Usage
This combination medication is used for the symptomatic relief of the common cold, flu, and allergies. It targets symptoms like fever, headache, nasal congestion, cough, runny nose, sneezing, itchy or watery eyes, and sore throat.
Pharmacological Classification: This drug combines several classifications:
- Analgesic (Paracetamol)
- Antihistamine (Chlorpheniramine Maleate)
- Antitussive (Dextromethorphan Hydrobromide)
- Decongestant (Phenylpropanolamine Hydrochloride)
Mechanism of Action: Each component contributes to symptom relief:
- Paracetamol: Reduces fever and pain.
- Chlorpheniramine: Blocks histamine H1 receptors, alleviating allergic symptoms.
- Dextromethorphan: Suppresses cough.
- Phenylpropanolamine: Acts as a decongestant, shrinking nasal blood vessels.
Alternate Names
This combination is sometimes referred to as “CPM + Dextromethorphan + Phenylpropanolamine.”
Brand Names: Alpara, Anadex, Decolsin, Lacoldin, Tuseran Forte, Conil P Syrup, Dinex P Syrup, Riakof Syrup, Tritus Plus Suspension, Tuneup P Expectorant, Tussiz P Syrup.
How It Works
Pharmacodynamics:
- Paracetamol: Exhibits analgesic and antipyretic effects.
- Chlorpheniramine: Antagonizes H1 histamine receptors, reducing allergic manifestations. It also exerts some anticholinergic activity.
- Dextromethorphan: Acts centrally to suppress the cough reflex.
- Phenylpropanolamine: Stimulates alpha-adrenergic receptors, causing vasoconstriction and decongestion.
Pharmacokinetics:
- Paracetamol: Rapidly absorbed after oral administration, metabolized in the liver primarily by conjugation with glucuronide and sulfate, and excreted in the urine.
- Chlorpheniramine: Well-absorbed orally, metabolized in the liver, and excreted in the urine.
- Dextromethorphan: Readily absorbed from the gastrointestinal tract, metabolized in the liver, and excreted in the urine.
- Phenylpropanolamine: Absorbed from the gastrointestinal tract, and eliminated primarily by renal excretion.
Mode of Action:
- Paracetamol: Inhibits cyclooxygenase (COX) in the central nervous system, reducing prostaglandin synthesis.
- Chlorpheniramine: Competes with histamine for binding at H1 receptors, preventing histamine-mediated responses.
- Dextromethorphan: Acts on sigma opioid receptors and NMDA receptors in the cough center of the medulla.
- Phenylpropanolamine: Stimulates alpha-adrenergic receptors in the nasal mucosa, leading to vasoconstriction.
Elimination Pathways: Primarily renal excretion for all components. Paracetamol is extensively metabolized before renal excretion.
Dosage
Standard Dosage
Adults: One tablet or two teaspoons (10ml) every 4-6 hours as needed. Do not exceed six doses in 24 hours.
Children:
- 6-12 years: Half a tablet or 1-2 teaspoons (5-10ml) every 4-6 hours as needed.
- 2-6 years: 1-2 teaspoons (5-10ml) every 4-6 hours as needed.
- 6 months - 2 years: 1/2 - 1 teaspoon (2.5-5ml) every 4-6 hours as needed.
- Under 6 months: Not recommended.
Special Cases:
- Elderly Patients: Start with a lower dose and monitor closely.
- Patients with Renal Impairment: Dosage adjustment is necessary.
- Patients with Hepatic Dysfunction: Dosage adjustment is necessary.
- Patients with Comorbid Conditions: Use with caution in patients with cardiac disease, diabetes, prostatic hypertrophy, and hypertension.
Clinical Use Cases
This combination is typically not used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations.
Dosage Adjustments
Adjustments are based on age, weight, renal function, and hepatic function.
Side Effects
Common Side Effects: Drowsiness, dizziness, dry mouth, nausea, constipation, headache, blurred vision, restlessness, or excitability.
Rare but Serious Side Effects: Allergic reactions (rash, itching, swelling), seizures, rapid or irregular heart rate, difficulty breathing, hallucinations, confusion.
Long-Term Effects: Long-term use of paracetamol, especially at high doses, can lead to liver damage. Phenylpropanolamine may increase blood pressure with chronic use.
Contraindications
- Hypersensitivity to any component.
- Severe hypertension or coronary artery disease.
- Hyperthyroidism.
- Narrow-angle glaucoma.
- Concomitant use of MAOIs.
- Urinary retention due to prostatic hypertrophy.
- Severe respiratory impairment.
Drug Interactions
- MAOIs: Avoid concurrent use due to the risk of hypertensive crisis.
- Alcohol: May potentiate drowsiness and dizziness.
- CNS depressants: Additive sedative effects.
- Anticholinergics: May exacerbate anticholinergic side effects.
- Tricyclic antidepressants: May potentiate cardiovascular effects.
- Beta-blockers: May interfere with the decongestant action.
Pregnancy and Breastfeeding
Pregnancy Safety Category: C. Use only if the potential benefit justifies the potential risk to the fetus.
Breastfeeding: Not recommended due to the potential for adverse effects in infants.
Drug Profile Summary
- Mechanism of Action: See “How It Works.”
- Side Effects: See “Side Effects.”
- Contraindications: See “Contraindications.”
- Drug Interactions: See “Drug Interactions.”
- Pregnancy & Breastfeeding: See “Pregnancy and Breastfeeding.”
- Dosage: See “Dosage.”
- Monitoring Parameters: Blood pressure, liver function tests (with prolonged paracetamol use).
Popular Combinations
This drug is itself a combination product. Additional combinations are generally not recommended.
Precautions
Pre-screening is essential for allergies, metabolic disorders, and organ dysfunction. Exercise caution in specific populations like pregnant or breastfeeding women, children, and the elderly. Consider lifestyle factors like alcohol and driving restrictions.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Chlorpheniramine Maleate + Dextromethorphan Hydrobromide + Paracetamol + Phenylpropanolamine?
A: See “Dosage” section for specifics based on age and condition.
Q2: Can this combination be used in patients with hypertension?
A: Use with caution in patients with mild to moderate hypertension, and avoid in severe hypertension. Monitor blood pressure closely.
Q3: Are there any significant drug interactions to be aware of?
A: Yes, particularly with MAOIs, alcohol, and CNS depressants. See “Drug Interactions.”
Q4: What are the common side effects?
A: Drowsiness, dizziness, dry mouth, nausea, and constipation. See “Side Effects.”
Q5: Can pregnant or breastfeeding women take this medication?
A: It is generally not recommended, particularly during the first trimester and while breastfeeding. Consult a physician to assess the risk-benefit ratio.
Q6: Is this combination safe for long-term use?
A: Long-term use is generally not recommended due to potential liver toxicity from paracetamol and cardiovascular effects of phenylpropanolamine.
Q7: What are the signs of an overdose?
A: Severe drowsiness, seizures, rapid or irregular heart rate, nausea, vomiting, liver damage. Seek immediate medical attention if overdose is suspected.
Q8: What should I do if a dose is missed?
A: Take the missed dose as soon as you remember, unless it is almost time for the next dose. Do not double the dose to catch up.
Q9: Can this combination be used in children younger than 6 months?
A: It is not recommended for infants under 6 months of age. Consult a pediatrician.
