Usage
This combination medication is primarily used for the symptomatic relief of dry cough associated with the common cold and allergies. It is also used to alleviate symptoms such as runny nose, sneezing, itchy eyes, and throat irritation. It combines the effects of an antihistamine (Cetirizine), a cough suppressant (Dextromethorphan Hydrobromide), and a topical anesthetic/cooling agent (Menthol). Pharmacologically, it is classified as an upper respiratory combination product containing an antihistamine, antitussive, and counterirritant.
Alternate Names
This specific combination does not have an official international nonproprietary name (INN). It is often referred to by its component names or by various brand names depending on the manufacturer and regional market. Some brand names containing these three ingredients include Kozifed Plus and variations thereof. Several similar combination products exist containing related drugs.
How It Works
Cetirizine: This antihistamine acts as an H1-receptor antagonist, blocking the effects of histamine, a chemical mediator responsible for allergic symptoms.
Dextromethorphan Hydrobromide: This antitussive acts centrally on the cough center in the medulla oblongata to suppress the cough reflex.
Menthol: This counterirritant provides a cooling sensation and acts as a topical anesthetic, soothing throat irritation.
Pharmacokinetics: Cetirizine is well-absorbed orally, reaching peak plasma concentrations in about an hour. It is metabolized to a lesser extent by the liver and primarily excreted unchanged in the urine. Dextromethorphan is also well-absorbed following oral administration and is extensively metabolized in the liver, primarily by CYP2D6. It and its metabolites are mainly excreted in urine. Menthol is absorbed from the mucous membranes and metabolized in the liver to glucuronide conjugates before urinary excretion.
Dosage
Dosage guidelines for this specific three-ingredient combination are not universally standardized and will vary depending on the specific product formulation and manufacturer. Always consult the product labeling and consider patient-specific factors. Dosages listed below are general ranges and may not be accurate for all products.
Standard Dosage
Adults:
The usual adult dose is 5-10 mg cetirizine, 10-30 mg dextromethorphan, and 1-10 mg menthol, administered orally, every 4-6 hours as needed. The maximum daily dose should not be exceeded. Specific doses and intervals vary depending on the brand.
Children:
Dosage in children should be determined by a healthcare professional, considering the child’s age and weight. The combination is generally not recommended for children under 4 years of age.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary due to age-related changes in renal and hepatic function.
- Patients with Renal Impairment: Dosage adjustment is necessary in patients with moderate to severe renal dysfunction.
- Patients with Hepatic Dysfunction: Exercise caution in patients with hepatic dysfunction.
- Patients with Comorbid Conditions: Caution is advised in patients with diabetes, cardiovascular disease, hyperthyroidism, prostatic hypertrophy, and glaucoma.
Clinical Use Cases
This combination is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, or the intensive care unit. It is primarily indicated for outpatient symptomatic relief of cough and cold symptoms.
Dosage Adjustments
Always consider the patient’s age, weight, renal and hepatic function, and any coexisting medical conditions when determining the appropriate dose.
Side Effects
Common Side Effects:
Drowsiness, dizziness, dry mouth, nausea, constipation, headache, fatigue.
Rare but Serious Side Effects: Allergic reactions (rash, itching, swelling), difficulty breathing, hallucinations, increased heart rate, seizures.
Long-Term Effects:
Chronic use of dextromethorphan may lead to tolerance and dependence.
Adverse Drug Reactions (ADR): Serotonin syndrome (with concomitant use of serotonergic drugs), respiratory depression (high doses of dextromethorphan).
Contraindications
Hypersensitivity to any component of the medication, concurrent use of MAO inhibitors, severe respiratory depression, asthma with excessive secretions, glaucoma, difficulty urinating due to enlarged prostate.
Drug Interactions
Alcohol, sedatives, tranquilizers, anticholinergics (some antidepressants, muscle relaxants), MAOIs, certain antifungals and antibiotics, other antihistamines, other drugs metabolized by CYP2D6.
Pregnancy and Breastfeeding
Use with caution during pregnancy and breastfeeding. The safety profile of this combination is not well established. Consult a physician before use.
Drug Profile Summary
- Mechanism of Action: Antihistamine, cough suppressant, and counterirritant.
- Side Effects: Drowsiness, dizziness, dry mouth, nausea.
- Contraindications: Hypersensitivity, MAOI use.
- Drug Interactions: Alcohol, CNS depressants, MAOIs.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: Varies according to product formulation; see specific product labeling.
- Monitoring Parameters: Respiratory rate, blood pressure, mental status.
Popular Combinations
This combination itself is a popular combination for cough and cold symptoms. It is sometimes combined with other agents, such as expectorants (guaifenesin) or analgesics/antipyretics (acetaminophen).
Precautions
- General Precautions: Avoid alcohol and operate machinery with caution due to potential drowsiness.
- Specific Populations: Use with caution during pregnancy, breastfeeding, and in pediatric and elderly patients.
- Lifestyle Considerations: Ensure adequate hydration.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cetirizine + Dextromethorphan Hydrobromide + Menthol?
A: The dosage varies depending on the specific product. Consult the product label or a physician for guidance.
Q2: Can this combination be used in children?
A: Use with caution in children. The specific formulation and dosage must be appropriate for the child’s age and weight. Consult a pediatrician.
Q3: What are the common side effects?
A: Common side effects include drowsiness, dizziness, dry mouth, nausea, and constipation.
Q4: Can I drink alcohol while taking this medication?
A: Alcohol may potentiate the sedative effects of this medication and should be avoided.
Q5: What are the serious side effects to watch out for?
A: Serious side effects include allergic reactions, difficulty breathing, hallucinations, increased heart rate, and seizures. Seek immediate medical attention if these occur.
Q6: Can pregnant or breastfeeding women take this combination?
A: Use with caution during pregnancy and breastfeeding. Consult a physician before use.
Q7: Does this medication interact with other medicines?
A: Yes, it can interact with alcohol, sedatives, anticholinergics, MAOIs, and certain antifungal and antibiotic drugs. Disclose all medications you are taking to your physician.
Q8: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it is near the time of the next dose, skip the missed dose and return to your regular schedule. Do not double the dose.
Q9: Can this combination treat my productive cough?
A: This combination is primarily indicated for dry cough. For a productive cough, an expectorant might be more appropriate. Consult a doctor for diagnosis and treatment.
