Chlorpheniramine Maleate + Dextromethorphan Hydrobromide + Pseudoephedrine

Usage

This combination medication is prescribed for the temporary relief of symptoms associated with the common cold, flu, and upper respiratory allergies, such as:

• Cough
• Nasal congestion
• Runny nose
• Sneezing
• Itchy and watery eyes
• Itching of the nose or throat

Pharmacological Classification:

This drug is a combination of an antihistamine (chlorpheniramine), a cough suppressant (dextromethorphan), and a decongestant (pseudoephedrine).

Mechanism of Action:

• Chlorpheniramine: Blocks the action of histamine, reducing allergy symptoms.
• Dextromethorphan: Suppresses the cough reflex by acting on the cough center in the brain.
• Pseudoephedrine: Constricts blood vessels in the nasal passages, reducing swelling and congestion.

Alternate Names

The combination itself does not have a specific international nonproprietary name (INN). It is identified by its component drugs. Some common brand names this combination might be marketed under are:

• Kidkare Cough/Cold
• Rescon DM
• Triaminic Cough and Cold
• Vicks Formula 44M

How It Works

Pharmacodynamics:

• Chlorpheniramine: Competes with histamine for H1-receptor sites, reducing the effects of histamine release.
• Dextromethorphan: Acts centrally on the medulla oblongata to elevate the cough threshold. It does not cause significant respiratory depression or addiction at therapeutic doses.
• Pseudoephedrine: Stimulates alpha-adrenergic receptors in the respiratory tract, causing vasoconstriction.

Pharmacokinetics:

• Chlorpheniramine: Well-absorbed orally, metabolized primarily in the liver, and excreted mainly in the urine.
• Dextromethorphan: Well-absorbed orally, metabolized in the liver, with a significant portion converted to the active metabolite dextrorphan. Excretion is primarily through the kidneys.
• Pseudoephedrine: Readily absorbed from the gastrointestinal tract, partially metabolized in the liver, and excreted mostly unchanged in the urine.

Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation:

• Chlorpheniramine: H1-receptor antagonist (blocker).
• Dextromethorphan: Sigma-1 receptor agonist, NMDA receptor antagonist (weak), serotonin reuptake inhibitor (weak).
• Pseudoephedrine: Alpha-adrenergic receptor agonist.

Elimination Pathways: Primarily renal excretion for all three components, with hepatic metabolism also contributing.

Dosage

Standard Dosage

Adults:

Liquid: Chlorpheniramine 2 mg, pseudoephedrine 30 mg, and dextromethorphan 10 mg per 5 mL: 10 mL every 4 hours (maximum: 40 mL/24 hours). Dosing may vary by product.

Children:

Liquid:

• 6 to 11 years: Chlorpheniramine 1 mg, pseudoephedrine 15 mg, and dextromethorphan 5 mg per 5 mL: 10 mL every 4 to 6 hours (maximum: 40 mL/24 hours).
• 6 to 11 years: Chlorpheniramine 2 mg, pseudoephedrine 30 mg, and dextromethorphan 10 mg per 5 mL: 5 mL every 4 hours (maximum: 20 mL/24 hours).
• 12 years and older: Refer to adult dosing.

Special Cases:

• Elderly Patients: Refer to adult dosing. Consider potential for increased sensitivity to side effects and adjust dosage as needed.
• Patients with Renal Impairment: No specific dosage adjustments are provided in the manufacturer’s labeling. Exercise caution and monitor closely.
• Patients with Hepatic Dysfunction: No specific dosage adjustments are provided in the manufacturer’s labeling. Exercise caution and monitor closely.
• Patients with Comorbid Conditions: Use cautiously in patients with hypertension, diabetes mellitus, ischemic heart disease, hyperthyroidism, increased intraocular pressure, prostatic hypertrophy, glaucoma, urinary retention, peptic ulcer, and asthma.

Clinical Use Cases

This combination is typically not used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary use is for outpatient symptom relief.

Dosage Adjustments

Dosage adjustments may be necessary based on individual patient response and tolerance. Careful consideration of potential drug interactions and comorbid conditions is crucial.

Side Effects

Common Side Effects

• Drowsiness or dizziness
• Dry mouth, nose, or throat
• Nausea or vomiting
• Constipation
• Trouble sleeping
• Anxiety
• Blurred Vision

Rare but Serious Side Effects

• Allergic reactions (hives, difficulty breathing, swelling)
• Serotonin syndrome (confusion, agitation, rapid heart rate, muscle rigidity)
• Seizures
• Increased blood pressure
• Difficulty urinating

Long-Term Effects

Generally, this medication is not intended for long-term use.

Adverse Drug Reactions (ADR)

Any of the rare but serious side effects listed above can be considered an ADR requiring immediate intervention.

Contraindications

• Hypersensitivity to any component of the medication
• Concurrent or recent (within 14 days) use of MAO inhibitors
• Severe hypertension or coronary artery disease
• Narrow-angle glaucoma
• Urinary retention
• During an asthma attack

Drug Interactions

• MAO inhibitors
• Alcohol and other CNS depressants
• Other antihistamines, decongestants, or cough suppressants
• Antihypertensives
• Tricyclic antidepressants

Pregnancy and Breastfeeding

• Pregnancy: Use should be avoided, especially during the first trimester. Use with caution in later trimesters if benefits outweigh risks.
• Breastfeeding: Not recommended unless deemed necessary by a physician. Potential for infant exposure and side effects. May inhibit lactation.

Drug Profile Summary

• Mechanism of Action: Antihistamine, cough suppressant, decongestant.
• Side Effects: Drowsiness, dry mouth, dizziness, nausea, constipation. Serious side effects include allergic reactions and serotonin syndrome.
• Contraindications: Hypersensitivity, MAOI use, severe cardiovascular disease, narrow-angle glaucoma.
• Drug Interactions: MAOIs, CNS depressants, other antihistamines/decongestants.
• Pregnancy & Breastfeeding: Use with caution; potential risks to fetus and infant.
• Dosage: Varies depending on age and formulation; see detailed dosage section.
• Monitoring Parameters: Blood pressure, heart rate, respiratory status, and signs of allergic reactions or CNS effects.

Popular Combinations

This combination itself is already a popular combination used to address multiple cold and allergy symptoms simultaneously.

Precautions

• General Precautions: Assess for allergies, pre-existing medical conditions (especially cardiovascular, respiratory, and metabolic conditions).
• Pregnant Women: Avoid use, especially in the first trimester. Discuss potential risks and benefits with a physician if considering use in later trimesters.
• Breastfeeding Mothers: Not recommended due to potential for infant exposure and lactation suppression.
• Children & Elderly: Age-specific dosing is crucial. Elderly patients may be more susceptible to side effects.
• Lifestyle Considerations: Avoid alcohol and other CNS depressants. Avoid driving or operating machinery until effects on alertness are known.

FAQs (Frequently Asked Questions)

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

A: See detailed dosage information above, which varies depending on age, formulation, and specific product. Always consult product labeling.

Q2: Can I take this medication if I am pregnant or breastfeeding?

A: It is generally recommended to avoid this medication during pregnancy, especially the first trimester. It is also not recommended while breastfeeding. Consult a physician for personalized advice.

Q3: What are the common side effects?

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

Q4: What should I do if I experience serious side effects?

A: Seek immediate medical attention if you experience any serious side effects, such as allergic reactions, serotonin syndrome, seizures, or significant changes in blood pressure.

Q5: Can I drink alcohol while taking this medication?

A: No, alcohol should be avoided as it can interact with this medication and exacerbate side effects like drowsiness.

Q6: Can I drive or operate machinery while taking this medication?

A: Use caution, as this medication can cause drowsiness and impair alertness. Avoid driving or operating machinery until you know how it affects you.

Q7: What are the main drug interactions I should be aware of?

A: Avoid taking this medication with MAO inhibitors, CNS depressants, and other antihistamines or decongestants. Consult a physician or pharmacist about other potential drug interactions.

Q8: How long can I take this medication?

A: This medication is intended for short-term use only, typically until cold or allergy symptoms subside. Consult a physician if symptoms persist beyond 7 days.

Q9: Are there any specific precautions for elderly patients?

A: Elderly patients may be more sensitive to the side effects of this medication, so it’s important to start with a lower dose and monitor closely.

Q10: Can I take this medication with other over-the-counter medications?

A: Consult a physician or pharmacist before combining this medication with other OTC medications, as interactions may occur.