Usage
This combination medication is primarily prescribed for the symptomatic relief of the common cold, flu, and allergies. It addresses symptoms such as cough (especially dry cough), fever, headache, body aches, nasal congestion, sneezing, runny nose, itchy or watery eyes, and sore throat.
Pharmacological Classifications:
- Cetirizine: Antihistamine (second-generation)
- Dextromethorphan Hydrobromide: Cough suppressant (antitussive)
- Menthol: Topical analgesic, counterirritant
- Paracetamol (Acetaminophen): Analgesic, antipyretic
- Phenylephrine: Decongestant (alpha-1 adrenergic agonist)
- Sodium Citrate: Mucolytic, expectorant
Mechanism of Action: This combination targets multiple symptoms simultaneously. Cetirizine blocks histamine action, relieving allergy symptoms. Dextromethorphan suppresses the cough reflex in the brain. Paracetamol reduces fever and pain. Phenylephrine constricts blood vessels in the nasal passages, reducing congestion. Sodium citrate helps thin and loosen mucus. Menthol provides a cooling and soothing effect.
Alternate Names
There is no single official alternate name for this specific combination. It is often referred to by the names of its individual components or brand names.
Brand Names: Brand names vary regionally. Some examples include Rexidil-P Suspension, and Kozifed Plus.
How It Works
Pharmacodynamics: The combined effects of the individual components lead to symptom relief as described in the “Mechanism of Action.”
Pharmacokinetics:
- Absorption: All components are absorbed orally, though at varying rates.
- Metabolism: Paracetamol is primarily metabolized in the liver. Cetirizine undergoes minimal hepatic metabolism. Dextromethorphan is metabolized by the CYP2D6 enzyme. Phenylephrine is metabolized by monoamine oxidase (MAO).
- Elimination: Most components are primarily eliminated renally, either unchanged or as metabolites.
Mode of Action: Cetirizine acts as an H1-receptor antagonist. Dextromethorphan acts centrally on the cough center in the medulla. Paracetamol inhibits prostaglandin synthesis. Phenylephrine activates alpha-1 adrenergic receptors. Sodium citrate increases the pH of respiratory secretions, reducing mucus viscosity. Menthol activates TRPM8 receptors, creating a cooling sensation.
Receptor Binding/Enzyme Inhibition: As noted above, cetirizine binds to H1 receptors, and phenylephrine binds to alpha-1 adrenergic receptors. Paracetamol inhibits cyclooxygenase (COX) enzymes. Dextromethorphan acts on sigma opioid receptors and NMDA receptors in the brain.
Elimination Pathways: Primarily renal excretion for most components.
Dosage
The dosage depends on the specific formulation and the patient’s age and condition. Consult the product’s packaging or a doctor for precise instructions.
Standard Dosage
Children: Pediatric dosages are weight or age-dependent and should be determined by a healthcare professional. Extreme caution should be used when administering to children under 6 years old.
Special Cases: Dosage adjustments may be required for:
- Elderly Patients: Lower doses may be necessary.
- Patients with Renal Impairment: Dose reduction may be necessary based on creatinine clearance.
- Patients with Hepatic Dysfunction: Dose adjustment may be required.
- Patients with Comorbid Conditions: Consider underlying medical conditions such as diabetes, cardiovascular disease, and others. Individualized dosing is essential.
Clinical Use Cases
This particular combination is typically not used in critical care settings like intubation, surgical procedures, mechanical ventilation, or the ICU. It is primarily intended for outpatient management of common cold and flu symptoms.
Dosage Adjustments
Adjustments are made based on patient factors like renal or hepatic dysfunction and other comorbid conditions. Always consider potential drug interactions.
Side Effects
Common Side Effects:
Drowsiness, dizziness, dry mouth, nausea, headache, and difficulty sleeping.
Rare but Serious Side Effects:
Allergic reactions (rash, itching, swelling), severe dizziness, and breathing difficulties.
Long-Term Effects:
Generally, this combination is intended for short-term use. Long-term effects are not typically observed, but chronic use of paracetamol can cause liver damage.
Adverse Drug Reactions (ADR):
Serious allergic reactions, liver damage (with prolonged paracetamol use), and serotonin syndrome (rare, with certain drug interactions).
Contraindications
Hypersensitivity to any component, severe liver or kidney disease, concurrent or recent use of MAO inhibitors.
Drug Interactions
MAO inhibitors, alcohol, other sedatives, and certain antidepressants. Consult a doctor or pharmacist for a complete list of interactions.
Pregnancy and Breastfeeding
Consult a healthcare professional before using this combination during pregnancy or while breastfeeding. Safety during pregnancy has not been fully established.
Drug Profile Summary
- Mechanism of Action: Multi-action formula for cold and flu symptom relief.
- Side Effects: Drowsiness, dizziness, dry mouth, nausea, headache.
- Contraindications: Hypersensitivity, severe liver/kidney disease, MAOI use.
- Drug Interactions: MAOIs, alcohol, sedatives, antidepressants.
- Pregnancy & Breastfeeding: Consult healthcare professional.
- Dosage: Varies depending on the formulation and age; consult product information.
- Monitoring Parameters: Observe for adverse reactions and symptom relief.
Popular Combinations
Often combined as seen in this formulation itself. Individual components may be combined with other drugs depending on specific symptoms.
Precautions
Consult a healthcare professional before use if pregnant, breastfeeding, or have other underlying medical conditions. Avoid alcohol and operating machinery while taking this medication.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cetirizine + Dextromethorphan Hydrochloride + Menthol + Paracetamol + Phenylephrine + Sodium Citrate?
A: The dosage varies based on the product and the patient’s age. Refer to specific product information or consult a doctor or pharmacist.
Q2: Can this combination be used in children?
A: Yes, but with caution and under the guidance of a healthcare professional. Dosage adjustments are crucial in pediatric populations.
Q3: What are the common side effects?
A: Common side effects include drowsiness, dry mouth, dizziness, nausea, and headache.
Q4: Are there any serious drug interactions?
A: Yes. This combination can interact with MAO inhibitors, alcohol, sedatives, and some antidepressants.
Q5: Can I take this while pregnant or breastfeeding?
A: Consult a healthcare professional before use during pregnancy or breastfeeding.
Q6: What should I do if I experience side effects?
A: Stop taking the medication and consult a healthcare professional.
Q7: Can I use this medication for a prolonged period?
A: It’s designed for short-term use. Consult a doctor if symptoms persist.
Q8: How should this medication be stored?
A: Store at room temperature, away from moisture and direct sunlight. Keep out of reach of children.
Q9: What if I miss a dose?
A: Take the missed dose as soon as you remember, unless it’s close to the next scheduled dose. Do not double the dose.
