Chlorpheniramine Maleate + Dextromethorphan Hydrobromide + Menthol + Phenylpropanolamine

Usage

• This combination medication is primarily prescribed for the symptomatic relief of cough, nasal congestion, and other symptoms associated with the common cold, flu, or allergies. It is indicated for the temporary relief of coughs caused by minor throat and bronchial irritation occurring with a cold or inhaled irritants. It also helps to loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive.

• Pharmacological Classification: This is a combination product containing a first-generation antihistamine, a cough suppressant, a decongestant, and a cooling agent.

• Mechanism of Action:

  • Chlorpheniramine maleate: An antihistamine that competes with histamine for H1-receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract. This action helps to reduce symptoms such as sneezing, runny nose, and watery eyes.
  • Dextromethorphan hydrobromide: A cough suppressant that acts centrally on the medulla oblongata to elevate the cough threshold.
  • Phenylpropanolamine: A sympathomimetic amine that acts as a nasal decongestant, shrinking swollen nasal mucous membranes by causing vasoconstriction. It produces localized vasoconstriction, primarily in the arterioles of nasal mucosa. It also may cause mild bronchodilation.
  • Menthol: A counterirritant that produces a cooling sensation and provides relief from throat irritation. It acts on cold receptors producing a sensation of coldness.

Alternate Names

• No widely recognized alternate names for this specific four-component combination exist. However, individual components have alternate names (e.g., chlorphenamine for chlorpheniramine).
• Brand Names: Numerous regional and international brand names exist, often reflecting the specific combination of ingredients. Examples of brand names (some may not include Menthol) are Cetcof, Copod, Broncho-D, Coform P.

How It Works

• Pharmacodynamics: The combination exerts its effects through the combined actions of its components: antihistaminic, cough-suppressing, decongestant, and cooling.

• Pharmacokinetics:

  • Absorption: All components are readily absorbed from the gastrointestinal tract.
  • Metabolism: Primarily hepatic metabolism, particularly by CYP450 enzymes for chlorpheniramine and dextromethorphan.
  • Elimination: Mainly renal excretion.

• Mode of Action: See Mechanism of Action under Usage.

• Receptor binding: Chlorpheniramine binds to H1 histamine receptors.

• Neurotransmitter modulation: Dextromethorphan affects cough reflex through central action on the medulla.

Dosage

Standard Dosage

Adults: Typically, 5-10 mL of syrup or 1-2 tablets every 4-6 hours, not exceeding the maximum daily dose of each ingredient.

Children: Dosage is dependent on the specific product formulation and the child’s age and weight. Consult pediatric dosing guidelines. Generally, this combination is avoided in children under 6 and used cautiously in children under 12.

Special Cases: Dosage adjustment is necessary for patients with renal or hepatic impairment. Consult with a specialist for guidance.

Clinical Use Cases

The combination is typically not used in clinical settings like intubation, surgical procedures, mechanical ventilation, or the ICU. Its use is limited to symptomatic relief of common cold or allergy symptoms in outpatient settings.

Dosage Adjustments

Dose adjustments may be necessary for elderly patients and those with renal or hepatic impairment.

Side Effects

Common Side Effects

• Drowsiness
• Dizziness
• Dry mouth
• Nausea
• Constipation
• Blurred vision

Rare but Serious Side Effects

• Allergic reactions (rash, itching, swelling, severe dizziness, trouble breathing)
• Seizures
• Fast/irregular heartbeat
• Hallucinations
• Difficulty urinating

Long-Term Effects

Chronic complications from prolonged use are not typically observed, as this medication is intended for short-term use.

Adverse Drug Reactions (ADR)

ADRs may include severe allergic reactions, cardiac arrhythmias, and central nervous system effects.

Contraindications

• Hypersensitivity to any of the components
• Severe hypertension or coronary artery disease
• Narrow-angle glaucoma
• Urinary retention
• MAOI therapy (current or within 14 days)
• Severe asthma, COPD, or sleep apnea

Drug Interactions

• Alcohol
• Other CNS depressants (opioids, sedatives, hypnotics)
• Anticholinergics (atropine)
• Tricyclic antidepressants (amitriptyline)
• MAOIs
• Beta-blockers
• Other sympathomimetic amines
• Some herbal supplements (St. John’s Wort, ginseng)

Pregnancy and Breastfeeding

The safety of this combination during pregnancy and breastfeeding is not well-established. Consult with a specialist if clearly needed.

Drug Profile Summary

• Mechanism of Action: See Usage and How it Works sections.
• Side Effects: Drowsiness, dizziness, dry mouth, nausea, constipation, blurred vision. Rarely, severe allergic reactions, seizures, cardiac arrhythmias.
• Contraindications: Hypersensitivity, severe cardiovascular disease, MAOI use, glaucoma, urinary retention, severe respiratory disease.
• Drug Interactions: CNS depressants, anticholinergics, antidepressants, MAOIs, beta-blockers, sympathomimetics.
• Pregnancy & Breastfeeding: Use with caution only if clearly needed.
• Dosage: See Dosage section.
• Monitoring Parameters: Blood pressure, heart rate, respiratory rate, mental status.

Popular Combinations

Formulations containing these ingredients (though not always including Menthol) are sometimes combined with analgesics such as acetaminophen or ibuprofen for broader symptom relief.

Precautions

• Evaluate patients with cardiovascular, respiratory, hepatic, renal, or metabolic disorders before prescribing.
• Use with caution in pregnant or breastfeeding women.
• Age-appropriate dosing is necessary for children and the elderly.
• Avoid alcohol and other CNS depressants.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Chlorpheniramine Maleate + Dextromethorphan Hydrobromide + Menthol + Phenylpropanolamine?

A: Dosage varies depending on age, formulation, and individual patient factors. Refer to the Dosage section and consult specific product information.

Q2: Can this combination be used in children?

A: It is generally avoided in children under 6 years old and used with caution in children under 12. Consult pediatric dosing guidelines.

Q3: What are the common side effects?

A: Common side effects include drowsiness, dizziness, dry mouth, nausea, and constipation.

Q4: Are there any serious side effects?

A: While rare, serious side effects such as allergic reactions, seizures, cardiac arrhythmias, and hallucinations can occur.

Q5: Can this medication interact with other drugs?

A: Yes, it can interact with numerous medications, including CNS depressants, anticholinergics, and some antidepressants. See the Drug Interactions section.

Q6: Can it be used during pregnancy or breastfeeding?

A: Safety during pregnancy and breastfeeding is not well-established. Use with caution only if clearly needed and after careful risk-benefit assessment by a specialist.

Q7: What are the contraindications for this medication?

A: Contraindications include hypersensitivity, severe cardiovascular disease, MAOI use, glaucoma, urinary retention, and severe respiratory conditions. See the Contraindications section for a complete list.

Q8: What precautions should be taken when prescribing this medication?

A: Carefully evaluate patients for pre-existing conditions, use cautiously in pregnant or breastfeeding women, adjust dosage for children and the elderly, and advise patients to avoid alcohol and other CNS depressants.

Q9: How does dextromethorphan work to suppress cough?

A: It acts centrally on the medulla in the brain to elevate the cough threshold.