Usage
Chlorpheniramine Maleate + Codeine + Menthol is prescribed for the temporary relief of cough and cold symptoms, particularly dry coughs, associated with upper respiratory allergies or the common cold. This combination addresses symptoms like cough due to throat irritation, sneezing, runny nose, and nasal congestion.
Pharmacological Classification: This drug is a combination product containing:
- Chlorpheniramine maleate: Antihistamine (first-generation)
- Codeine phosphate: Opioid analgesic and antitussive
- Menthol: Topical analgesic and counterirritant
Mechanism of Action: Chlorpheniramine provides relief from allergy symptoms by blocking histamine receptors. Codeine suppresses cough by acting on the cough center in the brain. Menthol soothes throat irritation and provides a cooling sensation.
Alternate Names
There are no widely recognized alternate generic names. The combination is often referred to by its component drugs. Brand names vary depending on the region and manufacturer. Some examples include “Piriton CS,” “Recodin with Codeine syrup”, “Planokuf Syrup” amongst others.
How It Works
Pharmacodynamics: Chlorpheniramine competes with histamine for H1-receptor sites, reducing allergic manifestations. Codeine binds to opioid receptors in the CNS, depressing the cough reflex and altering pain perception. Menthol activates TRPM8 receptors, resulting in a cooling sensation and topical analgesia.
Pharmacokinetics: Chlorpheniramine is well-absorbed orally. It is metabolized in the liver and excreted mainly in the urine. Codeine is also well-absorbed orally, metabolized in the liver (partially to morphine by CYP2D6), and excreted in the urine. Menthol is absorbed through the mucous membranes and skin. It is metabolized in the liver and excreted in urine and bile.
Mode of Action:
Chlorpheniramine: H1-receptor antagonist.
Codeine: Opioid receptor agonist.
Menthol: TRPM8 receptor agonist.
Elimination Pathways: Primarily renal excretion for all three components.
Dosage
Standard Dosage
Adults:
A common regimen is 5-10 mL syrup every 4-6 hours, not exceeding 30 mL in 24 hours. For tablets containing 4mg chlorpheniramine maleate and 10mg codeine phosphate, the typical adult dose is one tablet every 4-6 hours, not exceeding 6 tablets in 24 hours.
Children:
Use with extreme caution in children, particularly those under 12 years. It’s essential to consult a physician for appropriate dosage adjustments based on age and weight. Pediatric formulations may exist, and codeine use in children has specific safety considerations including risk of respiratory depression. The combination isn’t recommended for use in children under 6.
Special Cases:
- Elderly Patients: Start with lower doses and monitor closely.
- Patients with Renal Impairment: Dose reduction may be required.
- Patients with Hepatic Dysfunction: Dose reduction may be required.
- Patients with Comorbid Conditions: Careful consideration and dose adjustment is necessary in patients with asthma, COPD, glaucoma, heart disease, or other relevant conditions.
Clinical Use Cases
The Chlorpheniramine + Codeine + Menthol combination isn’t typically used in settings like intubation, surgical procedures, mechanical ventilation, or ICU. Its primary use is for symptomatic relief of cough and cold associated with allergies. In emergency situations, other therapies are generally preferred.
Dosage Adjustments
Dosage adjustments are based on patient response, age, and renal/hepatic function. Genetic polymorphisms affecting CYP2D6 activity can significantly alter codeine metabolism, requiring careful consideration.
Side Effects
Common Side Effects:
Drowsiness, dizziness, constipation, dry mouth/nose/throat, nausea, vomiting, blurred vision, and lightheadedness.
Rare but Serious Side Effects:
Respiratory depression (particularly with codeine), allergic reactions, seizures, hallucinations, and irregular heartbeat.
Long-Term Effects:
Codeine dependence with prolonged use.
Adverse Drug Reactions (ADR):
Severe allergic reactions (anaphylaxis), severe respiratory depression, and serotonin syndrome (rare, especially with concurrent serotonergic drug use).
Contraindications
Hypersensitivity to any components, respiratory depression, severe asthma or COPD, acute or severe bronchial asthma, and concurrent use of MAO inhibitors. Use with caution in narrow-angle glaucoma, prostatic hypertrophy, urinary retention, and GI obstruction.
Drug Interactions
Alcohol, CNS depressants (benzodiazepines, barbiturates, etc.), other antihistamines, MAOIs, antidepressants, anti-anxiety medications, opioid analgesics, and muscle relaxants. Some medications can increase the risk of seizures or reduce blood pressure. Grapefruit juice should be avoided. Check all other medications for potential interactions.
Pregnancy and Breastfeeding
Codeine and Chlorpheniramine cross the placenta and are present in breast milk. Their use during pregnancy and lactation should be carefully evaluated by a physician. Potential risks to the fetus/infant include respiratory depression and withdrawal symptoms. Safer alternatives should be considered if possible.
Drug Profile Summary
- Mechanism of Action: See “How it Works” above.
- Side Effects: Drowsiness, dizziness, constipation, dry mouth, nausea, respiratory depression (codeine).
- Contraindications: Hypersensitivity, respiratory depression, severe asthma/COPD, MAOI use.
- Drug Interactions: CNS depressants, alcohol, other antihistamines, MAOIs.
- Pregnancy & Breastfeeding: Use with caution, potential risks to the fetus/infant.
- Dosage: See “Dosage” above.
- Monitoring Parameters: Respiratory rate, oxygen saturation, mental status, bowel function.
Popular Combinations
This specific combination (Chlorpheniramine + Codeine + Menthol) is itself considered a combination drug. It is rarely further combined with other medications due to its potential for increased adverse reactions.
Precautions
Assess respiratory function, allergy history, concomitant medications, and potential drug interactions. Caution in patients with hepatic or renal impairment, elderly, pregnant/lactating women, and children. Avoid alcohol and other CNS depressants. May impair driving or operating machinery.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Chlorpheniramine Maleate + Codeine + Menthol?
A: See “Dosage” above for specific recommendations. Always consult with a doctor to assess patient specific conditions.
Q2: What are the common side effects?
A: Drowsiness, dizziness, constipation, dry mouth/nose/throat, nausea, and vomiting are common.
Q3: Is this combination safe for use during pregnancy or breastfeeding?
A: It is not recommended unless specifically deemed necessary by a physician due to potential fetal/infant risks.
Q4: What are the major contraindications?
A: Hypersensitivity, respiratory depression, severe asthma/COPD, MAOI use.
Q5: How does codeine contribute to the efficacy of this combination?
A: Codeine acts as a cough suppressant, targeting the cough center in the brain.
Q6: What is the role of menthol in this combination?
A: Menthol provides a soothing and cooling effect, relieving throat irritation.
Q7: What are the potential drug interactions with this combination?
A: Clinically significant interactions can occur with alcohol, CNS depressants, other antihistamines, and MAOIs among other.
Q8: Are there any specific monitoring parameters for patients on this medication?
A: Yes, monitor respiratory rate, oxygen saturation, and mental status, particularly in patients receiving codeine. Monitor bowel function as well.
Q9: Can this combination be used in children?
A: Use with extreme caution, and only under the guidance of a physician. Codeine use in children has important safety considerations, especially the risk of respiratory depression. Its use is not recommended for children under 6 years.
Q10: What should patients be advised regarding activities requiring alertness while taking this medication?
A: Patients should be cautioned against driving, operating machinery, or engaging in tasks requiring alertness due to the potential for drowsiness and dizziness.
