
- Elimination: Diphenhydramine metabolites are excreted in the urine. Ammonium chloride is eliminated primarily via the kidneys as ammonia and chloride. Sodium citrate is eliminated by the kidneys.
- Mode of Action: Ammonium chloride acts on the goblet cells of the respiratory tract to stimulate mucus secretion. Diphenhydramine competitively binds to H1 histamine receptors. Sodium citrate is converted to bicarbonate, which buffers excess hydrogen ions.
Dosage
Standard Dosage
Adults: 5-10 mL (1-2 teaspoonfuls) every 4 hours. Maximum: Do not exceed six doses in 24 hours.
Children:
- 6-12 years: 2.5-5 mL (1/2 -1 teaspoonful) every 4 hours. Do not exceed four doses in 24 hours. Consult a doctor if symptoms persist beyond two weeks. Some sources suggest not to administer to children under 6 years.
- 2-5 years: 2.5 mL. Do not give to children under 2 years of age without medical advice.
- Under 2 years: Not recommended unless specifically prescribed by a physician.
- 4 years and older: (Based on sources referring to the combination including menthol): 5 mL every four hours.
- 1-5 years: (Based on Abacoff Syrup information): Half of one 5 mL spoonful every 4 hours.
- 6-12 years: (Based on Abacoff Syrup information): One 5 mL spoonful every 4 hours.
Special Cases:
- Elderly Patients: Use with caution due to increased risk of side effects, especially from diphenhydramine (e.g., confusion, dizziness). Lower doses may be necessary.
- Patients with Renal Impairment: Dose adjustment may be required; consult a nephrologist.
- Patients with Hepatic Dysfunction: Use with caution; dose adjustment may be needed for diphenhydramine.
- Patients with Comorbid Conditions: Use with caution in patients with glaucoma, asthma, prostatic hypertrophy, cardiovascular disease, hyperthyroidism.
Clinical Use Cases
This particular combination of ammonium chloride, diphenhydramine, and sodium citrate is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, or the ICU. It’s primarily used for symptomatic relief of cough related to upper respiratory tract infections in an outpatient setting.
Dosage Adjustments
Adjustments should be made in cases of renal or hepatic impairment, elderly patients, and those with specific comorbidities. Consult specialized medical references for detailed dosage modifications in these populations.
Side Effects
Common Side Effects
- Drowsiness
- Dizziness
- Dry mouth
- Nausea and vomiting
- Headache
- Blurred vision
- Constipation
- Stomach upset
Rare but Serious Side Effects
- Allergic reactions (rash, itching, swelling, difficulty breathing)
- Confusion
- Hallucinations
- Seizures
- Cardiac arrhythmias
- Extrapyramidal symptoms (movement disorders)
- Blood disorders
- Liver dysfunction
- Hypotension
Long-Term Effects
No significant long-term effects are typically associated with short-term use. Prolonged use of diphenhydramine may increase the risk of cognitive impairment in elderly patients.
Adverse Drug Reactions (ADR)
Severe drowsiness, confusion, hallucinations, seizures, cardiac arrhythmias require immediate medical intervention.
Contraindications
- Hypersensitivity to any of the components.
- Patients on monoamine oxidase inhibitors (MAOIs).
- Children under 2 years of age (some formulations specify different age limits).
- Narrow-angle glaucoma
- Asthma
- Prostatic hypertrophy
- Stomach or bowel ulcers
Drug Interactions
- MAO inhibitors
- Alcohol
- CNS depressants (e.g., opioids, benzodiazepines, barbiturates)
- Tricyclic antidepressants
- Antihypertensives (e.g., metoprolol)
- Cholinergic medications
- Antacids containing aluminum or magnesium
- Antihistamines
- Sedatives
- Muscle relaxants
- Warfarin
- Chloramphenicol
- Pregabalin
- Metoprolol
- CYP2D6 inhibitors
Pregnancy and Breastfeeding
- Pregnancy: Use only if clearly necessary and the benefits outweigh the risks. Insufficient data exists about the safety of this combination during pregnancy. Ideally avoid use during the first trimester.
- Breastfeeding: Diphenhydramine is excreted in breast milk and may cause drowsiness in infants. Not recommended unless the potential benefits outweigh the risks. Consult a physician.
Drug Profile Summary
- Mechanism of Action: Ammonium chloride increases airway fluid; diphenhydramine blocks H1 receptors, reducing allergic symptoms; sodium citrate alkalizes blood and urine.
- Side Effects: Drowsiness, dizziness, dry mouth, nausea, headache. Rarely: allergic reactions, seizures, cardiac arrhythmias.
- Contraindications: Hypersensitivity, MAOI use, young children, glaucoma, asthma, prostatic hypertrophy.
- Drug Interactions: MAOIs, alcohol, CNS depressants, tricyclic antidepressants, certain antihypertensives.
- Pregnancy & Breastfeeding: Use with caution if clearly necessary.
- Dosage: Adults: 5-10 mL every 4 hours. Children (6-12 years): 2.5-5 mL every 4 hours. Age limits and dosing vary between formulations; consult product information.
- Monitoring Parameters: Respiratory status, mental status, blood pressure, heart rate.
Popular Combinations
This combination itself is a popular combination for cough and cold symptoms. Adding menthol is also common for its soothing effect on the throat.
Precautions
- Assess for allergies, renal/hepatic dysfunction, glaucoma, asthma, prostatic hypertrophy.
- Pregnant Women: Use with extreme caution; weigh benefits against risks.
- Breastfeeding Mothers: Not generally recommended.
- Children & Elderly: Adjust dosage based on age and health status.
- Avoid alcohol and other CNS depressants.
- May impair driving and operation of machinery.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ammonium Chloride + Diphenhydramine + Sodium Citrate?
A: Adults: 5-10 mL every 4 hours. Children (6-12 years): 2.5-5 mL every 4 hours. Consult specific product labeling for precise pediatric dosing instructions, as age restrictions may vary.
Q2: What are the common side effects?
A: Drowsiness, dizziness, dry mouth, nausea, headache.
Q3: Can pregnant or breastfeeding women take this medication?
A: Use with caution only if clearly necessary and after consultation with a physician. Not generally recommended for breastfeeding mothers.
Q4: What are the major drug interactions?
A: MAOIs, alcohol, CNS depressants, some antidepressants, some antihypertensives.
Q5: Can this medication be used in children under 2 years old?
A: Not generally recommended. Consult a physician. Some formulations are contraindicated for use in very young children; check specific product information.
Q6: What conditions is this medication contraindicated in?
A: Hypersensitivity, MAOI use, narrow-angle glaucoma, asthma, prostatic hypertrophy. Age restrictions apply to pediatric patients.
Q7: How does this combination work to relieve cough?
A: Ammonium chloride thins mucus, diphenhydramine reduces allergic responses that may contribute to cough, and sodium citrate alkalizes secretions.
Q8: What should patients avoid while taking this medication?
A: Alcohol, other CNS depressants, operating machinery, driving.
Q9: What are signs of an overdose?
A: Severe drowsiness, confusion, hallucinations, seizures, and cardiac arrhythmias. Seek immediate medical attention if overdose is suspected.
Q10: Can this medication be used long-term?
A: It is intended for short-term symptomatic relief. Prolonged use, especially of diphenhydramine, should be avoided unless under explicit medical supervision.
