This combination medication, now banned in India due to safety and efficacy concerns, was previously used to treat cough and symptoms associated with upper respiratory allergies or the common cold. It is crucial for medical professionals to be aware of this ban and consult updated regulatory guidelines and resources for current treatment recommendations.
Usage
- Medical Conditions: Previously indicated for the relief of cough and symptoms associated with upper respiratory allergies and the common cold, such as runny nose, sneezing, watery eyes, and throat irritation. Note: This combination is no longer recommended due to the ban.
- Pharmacological Classification: Antitussive (codeine), antihistamine (chlorpheniramine), expectorant/mucolytic (sodium citrate), topical analgesic/counterirritant (menthol).
- Mechanism of Action: This combination worked through multiple pathways:
- Chlorpheniramine maleate blocked histamine H1 receptors, reducing allergic symptoms.
- Codeine suppressed the cough reflex by acting on opioid receptors in the central nervous system.
- Menthol provided a cooling sensation, relieving throat irritation.
- Sodium citrate thinned and loosened mucus, making it easier to cough up.
Alternate Names
- This combination was marketed under various brand names (see source [9] for some examples).
- Codeine-containing cough syrups are sometimes generically referred to as antitussive syrups or cold and cough syrups.
How It Works
- Pharmacodynamics:
- Chlorpheniramine: Antagonizes H1 histamine receptors, reducing vascular permeability and smooth muscle contraction associated with allergic reactions.
- Codeine: Acts centrally on opioid receptors in the medulla to suppress the cough reflex. Metabolized to morphine, contributing to analgesic and other opioid effects.
- Menthol: Stimulates cold receptors, creating a cooling sensation. Mild local anesthetic and antipruritic effects.
- Sodium Citrate: Increases hydration of respiratory secretions, reducing viscosity and promoting expectoration.
- Pharmacokinetics:
- Absorption: Orally absorbed.
- Metabolism: Codeine is primarily metabolized by CYP2D6 in the liver. Chlorpheniramine also undergoes hepatic metabolism.
- Elimination: Both codeine and chlorpheniramine are primarily excreted by the kidneys.
Dosage
This fixed-dose combination is banned in India. Therefore, no dosage guidelines can be provided. Doctors must consult the latest regulatory updates and prescribing guidelines for the most up-to-date information. Previously, this combination was generally contraindicated in children under 12.
Side Effects
Common Side Effects
- Drowsiness
- Dizziness
- Constipation
- Dry mouth, nose, and throat
- Nausea
- Vomiting
- Headache
- Upset stomach
- Blurred vision
Rare but Serious Side Effects
- Respiratory depression
- Codeine dependence/addiction
- Allergic reactions (rash, itching, swelling)
- Seizures
- Irregular heartbeat
Contraindications
- Hypersensitivity to any component of the combination
- Respiratory depression or severe breathing problems (asthma, COPD, sleep apnea)
- Gastrointestinal obstruction
- Concurrent use of MAO inhibitors
Drug Interactions
This combination may interact with a range of medications, including:
- Other antihistamines
- Opioids
- Antidepressants (especially tricyclic antidepressants and MAOIs)
- Anti-anxiety medications
- Muscle relaxants
- Alcohol
Consult a drug interaction database for a detailed list.
Pregnancy and Breastfeeding
This combination is generally contraindicated during pregnancy and breastfeeding due to potential risks to the fetus/infant.
Drug Profile Summary
(Refer to the sections above for details. This combination is banned in India).
Popular Combinations
As this combination is banned, no recommendations for alternative combinations can be provided. Please consult updated resources and clinical guidelines.
Precautions
(Refer to the sections on Contraindications, Drug Interactions, and Pregnancy and Breastfeeding. Consult updated clinical resources.)
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Chlorpheniramine Maleate + Codeine + Menthol + Sodium Citrate?
A: This combination is banned in India, and no dosage can be recommended. Consult updated resources for current treatment guidelines.
Q2: Can this combination be used in children?
A: It was generally contraindicated in children younger than 12 and used with extreme caution in older children (12-18 years) due to the risk of codeine dependence and respiratory depression. Now, it is not recommended for any age group due to the ban.
Q3: What are the common side effects?
A: Common side effects included drowsiness, dizziness, constipation, dry mouth, nausea, and vomiting.
Q4: What are the serious side effects?
A: Serious side effects included respiratory depression, codeine dependence, allergic reactions, and seizures.
Q5: What are the contraindications?
A: Contraindications included hypersensitivity, respiratory problems, gastrointestinal obstruction, and concurrent use of MAO inhibitors.
Q6: Can this combination be used during pregnancy or breastfeeding?
A: It is generally contraindicated during pregnancy and breastfeeding.
Q7: What medications does this combination interact with?
A: It may interact with other antihistamines, opioids, antidepressants, anti-anxiety medications, and muscle relaxants.
Q8: Why is this combination banned in India?
A: It is banned due to safety and efficacy concerns, meaning the risks outweigh the potential benefits.
Q9: What are alternative treatments for cough and cold symptoms?
A: Consult updated clinical resources and guidelines for current recommendations on managing cough, cold, and allergy symptoms. Several individual components are available in other approved formulations or as standalone drugs. Always adhere to the latest regulations and prescribing information.
