Usage
Chlorpheniramine Maleate + Levodropropizine is prescribed for the symptomatic treatment of dry cough, often associated with allergic conditions like the common cold or hay fever (allergic rhinitis).
- Pharmacological Classification: This combination drug falls under two classifications: antihistamine (chlorpheniramine) and cough suppressant (levodropropizine).
- Mechanism of Action: Chlorpheniramine maleate is an antihistamine that works by blocking the action of histamine, a chemical mediator responsible for allergic symptoms like sneezing, runny nose, and watery eyes. Levodropropizine is a non-narcotic cough suppressant that acts centrally on the cough center in the brain to reduce the urge to cough. The combination provides relief from dry cough and associated allergic symptoms.
Alternate Names
There are no widely recognized alternate names for the combination itself. The individual components, however, are sometimes referred to by different chemical names (e.g., chlorphenamine maleate). Brand names vary depending on the manufacturer and region, and some examples from the sources provided include Delkodin-LV, Propizin-LC, Rescotus Plus, and Dropolev.
How It Works
- Pharmacodynamics: Chlorpheniramine exerts its antihistaminic effect by competitively binding to H1 histamine receptors, thus preventing histamine from eliciting its allergic effects. Levodropropizine suppresses the cough reflex by acting centrally on the cough center in the brain, potentially via modulation of neuronal pathways involved in cough.
- Pharmacokinetics: Both drugs are absorbed orally. Chlorpheniramine is metabolized in the liver, likely through CYP450 enzymes, and eliminated primarily through renal excretion. Levodropropizine is also metabolized hepatically and excreted mainly through the kidneys. More specific details on metabolism pathways (e.g., specific CYP enzymes) are not consistently reported in the sources provided.
- Mode of Action/Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation: As mentioned, chlorpheniramine competitively binds to H1 histamine receptors. Information on the precise cellular/molecular mechanism of levodropropizine is limited in the provided materials; while it is known to act centrally on the cough center, more details on specific receptor binding, enzyme interactions, or neurotransmitter modulation are not available.
- Elimination Pathways: Both chlorpheniramine and levodropropizine are predominantly eliminated via renal excretion, with hepatic metabolism playing a role.
Dosage
Standard Dosage
Adults:
The usual adult dose is 60 mg of levodropropizine and 2-4 mg of chlorpheniramine maleate, up to three times a day, taken at intervals of at least 6 hours.
Children:
For children aged 2 to 12 years, the recommended dose is 1 mg/kg of levodropropizine per dose, up to three times a day, at intervals of at least 6 hours. The maximum daily dose should not exceed 3 mg/kg. Children over 12 years may follow the adult dosage.
Special Cases:
- Elderly Patients: While pharmacokinetic changes might not be significant, elderly patients may be more susceptible to side effects. Dosage adjustments may be necessary, but should be determined on a case-by-case basis.
- Patients with Renal Impairment: Dose adjustments may be necessary in patients with severe renal impairment (creatinine clearance <35 ml/min), but no specific recommendations are consistently provided in the source material.
- Patients with Hepatic Dysfunction: Caution is advised in patients with hepatic impairment, and dosage adjustments may be necessary.
- Patients with Comorbid Conditions: Caution should be exercised in patients with asthma, COPD, cardiovascular disease, hypertension, glaucoma, urinary retention, or prostatic hypertrophy. Specific adjustments may depend on the nature and severity of the comorbidity.
Clinical Use Cases
The provided sources do not specify dosages for specific clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. The use of this combination in such settings would require careful consideration and potentially involve individualized dosing strategies under the supervision of a specialist.
Dosage Adjustments
Dosage adjustments may be necessary depending on patient-specific factors such as renal/hepatic dysfunction, age, and coexisting medical conditions. Consult product-specific guidelines and individual patient assessment for precise adjustments.
Side Effects
Common Side Effects:
Drowsiness, dizziness, dry mouth, constipation, vomiting, blurred vision, headache, fatigue, nausea.
Rare but Serious Side Effects:
Allergic reactions (skin rash, itching, swelling), difficulty breathing, chest tightness, irregular heartbeat.
Long-Term Effects:
The available information does not highlight specific long-term side effects associated with prolonged use. However, chronic use of any medication should be monitored for potential adverse effects.
Adverse Drug Reactions (ADR):
Clinically significant ADRs include severe allergic reactions, respiratory distress, and cardiac arrhythmias. These require immediate medical attention.
Contraindications
- Hypersensitivity to either levodropropizine or chlorpheniramine.
- Acute asthma attack.
- Narrow-angle glaucoma.
- Severe hypertension.
- Coronary artery disease.
- Breastfeeding.
- Concomitant use of MAO inhibitors.
- Children under 2 years of age (some sources suggest avoiding use in children under 12).
Drug Interactions
This combination can interact with:
- Other antihistamines (diphenhydramine, cetirizine).
- Other cough suppressants (dextromethorphan).
- Cold remedies containing pseudoephedrine.
- Sedatives (diazepam, temazepam).
- Antidepressants (fluoxetine, sertraline, MAOIs, tricyclic antidepressants).
- Muscle relaxants (baclofen).
- Medications for Parkinson’s disease (selegiline).
- Motion sickness medications (meclizine).
- Irritable bowel syndrome medications (dicyclomine).
- Antibiotics (erythromycin, ketoconazole).
- Alcohol (increases drowsiness and other adverse effects).
Pregnancy and Breastfeeding
- Pregnancy: The safety of this combination during pregnancy has not been established. Use only if clearly needed and after careful consideration of the benefits and risks.
- Breastfeeding: Both drugs are excreted in breast milk and may pose risks to the infant. This combination is generally contraindicated during breastfeeding.
Drug Profile Summary
- Mechanism of Action: Chlorpheniramine: H1 receptor antagonist; Levodropropizine: Central cough suppressant.
- Side Effects: Drowsiness, dizziness, dry mouth, constipation, nausea, headache. Rarely: allergic reactions, breathing problems, chest tightness.
- Contraindications: Hypersensitivity, acute asthma, narrow-angle glaucoma, severe hypertension, coronary artery disease, breastfeeding, MAOI use.
- Drug Interactions: Other antihistamines, cough suppressants, sedatives, antidepressants, alcohol.
- Pregnancy & Breastfeeding: Use with caution during pregnancy only if clearly needed. Contraindicated during breastfeeding.
- Dosage: Adults: 60 mg levodropropizine + 2-4 mg chlorpheniramine, up to three times daily. Children: 1 mg/kg/dose levodropropizine, up to three times daily.
- Monitoring Parameters: Monitor for adverse effects, especially drowsiness, dizziness, and allergic reactions.
Popular Combinations
The information provided does not specify other drugs routinely used in combination with Chlorpheniramine Maleate + Levodropropizine.
Precautions
- Pre-existing medical conditions: Assess for conditions such as asthma, COPD, cardiovascular disease, renal/hepatic impairment before prescribing.
- Pregnant Women: Use only if absolutely necessary and under close supervision.
- Breastfeeding Mothers: Avoid use.
- Children & Elderly: Age-appropriate dosing is crucial. Monitor closely for side effects.
- Lifestyle Considerations: Avoid alcohol, driving, and operating machinery if drowsiness occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Chlorpheniramine Maleate + Levodropropizine?
A: Adults: 60 mg levodropropizine + 2-4 mg chlorpheniramine, up to three times a day at least 6 hours apart. Children (2-12 years): 1 mg/kg/dose levodropropizine, up to three times a day at least 6 hours apart.
Q2: How does this combination work to relieve cough?
A: Chlorpheniramine reduces allergy symptoms that may contribute to cough, while levodropropizine acts centrally to suppress the cough reflex.
Q3: What are the common side effects?
A: Drowsiness, dizziness, dry mouth, constipation, and blurred vision are common side effects.
Q4: Who should not take this medication?
A: Patients with hypersensitivity, breastfeeding women, those with certain heart conditions or glaucoma, and children under 2 (or 12, according to some sources) should not take this medication.
Q5: Can I drink alcohol while taking this medicine?
A: No, alcohol may intensify the sedative effects of this medication and should be avoided.
Q6: Is it safe to drive while using this combination?
A: This medication can cause drowsiness. Avoid driving or operating machinery if you experience this side effect.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is almost time for your next dose. Do not double the dose to catch up.
Q8: Can I use this for a wet cough?
A: This combination is specifically indicated for dry cough. It might not be appropriate for a productive (wet) cough.
Q9: What should I tell my doctor before taking this medication?
A: Inform your doctor about all other medications you are taking, including OTC drugs and supplements, as well as any existing medical conditions.
Q10: How long can I take this medication?
A: Treatment duration should typically not exceed 7 days unless otherwise directed by your doctor. If symptoms persist, consult your physician.
