Ammonium Chloride + Methdilazine + Sodium Citrate

Usage

This combination medication is primarily used for the symptomatic relief of cough, particularly productive coughs associated with the common cold, bronchitis, and other respiratory tract infections. It may also provide relief from allergy symptoms such as runny nose and sneezing.

• Pharmacological Classification: Antitussive (Methdilazine), Expectorant (Ammonium Chloride), Mucolytic (Sodium Citrate)

• Mechanism of Action:

  • Methdilazine: A first-generation antihistamine that blocks histamine H1 receptors, reducing inflammation in the airways and suppressing the cough reflex. It also has sedative properties.
  • Ammonium Chloride: Acts as an expectorant by increasing the water content in respiratory secretions, thinning the mucus, and facilitating its expulsion. In the body, it is converted into ammonia and hydrochloric acid, aiding in clearing the airways.
  • Sodium Citrate: Acts as a mucolytic and alkalizing agent. It thins the mucus, making it easier to cough up, and reduces acidity in the blood and urine, maintaining pH balance.

Alternate Names

• Dilosyn Expectorant
• Rivdol Cough

How It Works

• Pharmacodynamics: The combined effects of methdilazine, ammonium chloride, and sodium citrate offer synergistic relief from cough. Methdilazine suppresses the cough reflex, while ammonium chloride and sodium citrate work together to thin and loosen mucus, making it easier to expectorate. This combined action addresses both the urge to cough and the difficulty in clearing mucus.

• Pharmacokinetics:

  • Methdilazine: Limited information is available on the precise pharmacokinetics of methdilazine. As a first-generation antihistamine, it is likely well-absorbed orally and metabolized in the liver.
  • Ammonium Chloride: Absorbed readily from the gastrointestinal tract. Metabolized in the liver to urea with the liberation of hydrogen and chloride ions.
  • Sodium Citrate: Absorbed from the gastrointestinal tract and metabolized to sodium bicarbonate.

• Mode of Action/Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation: Methdilazine acts as a histamine H1 receptor antagonist. Ammonium chloride and sodium citrate exert their effects through osmotic action and alteration of mucus viscosity, respectively. No direct enzyme inhibition or neurotransmitter modulation is known for this combination.

• Elimination Pathways: Ammonium chloride is eliminated primarily through renal excretion as urea and chloride ions. Sodium citrate is also eliminated renally as bicarbonate. The elimination pathway of methdilazine is primarily hepatic.

Dosage

Dosage depends on individual patient factors. Always consult product labeling. The following is for general guidance only:

Standard Dosage

Adults: 5-15 ml of syrup (containing specified amounts of each ingredient per 5 ml) every 4-6 hours, as needed. Do not exceed the maximum daily dose indicated on the product labeling.

Children: Dosage is determined by the child’s weight or age and according to pediatric dosing recommendations. Generally, a lower dose and/or less frequent administration is appropriate for younger children. Specifically:

• 2-12 years old: 8 ml every four hours, for up to seven days.
• Above 6 years old: Up to 15 ml every four hours, for up to seven days.
• Children 1-5 Years: 2.5ml every 4 hours.
• Children 6-12 years: 5ml every 4 hours.

Special Cases:

• Elderly Patients: Start with the lowest effective dose and monitor for side effects. Adjust dosage based on renal and hepatic function.
• Patients with Renal Impairment: Use with caution and reduce the dose as needed.
• Patients with Hepatic Dysfunction: Dose adjustments may be necessary. Monitor for adverse effects.
• Patients with Comorbid Conditions: Evaluate potential drug interactions. Use cautiously in patients with cardiovascular disease, diabetes, or other metabolic disorders.

Clinical Use Cases

This combination is typically used for outpatient management of cough symptoms and is not generally indicated for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.

Dosage Adjustments

Adjust dosages based on individual patient factors, including renal and hepatic function, and comorbid conditions. Consult product labeling for specific adjustments.

Side Effects

Common Side Effects:

• Drowsiness
• Dizziness
• Dry mouth
• Blurred vision
• Nausea
• Vomiting
• Stomach upset
• Headache

Rare but Serious Side Effects:

• Allergic reactions (rash, itching, hives, swelling)
• Difficulty breathing
• Irregular heartbeat
• Severe drowsiness

Long-Term Effects:

Chronic electrolyte imbalances, particularly in patients with renal impairment.

Adverse Drug Reactions (ADR):

Severe allergic reactions, respiratory depression, cardiac arrhythmias. These require immediate medical attention.

Contraindications

• Hypersensitivity to any of the ingredients
• Patients on MAOI therapy
• Asthma
• Glaucoma
• Children below one year of age
• Patients using potassium citrate

Drug Interactions

• Alcohol may increase dizziness.
• MAO inhibitors
• Sedating medications (opioids, benzodiazepines, barbiturates)
• Antidepressants (TCAs)
• Antihypertensives (beta-blockers)
• Cholinergic medications
• Antacids containing aluminum or magnesium

Pregnancy and Breastfeeding

Methdilazine is considered unsafe during pregnancy. The safety of ammonium chloride and sodium citrate during pregnancy is not well-established. Use with caution if benefits outweigh risks. Consult a physician before use during pregnancy or breastfeeding. It’s recommended to avoid use, especially during the first trimester and breastfeeding.

Drug Profile Summary

• Mechanism of Action: Antitussive, expectorant, and mucolytic
• Side Effects: Drowsiness, dizziness, dry mouth, blurred vision, nausea, vomiting, stomach upset, headache. Rarely: allergic reactions, difficulty breathing, irregular heartbeat.
• Contraindications: Hypersensitivity, MAOI therapy, asthma, glaucoma.
• Drug Interactions: Alcohol, MAOIs, sedatives, antidepressants, antihypertensives.
• Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks. Generally not recommended.
• Dosage: See detailed section above.
• Monitoring Parameters: Respiratory status, electrolyte levels (for long-term use).

Popular Combinations

Information not found.

Precautions

• Pre-existing medical conditions, including renal or liver problems, breathing problems, glaucoma, bladder problems, or prostate problems should be evaluated before administering the medication.
• Specific Populations: Pregnancy (use with caution if benefits outweigh risks); breastfeeding (avoid if possible); children and elderly (dose adjustments often needed).
• Lifestyle: Avoid driving or operating machinery if drowsiness occurs. Avoid alcohol.

FAQs (Frequently Asked Questions)

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

A: See detailed dosage section above. Dosing is patient-specific.

Q2: What are the common side effects?

A: Drowsiness, dizziness, dry mouth, blurred vision, nausea, vomiting, stomach upset, and headache are common side effects.

Q3: Is this combination safe during pregnancy?

A: It is generally not recommended during pregnancy, especially the first trimester. Consult a physician.

Q4: Can I breastfeed while taking this medicine?

A: It’s best to avoid this combination while breastfeeding. Consult a physician.

Q5: Are there any serious drug interactions I should be aware of?

A: Yes, significant interactions can occur with MAOIs, sedatives, antidepressants, and certain antihypertensives. Consult a physician regarding current medications.

Q6: Can I drive or operate heavy machinery while taking this medication?

A: Avoid these activities if experiencing drowsiness or dizziness.

Q7: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember unless it’s near the time for the next dose. Do not double the dose.

Q8: Can this combination be used in children?

A: It can be used in children but with dose adjustments according to the product label. Use with caution in children aged between 6 and 12 years, and it is not recommended for children under 1 year of age without a doctor’s advice.

Q9: How should this medication be stored?

A: Store in a cool, dry place away from direct sunlight and out of the reach of children. Do not freeze.