Amylmetacresol + Dextromethorphan Hydrobromide

Usage

• This combination medication is prescribed for the relief of dry cough associated with a sore throat (pharyngitis). It works locally to soothe and lubricate the irritated area in the mouth and throat.
• Pharmacological Classification: Antitussive (Dextromethorphan Hydrobromide), Antiseptic (Amylmetacresol).
• Mechanism of Action: Amylmetacresol acts as a local antiseptic and mild anesthetic, while Dextromethorphan Hydrobromide suppresses the cough reflex by acting on the cough center in the brain.

Alternate Names

• No widely recognized alternate names exist for this specific combination. Regional variations in nomenclature may occur.
• Brand Names: Tusq-D is a frequently encountered brand name. Other brand names may exist depending on the region and manufacturer.

How It Works

• Pharmacodynamics: Amylmetacresol provides local antiseptic action and mild local anesthetic effects. Dextromethorphan Hydrobromide suppresses the cough reflex centrally, similar to codeine, but without analgesic or addictive properties at typical doses. It does not inhibit ciliary activity.
• Pharmacokinetics:
  • Dextromethorphan: Absorbed rapidly from the GI tract, reaching peak plasma concentrations in about 2-2.5 hours. Extensive first-pass metabolism reduces bioavailability. Maximum clinical effects manifest 5-6 hours post-ingestion. Distributed widely in the body, metabolized by the liver (CYP2D6 enzyme), and excreted primarily in the urine. Genetic variations in CYP2D6 activity can influence drug levels and individual responses.
  • Amylmetacresol: Acts locally, minimal systemic absorption. Information on its metabolism and elimination pathways is limited.
• Mode of Action: Amylmetacresol is believed to work by altering bacterial protein structure. Its anesthetic effect likely involves modulation of sodium channels. Dextromethorphan Hydrobromide acts on sigma opioid receptors in the central nervous system, raising the threshold for coughing.
• Elimination Pathways: Dextromethorphan is mainly excreted renally. Limited data exists on Amylmetacresol excretion.

Dosage

Standard Dosage

Adults: One lozenge every 4 hours as needed, not to exceed 12 lozenges in 24 hours.

Children:

• 6 to 12 years: One lozenge every 4 hours, not exceeding 6 lozenges per 24 hours.
• Under 6 years: Not recommended due to choking risk.

Special Cases:

• Elderly Patients: Use with caution due to potential age-related changes in drug metabolism and clearance.
• Patients with Renal Impairment: Dosage adjustment may be necessary. Consult specialist guidance.
• Patients with Hepatic Dysfunction: Use with caution. Dosage adjustment may be warranted.
• Patients with Comorbid Conditions: Assess individual circumstances, particularly asthma, COPD, and concurrent use of CNS depressants or medications metabolized by CYP2D6.

Clinical Use Cases

This combination is specifically indicated for cough relief associated with a sore throat and is not typically used in settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations.

Dosage Adjustments

Adjustments are made based on individual patient factors such as renal or hepatic impairment, age, and concomitant medications, particularly CYP2D6 inhibitors.

Side Effects

Common Side Effects:

• Dizziness
• Drowsiness
• Nausea
• Vomiting
• Confusion
• Agitation
• Sore tongue
• Stomach upset

Rare but Serious Side Effects:

• Allergic reactions (rash, difficulty breathing, facial swelling)
• Serotonin syndrome (with MAOIs or other serotonergic drugs)
• Respiratory depression (in high doses or with other CNS depressants)

Long-Term Effects:

Data on chronic effects is limited. Prolonged use is generally not recommended.

Adverse Drug Reactions (ADR):

• Serotonin Syndrome
• Respiratory depression
• Allergic reactions

Contraindications

• Hypersensitivity to either Amylmetacresol or Dextromethorphan Hydrobromide.
• Concurrent use of MAO inhibitors (or within 14 days of discontinuation).
• Patients with productive cough, respiratory failure, or risk thereof.
• Cough associated with asthma, emphysema, or chronic bronchitis.
• Children under 6 years old.
• Fructose intolerance, glucose-galactose malabsorption, or sucrose-isomaltose insufficiency.

Drug Interactions

• MAO Inhibitors: Risk of serotonin syndrome (hyperpyrexia, hypotension, myoclonic jerks, coma).
• CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine): Elevated dextromethorphan levels, increased toxicity risk.
• CNS Depressants (e.g., alcohol, antihistamines, psychotropics): Additive CNS depressive effects.
• Serotonergic Drugs: Risk of serotonin syndrome.

Pregnancy and Breastfeeding

• Pregnancy Safety Category: C (consult sources for latest FDA classification). Potential adverse fetal effects. Use cautiously if benefits outweigh risks.
• Breastfeeding: Potential excretion in breast milk. Exercise caution. Discuss safer alternatives with a physician.

Drug Profile Summary

(as described in the previous sections.)

Popular Combinations

The combination of Amylmetacresol and Dextromethorphan itself is a popular formulation. Combining it with other medications requires careful consideration of potential interactions.

Precautions

(as described in previous sections)

FAQs (Frequently Asked Questions)

(Following are at least eight questions and answers related to Amylmetacresol + Dextromethorphan Hydrobromide)

Q1: What is the recommended dosage for Amylmetacresol + Dextromethorphan Hydrobromide?

A: Adults and children over 12 years: One lozenge every four hours, not exceeding 12 lozenges per day. Children aged 6 to 12 years: One lozenge every four hours, with a maximum of six lozenges per day. It’s not recommended for children under six.

Q2: How does this combination medication work to relieve cough and sore throat?

A: Amylmetacresol acts as an antiseptic and mild local anesthetic, soothing the throat. Dextromethorphan suppresses the cough reflex in the brain.

Q3: Can I use this while taking other medications, such as antidepressants?

A: Consult your doctor before use if you’re on other medications, especially MAO inhibitors, certain antidepressants (like fluoxetine or paroxetine), or other CNS depressants. These can interact with the drug.

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

A: While generally safe, serious side effects can occur. These include allergic reactions (rash, breathing difficulties, facial swelling) and serotonin syndrome (when combined with MAO inhibitors or other serotonergic drugs). Contact a doctor immediately if such symptoms appear.

Q5: Can I use this medication if I have asthma or other lung conditions?

A: It’s contraindicated in individuals with a productive cough, respiratory failure, or risk thereof. Cough associated with asthma, emphysema, or chronic bronchitis also warrants avoiding this medication.

Q6: Is it safe to use this during pregnancy or breastfeeding?

A: It’s generally advised to consult your doctor before using it during pregnancy or while breastfeeding. There are potential fetal risks and possible drug excretion in breast milk.

Q7: Can I drive or operate machinery after taking this medicine?

A: The medication can cause dizziness and drowsiness. Avoid driving or operating machinery if you experience these effects.

Q8: What should I do if I miss a dose?

A: If you miss a dose, take it as soon as you remember. But if it’s almost time for the next dose, skip the missed one and return to your regular dosing schedule. Don’t double the dose.

Q9: What are the long-term effects of using this combination?

A: Data on the long-term effects are limited. Prolonged use is generally discouraged, and you should consult your doctor if symptoms persist.

Q10: Can I consume alcohol while using this medication?

A: Alcohol can exacerbate the sedative effects of dextromethorphan, leading to increased drowsiness and impaired cognitive function. It’s best to avoid or limit alcohol consumption during treatment.