Ammonium Chloride + Noscapine + Sodium Citrate

Usage

• This combination medication is primarily prescribed for the symptomatic relief of dry cough caused by minor throat and bronchial irritation. It’s also used to manage coughs associated with the common cold, flu, post-nasal drip, bronchitis, chest congestion, and coughs related to inhaled irritants.
• Pharmacological Classification: Antitussive (Noscapine), Expectorant (Ammonium Chloride), and Mucolytic agent (Sodium Citrate).
• Mechanism of Action: Ammonium chloride works by irritating the bronchial mucosa, stimulating mucus production and thinning the existing mucus, making it easier to cough up. Noscapine suppresses the cough reflex by acting centrally on the medullary cough center in the brain. Sodium citrate alkalinizes and thins the mucus, further facilitating expectoration.

Alternate Names

• No widely recognized alternate names exist for this specific combination.
• Brand Names: Coscopin, Coscopin Plus, Coscopin Linctus, Coscopin Paediatric, Coupress N, Gocosco, and others (availability may vary by region).

How It Works

• Pharmacodynamics: Ammonium chloride increases the water content of the mucus, making it less viscous. Noscapine acts on sigma receptors in the central nervous system to suppress the cough reflex. Sodium citrate increases the pH of mucus, reducing its viscosity.
• Pharmacokinetics: All three components are absorbed orally. Metabolism and elimination pathways are not fully elucidated for this specific combination, but generally, Ammonium Chloride is excreted renally, Noscapine is metabolized in the liver and excreted in urine and bile, and Sodium Citrate is primarily excreted unchanged in the urine.
• Mode of Action: Ammonium chloride acts on bronchial glands. Noscapine is a sigma-receptor agonist in the CNS. Sodium citrate increases pH through its citrate component.
• Receptor Binding/Enzyme Inhibition: Specific receptor interactions or enzyme inhibitions beyond the sigma receptor activity of Noscapine aren’t well-characterized for this combination.
• Elimination Pathways: Primarily renal excretion (Ammonium Chloride, Sodium Citrate) and hepatic metabolism followed by renal and biliary excretion (Noscapine).

Dosage

Standard Dosage

Adults:

• Standard dose varies by formulation; typically 5-10 ml of syrup every 4-6 hours. Consult specific product labeling. Maximum daily dosage should not exceed recommendations on the packaging.

Children:

• Dosage should be based on the child’s age and weight and adjusted according to the specific product formulation. Always consult the product packaging or a healthcare professional for appropriate pediatric dosing.

Special Cases:

• Elderly Patients: Start with a lower dose and adjust as needed based on tolerance and efficacy. Consider renal function.
• Patients with Renal Impairment: Dose reduction may be required.
• Patients with Hepatic Dysfunction: Use with caution, and dose adjustment may be necessary.
• Patients with Comorbid Conditions: Consider individual patient characteristics and concomitant medications.

Clinical Use Cases

• This specific combination isn’t typically used in intubation, surgical procedures, mechanical ventilation, ICU settings, or emergency situations. Its use is generally limited to outpatient treatment of cough.

Dosage Adjustments

• Dose adjustments are based on patient factors like age, weight, renal function, and hepatic function. Always consult product labeling and consider individual patient characteristics.

Side Effects

Common Side Effects

• Nausea, vomiting, upset stomach, diarrhea, headache, dizziness, drowsiness, skin rash, itching, dry mouth.

Rare but Serious Side Effects

• Allergic reactions (difficulty breathing, swelling of face/tongue/throat), severe dizziness, confusion, irregular heartbeat, muscle twitching/tremors, difficulty urinating.

Long-Term Effects

• No specific long-term effects are established for this combination, but chronic use of any medication carries potential risks.

Adverse Drug Reactions (ADR)

• Severe allergic reactions, respiratory depression (rare), paradoxical excitation.

Contraindications

• Hypersensitivity to any component, severe liver or kidney disease, productive cough with excessive phlegm, respiratory failure, bronchial asthma (especially in infants and young children), concurrent use of MAO inhibitors, newborns, premature infants.

Drug Interactions

• Other cough suppressants, antihistamines, alcohol, liquorice extract, medications that can cause drowsiness (e.g., sedatives, opioids, muscle relaxants), potassium chloride, potassium citrate.

Pregnancy and Breastfeeding

• Pregnancy Safety Category: Generally considered unsafe during pregnancy; consult a healthcare professional.
• Fetal Risks: Potential adverse effects on the developing fetus.
• Breastfeeding: Not recommended during breastfeeding unless benefits outweigh risks; consult a healthcare professional.

Drug Profile Summary

• Mechanism of Action: See above.
• Side Effects: See above.
• Contraindications: See above.
• Drug Interactions: See above.
• Pregnancy & Breastfeeding: See above.
• Dosage: See above.
• Monitoring Parameters: Respiratory status, liver function tests (if indicated), renal function (if indicated).

Popular Combinations

• This combination itself is a popular formulation. Other cough and cold medications may be added (under medical supervision) for comprehensive symptom management.

Precautions

• General Precautions: Assess for allergies, underlying medical conditions (liver/kidney disease, respiratory disorders), and concurrent medications.
• Specific Populations: See above (Pregnancy, Breastfeeding, Children, Elderly).
• Lifestyle Considerations: Avoid alcohol, avoid driving or operating machinery if drowsiness occurs.

FAQs (Frequently Asked Questions)

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

A: Dosage varies depending on age, weight, and product formulation. Consult the product packaging or a healthcare professional for specific recommendations. Do not exceed the maximum daily dose.

Q2: Can I take this medication while pregnant or breastfeeding?

A: It is generally advised not to take this medication during pregnancy or while breastfeeding unless specifically recommended by a healthcare professional due to potential risks to the fetus or infant.

Q3: What are the common side effects?

A: Common side effects include nausea, vomiting, upset stomach, dizziness, drowsiness, headache, dry mouth, skin rash, and itching.

Q4: Are there any serious side effects I should be aware of?

A: Rare but serious side effects can include allergic reactions (difficulty breathing, swelling), severe dizziness, confusion, irregular heartbeat, and muscle twitching. Seek immediate medical attention if these occur.

Q5: Can I take this medication with other over-the-counter cough and cold medicines?

A: It is not recommended to combine this medication with other cough and cold medicines, especially those containing antihistamines or cough suppressants, without consulting a doctor due to potential drug interactions or overdose risks.

Q6: 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 your next dose. Do not double the dose.

Q7: Can I drive or operate machinery while taking this medication?

A: This medication may cause drowsiness or dizziness. Avoid driving or operating heavy machinery until you know how it affects you.

Q8: How does this medication work to relieve cough?

A: Ammonium chloride helps thin and loosen mucus, Noscapine suppresses the cough reflex, and sodium citrate alkalinizes the mucus, further easing expectoration.

Q9: Is this medication addictive?

A: Noscapine, while an opioid, is not considered addictive at therapeutic doses. Ammonium Chloride and Sodium Citrate are also not addictive.

Q10: Can this medication be given to children?

A: Yes, but the dosage must be adjusted based on the child’s age and weight. Consult a healthcare professional or the product labeling for pediatric dosing instructions. It is not recommended for newborns, premature infants, or children under 2 years old without a doctor’s advice.