Chlorpheniramine Maleate + Menthol + Phenylephrine + Sodium Citrate

Usage

• This combination medication is primarily prescribed for the symptomatic relief of the common cold, flu, and allergies (allergic rhinitis). It addresses symptoms such as runny nose, stuffy nose, sneezing, cough, sore throat, and watery eyes.
• Pharmacological Classification: This is a combination product containing drugs from different classifications:
  • Chlorpheniramine: Antihistamine (H1 receptor antagonist)
  • Phenylephrine: Decongestant (α1-adrenergic agonist)
  • Sodium Citrate: Expectorant/Mucolytic
  • Menthol: Topical analgesic and counterirritant
• Mechanism of Action: Briefly, Chlorpheniramine blocks histamine action, reducing allergy symptoms; Phenylephrine constricts nasal blood vessels, relieving congestion; Sodium Citrate thins mucus, aiding expectoration; and Menthol provides a cooling sensation, soothing throat irritation.

Alternate Names

• No specific alternate generic names exist for this exact combination. However, individual ingredients might have synonyms (e.g., Acetaminophen for Paracetamol).
• Brand Names: This combination is marketed under various brand names like Sinarest AF Jr., KOLQ Syrup, and others depending on the manufacturer and region. International and regional brand names may vary.

How It Works

• Pharmacodynamics:
  • Chlorpheniramine: Competes with histamine for H1 receptors, reducing vasodilation, capillary permeability, and itching.
  • Phenylephrine: Stimulates α1-adrenergic receptors in nasal mucosa causing vasoconstriction, thus reducing congestion.
  • Sodium Citrate: Increases bronchial secretions, making mucus less viscous and facilitating its removal.
  • Menthol: Activates TRPM8 receptors, creating a cooling sensation and acting as a counterirritant to relieve minor throat irritation.
• Pharmacokinetics:
  • Chlorpheniramine: Well-absorbed orally, metabolized in the liver (CYP450 enzymes), and excreted primarily in urine.
  • Phenylephrine: Less well-absorbed orally compared to chlorpheniramine. It undergoes first-pass metabolism. Excreted in urine.
  • Sodium Citrate: Absorbed from the gastrointestinal tract. Excreted renally.
  • Menthol: Absorbed through skin and mucous membranes; metabolized in the liver and excreted in urine and bile.
• Receptor Binding, Enzyme Inhibition, Neurotransmitter Modulation:
  • Chlorpheniramine: H1 receptor antagonist.
  • Phenylephrine: α1-adrenergic receptor agonist.
  • Menthol: TRPM8 receptor agonist.
• Elimination Pathways:
  • Primarily renal excretion for all ingredients, with some hepatic metabolism (especially Chlorpheniramine and Menthol).

Dosage

The dosage information provided here is for general guidance only. Prescribing information can vary based on brand, formulation, and region. Always refer to the specific product’s prescribing information. Dosing recommendations may be different in other parts of the world.

Standard Dosage

Adults:

• The standard adult dose varies depending on the specific product. A common dose is 10ml every 4-6 hours, not to exceed 6 doses in 24 hours. Always consult the specific product label for the recommended dose.

Children:

• Dosing in children is based on age and weight. It is crucial to follow the product-specific pediatric dosage guidelines. This medication is not typically recommended for children under 2 years of age, and caution is advised in children under 6.

Special Cases:

• Elderly Patients: Dose adjustment may be necessary due to potential age-related decline in organ function.
• Patients with Renal Impairment: Dosage modification might be needed. Consult product information and clinical guidelines.
• Patients with Hepatic Dysfunction: Exercise caution and adjust dosage as needed based on liver function tests.
• Patients with Comorbid Conditions: Caution is advised in patients with hypertension, diabetes, glaucoma, hyperthyroidism, cardiovascular disease, and other chronic conditions. Dosage adjustments may be needed.

Clinical Use Cases

• The combination is typically not used in clinical settings like intubation, surgical procedures, mechanical ventilation, or the ICU, except for managing co-incidental cold and flu symptoms as deemed appropriate by the physician.

Dosage Adjustments

• Dose adjustments are based on patient-specific factors such as renal/hepatic impairment and comorbid conditions. Consult product prescribing information and/or specialist advice for appropriate adjustments.

Side Effects

Common Side Effects

• Drowsiness
• Dizziness
• Dry mouth, nose, and throat
• Nausea, vomiting
• Headache
• Blurred vision
• Constipation

Rare but Serious Side Effects

• Allergic reactions (rash, itching, swelling)
• Difficulty breathing
• Irregular heartbeat
• Hallucinations
• Seizures

Long-Term Effects

• Prolonged use of Phenylephrine can lead to rebound congestion.

Adverse Drug Reactions (ADR)

• Severe allergic reactions (anaphylaxis)
• Hepatotoxicity (with high doses of Paracetamol if present in the specific formulation)

Contraindications

• Hypersensitivity to any of the ingredients.
• Severe hypertension, coronary artery disease.
• Narrow-angle glaucoma.
• Concurrent or recent use of MAO inhibitors.

Drug Interactions

• MAO inhibitors, tricyclic antidepressants.
• CNS depressants (alcohol, sedatives, hypnotics).
• Antihypertensives.
• Other medications containing similar ingredients.

Pregnancy and Breastfeeding

• Consult a doctor before use during pregnancy or breastfeeding. Use with caution.

Drug Profile Summary

• Mechanism of Action: See above.
• Side Effects: See above.
• Contraindications: See above.
• Drug Interactions: See above.
• Pregnancy & Breastfeeding: Consult a doctor.
• Dosage: See above.
• Monitoring Parameters: Blood pressure, liver function tests (if indicated).

Popular Combinations

• This combination itself is a popular formulation. Sometimes other drugs like paracetamol or dextromethorphan are added.

Precautions

• See “Special Cases” under “Dosage” and “Contraindications.”

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Chlorpheniramine Maleate + Menthol + Phenylephrine + Sodium Citrate?

A: Please refer to the detailed dosage section above, which includes information for adults, children, and special cases. Always consult the specific product label for dosage information.

Q2: Can this combination be used in children under 2 years of age?

A: It’s generally not recommended for children under 2 years of age. Consult a pediatrician.

Q3: Is it safe to drive or operate machinery while taking this medication?

A: This combination may cause drowsiness or dizziness. It is best to avoid driving or operating heavy machinery until you know how it affects you.

Q4: 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.

Q5: Can I consume alcohol while taking this medication?

A: Alcohol can exacerbate the sedative effects of Chlorpheniramine. It’s best to avoid alcohol while taking this medication.

Q6: What are the signs of an allergic reaction to this medication?

A: Signs of an allergic reaction include rash, itching, swelling (especially of the face, tongue, or throat), difficulty breathing, and dizziness. Seek immediate medical attention if these occur.

Q7: Can I use this medicine if I have high blood pressure?

A: Use with caution and under the supervision of a physician if you have high blood pressure, as Phenylephrine can elevate blood pressure.

Q8: What are the long-term effects of using this combination?

A: Prolonged use of decongestants like Phenylephrine can lead to rebound congestion. It’s best to use this combination only for the recommended duration.

Q9: Can this combination be used during pregnancy?

A: Consult a doctor before using this combination during pregnancy. There are potential risks, and the benefits must be weighed against the risks.

Q10: What should I do if I experience severe side effects?

A: Discontinue the medication and consult your doctor immediately.