Ammonium chloride/chlorpheniramine maleate/dextromethorphan hydrobromide/guaifenesin Uses

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How times a day do you take this medicine?

Consists of ammonium chloride, chlorpheniramine maleate, dextromethorphan hydrobromide, guaifenesin

Ammonium chloride indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Ammonium Chloride Injection, USP, after dilution in isotonic sodium chloride injection, may be indicated in the treatment of patients with (1) hypochloremic states and (2) metabolic alkalosis.

Uses of Ammonium chloride in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.

Ammonium chloride is used for the relief of cough in the form of cough expectorant. It is also used as an injection to treat patients with hypochloremia and metabolic alkalosis.

Ammonium chloride dosage

Ammonium Chloride Injection, USP is administered intravenously and must be diluted before use. Solutions for intravenous infusion should not exceed a concentration of 1% to 2% of Ammonium Chloride.

Dosage is dependent upon the condition and tolerance of the patient. It is recommended that the contents of one to two vials (100 to 200 mEq) be added to 500 or 1000 mL of isotonic (0.9%) sodium chloride injection. The rate of intravenous infusion should not exceed 5 mL per minute in adults (approximately 3 hours for infusion of 1000 mL). Dosage should be monitored by repeated serum bicarbonate determinations.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.

Ammonium chloride interactions

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In a treatment, patients should be monitored closely for signs of ammonia poisoning: pallor, sweating, irregular breathing, vomiting, bradycardia, arrhythmias, tremors, convulsions and coma.

Ammonium chloride should be used with caution in patients with heart and lung failure.

A longer-term correction of a hypochloraemia in patients with secondary metabolic alkalosis due to an intracellular potassium depletion can not be achieved by the sole administration of Ammonium chloride. Concomitant administration of potassium is also necessary.

Ammonium chloride side effects

See also:
What are the possible side effects of Ammonium chloride?

Rapid intravenous administration of Ammonium Chloride may be accompanied by pain or irritation at the site of injection or along the venous route.

Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation and hypervolemia (from large volume diluent).

If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and save the remainder of the fluid for examination if deemed necessary.

Ammonium chloride contraindications

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Ammonium Chloride is contraindicated in patients with severe impairment of renal or hepatic function.

Ammonium Chloride should not be administered when metabolic alkalosis due to vomiting of hydrochloric acid is accompanied by loss of sodium (excretion of sodium bicarbonate in the urine).

What is Chlorpheniramine maleate?

Relieving symptoms of sinus congestion, sinus pressure, runny nose, watery eyes, itching of the nose and throat, and sneezing due to upper respiratory infections (eg, colds), allergies, and hay fever. It may also be used for other conditions as determined by your doctor.

Chlorpheniramine maleate is an antihistamine. It works by blocking the action of histamine, which helps reduce symptoms such as watery eyes and sneezing.

Chlorpheniramine maleate indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.

Temporary relief of sneezing, itchy, watery eyes, itchy nose or throat, and runny nose caused by hay fever (allergic rhinitis), or other respiratory allergies.

How should I use Chlorpheniramine maleate?

Use Chlorpheniramine maleate as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Chlorpheniramine maleate may be taken with or without food.
  • Shake well before using.
  • Use the dropper that comes with Chlorpheniramine maleate to measure your dose. Ask your pharmacist for help if you are unsure of how to measure your dose.
  • If you miss a dose of Chlorpheniramine maleate, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Chlorpheniramine maleate.

Uses of Chlorpheniramine maleate in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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This medication is used to treat itching and pain caused by minor burns/cuts/scrapes, sunburn, insect bites, minor skin irritations, or rashes from poison ivy, poison oak, or poison sumac.

Diphenhydramine belongs to a class of drugs known as antihistamines. It works by preventing the effects of a certain natural substance (histamine) that causes itching. Calamine helps to dry the oozing and weeping caused by irritation from poisonous plants.

Use of this medication is not recommended in children younger than 2 years unless directed by the doctor.

How to use Chlorpheniramine maleate topical

Use this medication on the skin only. Some products may need to be shaken well before use. Follow all directions on the product package, or use as directed by your doctor. Before applying, clean the affected area with soap and water. Gently pat dry. Apply to the affected area as directed, usually 3 to 4 times a day. Wash hands immediately after use, unless the area being treated includes the hands.

Do not use on large areas of the body or apply more often than directed. Do not use on chickenpox or measles. Do not use with other products that contain diphenhydramine (e.g., allergy medication taken by mouth). Your condition will not clear faster, but side effects may be increased.

Avoid getting the product in your eyes, nose, ears, or mouth. If the medication gets in these areas, rinse the area right away with clean water.

Tell your doctor if your condition persists or worsens after 7 days of treatment. If you think you may have a serious medical problem, seek immediate medical attention.

Chlorpheniramine maleate description

An alpha- and beta-adrenergic agonist that may also enhance release of norepinephrine. It has been used in the treatment of several disorders including asthma, heart failure, rhinitis, and urinary incontinence, and for its central nervous system stimulatory effects in the treatment of narcolepsy and depression. It has become less extensively used with the advent of more selective agonists.

Chlorpheniramine maleate dosage

Tab Adult & childn >12 yr 1 tab tds-qds. Childn 6-12 yr ½ tab tds-qds. Syr Adult 5 mL tds-qds. Childn 6-12 yr 2.5 mL tds-qds, 2-5 yr 1.25 mL tds-qds.

Chlorpheniramine maleate interactions

See also:
What other drugs will affect Chlorpheniramine maleate?

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: antihistamines applied to the skin (such as diphenhydramine cream, ointment, spray), antispasmodics (e.g., atropine, belladonna alkaloids), drugs for Parkinson's disease (e.g., anticholinergics such as benztropine, trihexyphenidyl), scopolamine, tricyclic antidepressants (e.g., amitriptyline).

Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), medicine for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, risperidone, amitriptyline, trazodone). Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain drowsiness-causing ingredients. Ask your pharmacist about the safe use of those products.

Chlorpheniramine is very similar to dexchlorpheniramine. Do not use medications containing dexchlorpheniramine while using chlorpheniramine.

This medication may interfere with certain laboratory tests (including allergy skin testing), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Chlorpheniramine maleate side effects

See also:
What are the possible side effects of Chlorpheniramine maleate?

Drowsiness, dizziness, headache, constipation, stomach upset, blurred vision, decreased coordination, or dry mouth/nose/throat may occur. These effects may decrease as your body adjusts to the medication. If any of these effects persist or worsen, contact your doctor or pharmacist promptly.

To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute. Chlorpheniramine can dry up and thicken mucus in your lungs, making it more difficult to breathe and clear your lungs. To help prevent this effect, drink plenty of fluids unless otherwise directed by your doctor.

If you are using a sustained-release product, an empty tablet shell may appear in your stool. This is harmless.

If your doctor has prescribed this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these unlikely but serious side effects occur: mental/mood changes (e.g., hallucinations, irritability, nervousness, confusion), ringing in the ears, trouble urinating.

Tell your doctor right away if any of these rare but very serious side effects occur: easy bruising/bleeding, fast/irregular heartbeat, seizure.

A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Chlorpheniramine maleate contraindications

See also:
What is the most important information I should know about Chlorpheniramine maleate?

Hypersensitivity to antihistamines; narrow-angle glaucoma; stenosing peptic ulcer; symptomatic prostatic hypertrophy; asthmatic attack; bladder neck obstruction; pyloroduodenal obstruction; MAO therapy; use in newborn or premature infants and in breast-feeding mothers.

What is Dextromethorphan hydrobromide?

Dextromethorphan hydrobromide is a cough suppressant. It affects the signals in the brain that trigger cough reflex.

Dextromethorphan hydrobromide is used to treat a cough.

Dextromethorphan hydrobromide will not treat a cough that is caused by smoking, asthma, or emphysema.

Dextromethorphan hydrobromide may also be used for purposes not listed in this medication guide.

Dextromethorphan hydrobromide indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.

*Pholcodine is used to help stop coughing.

* It is a member of a group of drugs called anti-tussives, sometimes known as cough suppressants.

* In general this drug is used to relieve dry and tickly coughs that do not produce any mucus (phlegm).

* Benefits of being on this drug can include decreasing or stopping you coughing.

Listed below are the typical uses of Pholcodine:

* Relief of dry, tickly cough (does not produce any mucus (phlegm)) which is linked to an infection in your nose, sinuses or windpipe (upper respiratory tract).

How should I use Dextromethorphan hydrobromide?

Use Dextromethorphan hydrobromide as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Take Dextromethorphan hydrobromide by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
  • Do not remove the strip from the pouch until you are ready to take Dextromethorphan hydrobromide. Be sure that your hands are dry when you touch the strip.
  • Remove the strip from the pouch and place it onto the tongue. The strip dissolves quickly and can be swallowed with saliva. It may be taken with or without water.
  • Use the strip right away after you open the pouch. Do not store it for future use.
  • If you miss a dose of Dextromethorphan hydrobromide and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Dextromethorphan hydrobromide.

Uses of Dextromethorphan hydrobromide in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.

This medication is used for temporary relief of coughs without phlegm that are caused by certain infections of the air passages (e.g., sinusitis, common cold). This product should not usually be used for an ongoing cough from smoking or long-term breathing problems (e.g., chronic bronchitis, emphysema) unless directed by your doctor. This product contains Dextromethorphan hydrobromide. It is a cough suppressant that works by decreasing the feeling of needing to cough.

Cough-and-cold products have not been shown to be safe or effective in children younger than 6 years. Therefore, do not use this product to treat cold symptoms in children younger than 6 years unless specifically directed by the doctor. Ask your doctor or pharmacist for more details about using your product safely.

These products do not cure or shorten the length of the common cold and may cause serious side effects. To decrease the risk for serious side effects, carefully follow all dosage directions. Do not use this product to make a child sleepy. Do not give other cough-and-cold medication that might contain the same or similar ingredients. Ask the doctor or pharmacist about other ways to relieve cough and cold symptoms (such as drinking enough fluids, using a humidifier or saline nose drops/spray).

How to use Dextromethorphan hydrobromide

Take this medication by mouth, usually every 4 to 12 hours as needed or as directed by your doctor. If stomach upset occurs, take with food or milk. Use a medication-measuring device to measure your dose of liquid medication. Do not use a household spoon because you may not get the correct dose. If you are taking a suspension, shake the product well before measuring out your dose.

Dosage is based on the product you are taking and your age, medical condition, and response to treatment. If you are using this medication for self-treatment (without a prescription from your doctor), follow the specific dosing instructions on the packaging to find the correct dose for your age.

If your doctor directs you to take this medication daily, take it regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

Improper use of this medication (abuse) may result in serious harm (e.g., brain damage, seizure, death). Do not increase your dose, take it more frequently, or use it for a longer time than prescribed. Properly stop the medication when so directed.

Tell your doctor if your symptoms persist or worsen after more than 1 week or if you also have fever, chills, headache, or rash. These may be signs of a more serious condition.

Dextromethorphan hydrobromide description

The d-isomer of the codeine analog of levorphanol. Dextromethorphan hydrobromide shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is an NMDA receptor antagonist (receptors, N-methyl-D-aspartate) and acts as a non-competitive channel blocker. It is one of the widely used antitussives, and is also used to study the involvement of glutamate receptors in neurotoxicity.

Dextromethorphan hydrobromide dosage

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule,

Oral, as hydrobromide:

Robafen Cough: 15 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40]

Robitussin Lingering CoughGels: 15 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40, polyethylene glycol, propylene glycol]

Gel,

Oral, as hydrobromide:

ElixSure Cough: 7.5 mg/5 mL (120 mL) [alcohol free; contains carbomer 934p, propylene glycol, propylparaben; cherry bubblegum flavor]

Liquid,

Oral, as hydrobromide:

Buckleys Cough: 12.5 mg/5 mL (118 mL) [alcohol free, sugar free; contains butylparaben, menthol, propylparaben, saccharin sodium]

Little Colds Cough Formula: 7.5 mg/mL (30 mL) [alcohol free, dye free, saccharin free; contains sodium benzoate; grape flavor]

PediaCare Childrens Long-Act: 7.5 mg/5 mL (118 mL) [contains brilliant blue fcf (fd&c blue #1), saccharin sodium, sodium benzoate]

Robitussin Lingering LA Cough: 15 mg/5 mL (118 mL [DSC]) [contains alcohol, usp, fd&c red #40, menthol, saccharin sodium, sodium benzoate]

Dextromethorphan hydrobromide: 10 mg/5 mL (480 mL [DSC], 3780 mL [DSC]) [alcohol free, dye free, fructose free, sodium free, sorbitol free, sugar free]

Triaminic Long Acting Cough: 7.5 mg/5 mL (118 mL) [alcohol free, dye free, pseudoephedrine free; contains benzoic acid, propylene glycol]

Lozenge, Mouth/Throat, as hydrobromide:

Hold: 5 mg (10 ea)

Hold: 5 mg (10 ea) [cherry flavor]

Trocal Cough Suppressant: 7.5 mg (1 ea [DSC])

Strip,

Oral, as hydrobromide:

Triaminic Long Acting Cough: 7.5 mg (14 ea, 16 ea) [contains alcohol, usp, fd&c red #40; cherry flavor]

Triaminic Long Acting Cough: 7.5 mg (14 ea) [contains alcohol, usp, fd&c red #40, isopropyl alcohol]

Suspension Extended Release,

Oral:

Cough DM: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (89 mL) [alcohol free; contains fd&c yellow #10 aluminum lake, methylparaben, polysorbate 80, propylparaben, sodium metabisulfite; orange flavor]

Delsym: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (89 mL, 148 mL) [alcohol free; contains brilliant blue fcf (fd&c blue #1), disodium edta, methylparaben, polyethylene glycol, polysorbate 80, propylene glycol, propylparaben; grape flavor]

Delsym: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (89 mL, 148 mL) [alcohol free; contains edetate disodium, fd&c yellow #6 (sunset yellow), methylparaben, polyethylene glycol, polysorbate 80, propylene glycol, propylparaben; orange flavor]

Delsym Cough Childrens: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (89 mL, 148 mL) [alcohol free; contains brilliant blue fcf (fd&c blue #1), edetate disodium, methylparaben, polyethylene glycol, polysorbate 80, propylene glycol, propylparaben, soybean oil; grape flavor]

Delsym Cough Childrens: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (89 mL, 148 mL) [alcohol free; contains edetate disodium, fd&c yellow #6 (sunset yellow), methylparaben, polyethylene glycol, polysorbate 80, propylene glycol, propylparaben, soybean oil; orange flavor]

GoodSense Cough DM: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (148 mL) [alcohol free, gluten free; contains fd&c yellow #10 aluminum lake, methylparaben, polysorbate 80, propylparaben, sodium metabisulfite]

GoodSense Cough DM Childrens: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (89 mL, 148 mL) [alcohol free, gluten free; contains fd&c yellow #10 aluminum lake, methylparaben, polysorbate 80, propylparaben, sodium metabisulfite]

Robitussin 12 Hour Cough: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (89 mL) [alcohol free; contains brilliant blue fcf (fd&c blue #1), methylparaben, polysorbate 80, propylparaben, sodium metabisulfite]

Robitussin 12 Hour Cough: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (89 mL) [alcohol free; contains fd&c yellow #10 (quinoline yellow), methylparaben, polysorbate 80, propylparaben, sodium metabisulfite]

Robitussin 12 Hour Cough

Child: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (89 mL) [alcohol free; contains brilliant blue fcf (fd&c blue #1), methylparaben, polysorbate 80, propylparaben, sodium metabisulfite]

Generic: Dextromethorphan hydrobromide polistirex [equivalent to Dextromethorphan hydrobromide hydrobromide 30 mg/5 mL] (89 mL)

Syrup,

Oral, as hydrobromide:

Creomulsion

Adult: 20 mg/15 mL (118 mL [DSC])

Creomulsion for Children: 5 mg/5 mL (118 mL [DSC]) [cherry flavor]

Robitussin Childrens Cough LA: 7.5 mg/5 mL (118 mL) [alcohol free; contains fd&c red #40, propylene glycol, saccharin sodium, sodium benzoate; fruit punch flavor]

Silphen DM Cough: 10 mg/5 mL (118 mL) [contains alcohol, usp; strawberry flavor]

Triaminic Long Acting Cough: 7.5 mg/5 mL (118 mL [DSC]) [alcohol free, dye free; contains benzoic acid, edetate disodium, propylene glycol]

Dosing: Adult

Cough suppressant:

Oral: 10 to 20 mg every 4 hours

or 20 to 30 mg every 6 to 8 hours; extended release: 60 mg twice daily; maximum: 120 mg/24 hours

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Note: Safety and efficacy for the use of cough and cold products in infants and young children limited; the AAP warns against the use of these products for respiratory illnesses in infants and young children (AAP 2018; FDA 2017).

Cough suppressant:

Oral:

Oral syrup (immediate release):

Children 2 to <6 years: 5 mg every 4 hours as needed; do not exceed 6 doses in 24 hours.

Children 6 to <12 years: 10 mg every 4 hours as needed; do not exceed 6 doses in 24 hours.

Children ≥12 years and Adolescents: 20 mg every 4 hours as needed; do not exceed 6 doses in 24 hours.

Long-acting liquid: Children ≥12 years and Adolescents: 30 mg every 6 to 8 hours as needed; do not exceed 4 doses in 24 hours.

Oral capsule: Children ≥12 years and Adolescents: 30 mg every 6 to 8 hours as needed; do not exceed 4 doses in 24 hours.

Extended-release suspension (Dextromethorphan hydrobromide polistirex):

Children 4 to <6 years: 15 mg every 12 hours as needed; do not exceed 30 mg in 24 hours.

Children 6 to <12 years: 30 mg every 12 hours as needed; do not exceed 60 mg in 24 hours.

Children ≥12 years and Adolescents: 60 mg every 12 hours as needed; do not exceed 120 mg in 24 hours.

Dextromethorphan hydrobromide interactions

See also:
What other drugs will affect Dextromethorphan hydrobromide?

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.

This drug should not be used with the following medications because very serious, possibly fatal interactions may occur: Monoamine Oxidase Inhibitors (MAOIs).

If you are currently using any such medicine, tell your doctor or pharmacist before starting Pholcodine.

Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:

* CNS depressants e.g. hypnotics (sleeping tablets including barbiturates)

* Minor tranquillisers (drugs used to relax muscles or decrease anxiety)

* Opioid analgesics (drugs used to relieve pain e.g. codeine, tramadol, morphine)

* Tricyclic antidepressants (drugs to treat mood disorders)

* Phenothiazine (drug used to treat mood disorders)

* Diuretics (water pills used for high blood pressure)

* Antihypertensives (drugs used to treat high blood pressure and other conditions)

* Neuromuscular blocking agents (anaesthetics used during surgery)

* Any other cough or cold medicines

Dextromethorphan hydrobromide side effects

See also:
What are the possible side effects of Dextromethorphan hydrobromide?

  • Nausea (feeling sick)

  • Vomiting

  • Constipation

  • Drowsiness

  • Dizziness

  • Excitation

  • Confusion

  • Generalised rash

  • Excess mucus (phlegm)

  • Congestion (too much mucus / sputum staying in your airways)

    If any of these persist or you consider them severe then inform your doctor or pharmacist.

    Tell your doctor immediately if you develop any of the following symptoms: sudden wheeziness; difficulty in breathing.

    Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

    A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.

    Dextromethorphan hydrobromide contraindications

    See also:
    What is the most important information I should know about Dextromethorphan hydrobromide?

    This medication is not recommended cons in the following situations:

    - Hypersensitivity to any component of the syrup,

    - Respiratory failure,

    - Cough in asthmatic

    - Breastfeeding: pholcodine passes into breast milk with codeine, some cases of hypotonia and respiratory pauses were described in infants after ingestion by mothers of supratherapeutic doses of codeine. If breastfeeding, and by extrapolation of codeine, this medication is given cons-

    Due to the presence of sucrose, this drug is cons-indicated in cases of fructose intolerance, malabsorption of glucose and galactose or sucrase-isomaltase.

    What is Guaifenesin?

    Guaifenesin is used to reduce chest congestion caused by the common cold, flu, or chronic bronchitis.

    Guaifenesin helps loosen congestion in your chest and throat, making it easier to cough out through your mouth.

    There are many brands and forms of guaifenesin available. Not all brands are listed on this leaflet.

    Guaifenesin may also be used for purposes not listed in this medication guide.

    Guaifenesin indications

    An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.

    Guaifenesin and hydrocodone is used to treat cough and reduce chest congestion caused by the common cold, flu, or allergies.

    How should I use Guaifenesin?

    Use Guaifenesin as directed by your doctor. Check the label on the medicine for exact dosing instructions.

    • Take Guaifenesin by mouth with or without food.
    • Drinking extra fluids while you are taking Guaifenesin is recommended. Check with your doctor for instructions.
    • Swallow Guaifenesin whole. Do not break, crush, or chew before swallowing.
    • If you miss a dose of Guaifenesin and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose. Go back to your regular dosing schedule. Do not take 2 doses at once.

    Ask your health care provider any questions you may have about how to use Guaifenesin.

    Uses of Guaifenesin in details

    There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.

    Guaifenesin is used to treat coughs and congestion caused by the common cold, bronchitis, and other breathing illnesses. This product is usually not used for ongoing cough from smoking or long-term breathing problems (such as chronic bronchitis, emphysema) unless directed by your doctor. Guaifenesin is an expectorant. It works by thinning and loosening mucus in the airways, clearing congestion, and making breathing easier.

    If you are self-treating with this medication, it is important to read the package instructions carefully before you start using this product to be sure it is right for you.

    Cough-and-cold products have not been shown to be safe or effective in children younger than 6 years. Therefore, do not use this product to treat cold symptoms in children younger than 6 years unless specifically directed by the doctor. Some products (such as long-acting tablets/capsules) are not recommended for use in children younger than 12 years. Ask your doctor or pharmacist for more details about using your product safely.

    These products do not cure or shorten the length of the common cold. To decrease the risk for side effects, carefully follow all dosage directions. Do not give other cough-and-cold medication that might contain the same or similar ingredients. Ask the doctor or pharmacist about other ways to relieve cough and cold symptoms (such as drinking enough fluids, using a humidifier or saline nose drops/spray).

    How to use 2/G

    Take this medication by mouth with or without food, as directed by your doctor, usually every 4 hours. If you are self-treating, follow all directions on the product package. If you are uncertain about any of the information, ask your doctor or pharmacist.

    Guaifenesin may have a bitter taste. Do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.

    If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.

    For powder packets, empty the entire contents of the packet onto the tongue and swallow. To prevent a bitter taste, do not chew.

    Dosage is based on your age, medical condition, and response to treatment. Do not take more than 6 doses in a day. Do not increase your dose or take this drug more often than directed.

    Drink plenty of fluids while taking this medication. Fluids will help to break up mucus and clear congestion.

    Tell your doctor if your cough is accompanied by fever, severe sore throat, rash, persistent headache, or if it persists, returns, or worsens after 7 days. These may be signs of a serious medical problem. Seek immediate medical attention if you think you may have a serious medical problem.

    Guaifenesin description

    A synthetic opioid that is used as the hydrochloride. It is an opioid analgesic that is primarily a mu-opioid agonist. It has actions and uses similar to those of morphine. It also has a depressant action on the cough center and may be given to control intractable cough associated with terminal lung cancer. Guaifenesin is also used as part of the treatment of dependence on opioid drugs, although prolonged use of methadone itself may result in dependence. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1082-3)

    Guaifenesin dosage

    ORGANIDIN® NR (guaifenesin)

    Tablets — Adults and children 12 years of age and older: One to 2 tablets (200 mg to 400 mg) every four hours, not to exceed 2400 mg (12 tablets) in 24 hours.

    PATIENTS SHOULD BE ADVISED TO KEEP THESE AND ALL DRUGS OUT OF THE REACH OF CHILDREN AND TO SEEK PROFESSIONAL ASSISTANCE OR CONTACT A POISON CONTROL CENTER IMMEDIATELY IN CASE OF ACCIDENTAL OVERDOSE.

    How supplied

    ORGANIDIN® NR (guaifenesin)

    Tablets — Each round, scored, rose-colored tablet contains 200 mg guaifenesin USP—available in bottles of 100 (NDC 0037-4312-01)

    Storage

    Store at controlled room temperature 20°-25°C (68°-77°F). Protect tablets from moisture. Keep bottle tightly closed.

    To report SUSPECTED ADVERSE REACTIONS, contact Meda Pharmaceuticals Inc. at 1-800-526-3840 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

    Meda Pharmaceuticals Inc. Somerset, New Jersey 08873-4120. Rev. 11/09

    Guaifenesin interactions

    See also:
    What other drugs will affect Guaifenesin?

    In vitro results suggest that methadone undergoes hepatic N-demethylation by cytochrome P450 enzymes, principally CYP3A4, CYP2B6, CYP2C19 and to a lesser extent by CYP2C9 and CYP2D6. Coadministration of methadone with CYP inducers of these enzymes may result in a more rapid metabolism and potential for decreased effects of methadone, whereas administration with CYP inhibitors may reduce metabolism and potentiate methadones effects. Although antiretroviral drugs such as efavirenz, nelfinavir, nevirapine, ritonavir, lopinavir+ritonavir combination are known to inhibit CYPs, they are shown to reduce the plasma levels of methadone, possibly due to their CYP induction activity. Therefore, drugs administered concomitantly with methadone should be evaluated for interaction potential; clinicians are advised to evaluate individual response to drug therapy.

    Opioid Antagonists, Mixed Agonist/Antagonists, and Partial Agonists

    As with other mu-agonists, patients maintained on methadone may experience withdrawal symptoms when given opioid antagonists, mixed agonist/antagonists, and partial agonists. Examples of such agents are naloxone, naltrexone, pentazocine, nalbuphine, butorphanol, and buprenorphine.

    Anti-retroviral Agents

    Abacavir, amprenavir, efavirenz, nelfinavir, nevirapine, ritonavir, lopinavir+ritonavir combination - Coadministration of these anti-retroviral agents resulted in increased clearance or decreased plasma levels of methadone. Guaifenesin-maintained patients beginning treatment with these antiretroviral drugs should be monitored for evidence of withdrawal effects and methadone dose should be adjusted accordingly.

    Didanosine and Stavudine - Experimental evidence demonstrated that methadone decreased the AUC and peak levels for didanosine and stavudine, with a more significant decrease for didanosine. Guaifenesin disposition was not substantially altered.

    Zidovudine - Experimental evidence demonstrated that methadone increased the area under the concentration-time curve (AUC) of zidovudine which could result in toxic effects.

    Cytochrome P450 Inducers

    Guaifenesin-maintained patients beginning treatment with CYP3A4 inducers should be monitored for evidence of withdrawal effects and methadone dose should be adjusted accordingly. The following drug interactions were reported following coadministration of methadone with inducers of cytochrome P450 enzymes:

    Rifampin - In patients well-stabilized on methadone, concomitant administration of rifampin resulted in a marked reduction in serum methadone levels and a concurrent appearance of withdrawal symptoms.

    Phenytoin - In a pharmacokinetic study with patients on methadone maintenance therapy, phenytoin administration (250 mg b.i.d. initially for 1 day followed by 300 mg QD for 3 to 4 days) resulted in an approximately 50% reduction in methadone exposure and withdrawal symptoms occurred concurrently. Upon discontinuation of phenytoin, the incidence of withdrawal symptoms decreased and methadone exposure increased to a level comparable to that prior to phenytoin administration.

    St. Johns Wort, Phenobarbital, Carbamazepin/strong>Administration of methadone along with other CYP3A4 inducers may result in withdrawal symptoms.

    Cytochrome P450 Inhibitors

    Since the metabolism of methadone is mediated primarily by CYP3A4 isozyme, coadministration of drugs that inhibit CYP3A4 activity may cause decreased clearance of methadone. The expected clinical results would be increased or prolonged opioid effects. Thus, methadone-treated patients coadministered strong inhibitors of CYP3A4, such as azole antifungal agents (e.g., ketoconazole) and macrolide antibiotics (e.g., erythromycin), with methadone should be carefully monitored and dosage adjustment should be undertaken if warranted. Some selective serotonin reuptake inhibitors (SSRIs) (e.g., sertraline, fluvoxamine) may increase methadone plasma levels upon coadministration with methadone and result in increased opiate effects and/or toxicity.

    Voriconazole - Repeat dose administration of oral voriconazole (400mg Q12h for 1 day, then 200mg Q12h for 4 days) increased the Cmax and AUC of (R)-methadone by 31% and 47%, respectively, in subjects receiving a methadone maintenance dose (30 to 100 mg QD). The Cmax and AUC of (S)-methadone increased by 65% and 103%, respectively. Increased plasma concentrations of methadone have been associated with toxicity including QT prolongation. Frequent monitoring for adverse events and toxicity related to methadone is recommended during coadministration. Dose reduction of methadone may be needed.

    Others

    Monoamine Oxidase (MAO) Inhibitors - Therapeutic doses of meperidine have precipitated severe reactions in patients concurrently receiving monoamine oxidase inhibitors or those who have received such agents within 14 days. Similar reactions thus far have not been reported with methadone. However, if the use of methadone is necessary in such patients, a sensitivity test should be performed in which repeated small, incremental doses of methadone are administered over the course of several hours while the patients condition and vital signs are under careful observation.

    Desipramine - Blood levels of desipramine have increased with concurrent methadone administration.

    Potentially Arrhythmogenic Agents

    Extreme caution is necessary when any drug known to have the potential to prolong the QT interval is prescribed in conjunction with methadone. Pharmacodynamic interactions may occur with concomitant use of methadone and potentially arrhythmogenic agents such as class I and III antiarrhythmics, some neuroleptics and tricyclic antidepressants, and calcium channel blockers.

    Caution should also be exercised when prescribing methadone concomitantly with drugs capable of inducing electrolyte disturbances (hypomagnesemia, hypokalemia) that may prolong the QT interval. These drugs include diuretics, laxatives, and, in rare cases, mineralocorticoid hormones.

    Interactions with Alcohol and Drugs of Abuse

    Guaifenesin may be expected to have additive effects when used in conjunction with alcohol, other opioids or CNS depressants, or with illicit drugs that cause central nervous system depression. Deaths have been reported when methadone has been abused in conjunction with benzodiazepines.

    Anxiety - Since methadone as used by tolerant patients at a constant maintenance dosage does not act as a tranquilizer, patients who are maintained on this drug will react to life problems and stresses with the same symptoms of anxiety as do other individuals. The physician should not confuse such symptoms with those of narcotic abstinence and should not attempt to treat anxiety by increasing the dose of methadone. The action of methadone in maintenance treatment is limited to the control of narcotic withdrawal symptoms and is ineffective for relief of general anxiety.

    Acute Pain - Maintenance patients on a stable dose of methadone who experience physical trauma, postoperative pain or other acute pain cannot be expected to derive analgesia from their existing dose of methadone. Such patients should be administered analgesics, including opioids, in doses that would otherwise be indicated for non-methadone-treated patients with similar painful conditions. Due to the opioid tolerance induced by methadone, when opioids are required for management of acute pain in methadone patients, somewhat higher and/or more frequent doses will often be required than would be the case for non-tolerant patients.

    Risk of Relapse in Patients on Guaifenesin Maintenance Treatment of Opioid Addiction

    Abrupt opioid discontinuation can lead to development of opioid withdrawal symptoms. Presentation of these symptoms have been associated with an increased risk of susceptible patients to relapse to illicit drug use and should be considered when assessing the risks and benefit of methadone use.

    Tolerance and Physical Dependence

    Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia (in the absence of disease progression or other external factors). Physical dependence is manifested by withdrawal symptoms after abrupt discontinuation of a drug or upon administration of an antagonist. Physical dependence and/or tolerance are not unusual during chronic opioid therapy.

    If methadone is abruptly discontinued in a physically dependent patient, an abstinence syndrome may occur. The opioid abstinence or withdrawal syndrome is characterized by some or all of the following: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis. Other symptoms also may develop, including irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate.

    In general, chronically administered methadone should not be abruptly discontinued.

    Special-Risk Patients

    Guaifenesin should be given with caution and the initial dose reduced in certain patients, such as the elderly and debilitated and those with severe impairment of hepatic or renal function, hypothyroidism, Addisons disease, prostatic hypertrophy, or urethral stricture. The usual precautions appropriate to the use of parenteral opioids should be observed and the possibility of respiratory depression should always be kept in mind.

    Guaifenesin side effects

    See also:
    What are the possible side effects of Guaifenesin?

    Applies to guaifenesin: oral capsule, oral capsule extended release, oral elixir, oral liquid, oral packet, oral solution, oral syrup, oral tablet, oral tablet extended release

    In addition to its needed effects, some unwanted effects may be caused by guaifenesin (the active ingredient contained in Guaifenesin). In the event that any of these side effects do occur, they may require medical attention.

    Minor Side Effects

    Some of the side effects that can occur with guaifenesin may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

    Less common or rare:

    • Diarrhea
    • dizziness
    • headache
    • hives
    • nausea or vomiting
    • skin rash
    • stomach pain

    Guaifenesin contraindications

    See also:
    What is the most important information I should know about Guaifenesin?

    Guaifenesin is contraindicated in patients with a known hypersensitivity to methadone hydrochloride or any other ingredient in DOLOPHINE.

    Guaifenesin is contraindicated in any situation where opioids are contraindicated such as: patients with respiratory depression (in the absence of resuscitative equipment or in unmonitored settings), and in patients with acute bronchial asthma or hypercarbia.

    Guaifenesin is contraindicated in any patient who has or is suspected of having a paralytic ileus.

    Active ingredient matches for Ammonium chloride/chlorpheniramine maleate/dextromethorphan hydrobromide/guaifenesin:

    Ammonium chloride/chlorpheniramine maleate/dextromethorphan hydrobromide/guaifenesin


    References

    1. DailyMed. "CHLORPHENIRAMINE POLISTIREX; HYDROCODONE POLISTIREX: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
    2. DailyMed. "GUAIFENESIN; HYDROCODONE BITARTRATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
    3. DailyMed. "DEXTROMETHORPHAN HYDROBROMIDE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).

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