Chlorpheniramine, Dexchlorpheniramine (Monograph)

Brand names: Advil Allergy Sinus, Alka-Seltzer Plus, Aller-Chlor, Chlor-Trimeton, Coricidin, ... show all 13 brands
Drug class: First Generation Antihistamines

Introduction

First generation antihistamine; a propylamine-derivative.^a

Uses for Chlorpheniramine, Dexchlorpheniramine

Allergic Rhinitis

Symptomatic relief of allergic symptoms (e.g., rhinorrhea, sneezing, oronasopharyngeal irritation or itching, lacrimation, red, irritated, or itching eyes) caused by histamine release.^c ^t ^u ^v ^w ^tt ^uu ^vv

Used in fixed combination with other agents (e.g., acetaminophen, dextromethorphan, guaifenesin, ibuprofen, phenylephrine, pseudoephedrine) for relief of rhinorrhea, sneezing, lacrimation, itching eyes, oronasopharyngeal itching, and/or other symptoms (e.g., nasal/sinus congestion, cough) associated with allergic rhinitis (e.g., hay fever).¹⁰³ ¹⁰⁴ ¹⁰⁵ ¹⁰⁶ ¹¹¹ ¹¹⁶

Use fixed-combination preparations only when symptoms amenable to each ingredient are present concurrently.^c

Chlorpheniramine, Dexchlorpheniramine Dosage and Administration

Administration

Oral Administration

Administer orally.^a

May be administered as self-medication in adults and children >6 years of age.^a

Administer to children 2 to ≤6 years of age under the direction of a clinician.^a

Dosage

Individualize dosage according to patient’s response and tolerance.^a

Fixed-combination preparations do not permit individual titration of dosages.^c When used in fixed combination with other agents (e.g., acetaminophen, dextromethorphan, guaifenesin, ibuprofen, phenylephrine, pseudoephedrine), select a dosage that is within the usual therapeutic range for each ingredient.^c Lower maximum daily chlorpheniramine dosages may be necessary because of other ingredients included in the formulations.^a Because combinations and dosage strengths vary for fixed-combination preparations, consult manufacturer’s product labeling for appropriate dosage of the specific preparation.

Pediatric Patients

Allergic Rhinitis

Oral

Children 2 to <6 years of age: 1 mg every 4–6 hours (as conventional formulations).^c ^v ^oo

Children 6 to <12 years of age: 2 mg every 4–6 hours (as conventional formulations)^c ^v ^oo or 8 mg (as extended-release tablets) once daily at bedtime or during the day, as indicated.^a

Children ≥12 years of age: 4 mg every 4–6 hours (as conventional formulations)^c ^v ^oo or 8 or 12 mg (as extended-release tablets) twice daily in the morning and evening.^a

Adults

Allergic Rhinitis

Oral

4 mg every 4–6 hours (as conventional formulations)^c ^v ^oo or 8 or 12 mg (as extended-release tablets) twice daily in the morning and evening.^a

Prescribing Limits

Pediatric Patients

Allergic Rhinitis

Oral

Children 2 to <6 years of age: Maximum 6 mg daily (as conventional formulations).^oo

Children 6 to <12 years of age: Maximum 12 mg daily (as conventional formulations)^c ^v ^oo or maximum 8 mg daily (as extended-release tablets).^a

Children ≥12 years of age: Maximum 24 mg daily (as immediate-release formulations or extended-release tablets).^c ^v ^oo ^a

Adults

Allergic Rhinitis

Oral

Maximum 24 mg daily (as conventional formulations or extended-release tablets).^c ^v ^oo ^a

Cautions for Chlorpheniramine, Dexchlorpheniramine

Warnings/Precautions

Sensitivity Reactions

Tartrazine Sensitivity

Some commercially available preparations may contain the dye tartrazine (FD&C yellow No. 5); possible allergic reactions in susceptible individuals (e.g., those sensitive to aspirin).^pp

General Precautions

CNS Effects

Possible CNS depression (e.g., drowsiness, dizziness, weakness).^b

Caution when driving a motor vehicle or operating machinery.¹⁰¹ (See CNS Depressants under Interactions.)

Anticholinergic Effects

Possible anticholinergic effects (e.g., dryness of mouth, nose, and throat; dysuria; urinary retention).^b Use with caution, if at all, in patients with angle-closure glaucoma, prostatic hypertrophy,¹⁰¹ stenosing peptic ulcer, pyloroduodenal obstruction, or bladder neck obstruction.^b

Bronchopulmonary Effects

Possible bronchopulmonary effects (e.g., tightness of the chest, thickening of bronchial secretions, wheezing).^b Use not recommended, unless under the direction of a clinician, in patients who have a breathing problem (e.g., emphysema, chronic bronchitis).¹⁰¹ ^oo ^r ^ss Use generally not recommended in asthmatics who previously experienced a serious antihistamine-induced adverse bronchopulmonary effect.^oo ^qq

Phenylketonuria

Some commercially available preparations may contain aspartame (e.g., NutraSweet) which is metabolized in the GI tract to phenylalanine.^hh ⁱⁱ ^jj ^kk ^ll

Use of Fixed Combinations

When used in fixed combination with other agents (e.g., acetaminophen, dextromethorphan, guaifenesin, ibuprofen, phenylephrine, pseudoephedrine), consider the cautions, precautions, and contraindications associated with the concomitant agent(s).¹⁰² ¹⁰³ ¹⁰⁴ ¹⁰⁵ ¹⁰⁶ ¹⁰⁷ ¹⁰⁸ ¹⁰⁹ ¹¹⁰ ¹¹¹ ¹¹² ¹¹³ ¹¹⁴ ¹¹⁵ ¹¹⁶ ¹¹⁷ ¹¹⁸ ¹¹⁹

Specific Populations

Pregnancy

Category B. Use not recommended during the third trimester.^a

Lactation

Not known whether chlorpheniramine is distributed into milk;^r ^s discontinue nursing or chlorpheniramine because of potential risk to nursing infants.^a

Pediatric Use

Possible severe reactions (e.g., seizures) in neonates; use not recommended in premature or full-term neonates.^a Possible paradoxical excitement (e.g., restlessness, insomnia, tremors, euphoria, nervousness, delirium, palpitation, seizures).^b

Use conventional and extended-release preparations only under the direction and supervision of a clinician in children <6 years of age and in those <12 years of age, respectively.^a

Risk of overdosage and toxicity (including death) in children <2 years of age receiving OTC preparations containing antihistamines, cough suppressants, expectorants, and nasal decongestants alone or in combination for relief of symptoms of upper respiratory tract infection.^yy ^zz Limited evidence of efficacy for these preparations in this age group; appropriate dosages not established.^yy Therefore, FDA recommended not to use such preparations in children <2 years of age;^aaa safety and efficacy in older children under evaluation.^ccc ^eee Because children 2–3 years of age also are at increased risk of overdosage and toxicity, some manufacturers of oral nonprescription cough and cold preparations agreed to voluntarily revise the product labeling to state that such preparations should not be used in children <4 years of age.^bbb ^ccc ^ddd ^eee FDA recommends that parents and caregivers adhere to dosage instructions and warnings on the product labeling that accompanies the preparation and consult a clinician about any concerns.^bbb ^ccc ^ddd Clinicians should ask caregivers about use of nonprescription cough/cold preparations to avoid overdosage.^yy

Geriatric Use

Possible increased risk of dizziness, sedation, and hypotension.^b

Common Adverse Effects

Sedation (e.g., drowsiness, dizziness, weakness), CNS stimulation (e.g., restlessness, insomnia, nervousness).¹⁰¹ ^a

Drug Interactions

CNS Depressants

Potential pharmacologic interaction (additive CNS depression) with alcohol and other CNS depressants (e.g., hypnotics, sedatives, tranquilizers).^b

Laboratory Test Interferences

Antihistamines may suppress inhalation-challenge testing with histamine or antigen as well as the wheal and flare reactions to antigen skin testing.^y ^z ^aa ^bb ^cc ^dd ^ee ^ff ^gg

Specific Drugs

Drug	Interaction	Comments
MAO inhibitors	MAO inhibitors prolong and intensify anticholinergic effects of antihistamines^b

Chlorpheniramine, Dexchlorpheniramine Pharmacokinetics

Absorption

Bioavailability

Well absorbed following oral administration, ^d ^e ^f ^g ⁿ but only 25–45% (conventional tablets) or 35–60% (solution) of a single oral dose reaches the systemic circulation as unchanged drug.ⁿ

Bioavailability of extended-release preparations is reduced compared to conventional tablets or solution.^f

Peak plasma concentrations generally occur within 2–6 hours following oral administration of conventional tablets or solution.^d ^e ^f ^g ⁿ

Onset

Antihistamine effect is apparent within 6 hours after a single dose.^g

Duration

Antihistamine effect may persist for ≥24 hours.^g

Distribution

Extent

Undergoes rapid and extensive distribution;^e ^h ⁱ ⁿ however, distribution has not been characterized fully.^e ^g ^h ⁱ ⁿ ^p

Plasma Protein Binding

Approximately 69–72%.^e

Elimination

Metabolism

Undergoes substantial metabolism in the GI mucosa during absorption and on first pass through the liver.ⁿ ^o Rapidly and extensively metabolized^e ^m ⁿ principally to at least 2 unidentified metabolites^e and monodesmethylchlorpheniramine and didesmethylchlorpheniramine.^e ^m ⁿ

Elimination Route

Excreted in urine.^e ^k ^l ^m ⁿ

Half-life

Terminal elimination half-life of chlorpheniramine is about 12–43 hours.^e ^f ⁱ ^j ⁿ

Special Populations

Terminal elimination half-life in children is about 9.6–13.1 hours (range: 5.2–23.1 hours).^g ^h

Terminal elimination half-life in patients with chronic renal failure undergoing hemodialysis is about 280–330 hours.^q

Stability

Storage

Oral

Tablets

Tight containers at 15–30°C.^a

Extended-release Tablets

Well-closed containers at 15–30°C.^a

Oral Solution

Tight, light-resistant containers at 15–30°C; avoid freezing.^a

Actions and Spectrum

Blocks H₁-receptor sites and prevents the action of histamine on the cell.^b
Suppresses flare and pruritus that accompany the endogenous release of histamine.^b
Exhibits some activities common to anticholinergics, ganglionic and adrenergic blocking agents, local anesthetics, and antispasmodics.^b
Causes less drowsiness and more CNS stimulation than some other first generation antihistamines.^b
Antihistamines do not block the stimulating effect of histamine on gastric acid secretion, which is mediated by H₂-receptors of the parietal cells.^b

Advice to Patients

Importance of informing individuals who perform potentially hazardous tasks requiring mental alertness or physical coordination (e.g., operating machinery, driving a motor vehicle) about possible drowsiness, dizziness, or weakness.¹⁰¹
Importance of avoiding alcoholic beverages during antihistamine therapy.^mm ⁿⁿ ^ww ^xx
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.^a Importance of patients already receiving another CNS depressant (e.g., sedatives, tranquilizers) not undertaking self-medication without first consulting a clinician.^mm ⁿⁿ ^ww ^xx
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^x
Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Chlorpheniramine Maleate
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Bulk	Powder*
Oral	Solution	2 mg/5 mL*	Aller-Chlor Syrup	Rugby
			Chlorpheniramine Maleate Solution
	Tablets	4 mg*	Aller-Chlor	Rugby
			Chlorpheniramine Maleate Tablets
			Chlor-Trimeton 4 Hour Allergy (scored)	Schering-Plough
	Tablets, extended-release	8 mg*	Chlorpheniramine Maleate Extended-release Tablets
		12 mg*	Chlorpheniramine Maleate Extended-release Tablets

Chlorpheniramine Maleate Combinations
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Capsules, liquid-filled	2 mg with Acetaminophen 325 mg, Dextromethorphan Hydrobromide 10 mg, and Phenylephrine Hydrochloride 5 mg	Alka-Seltzer Plus Cold & Cough Formula	Bayer
	Solution	1 mg/5 mL with Acetaminophen 160 mg/5 mL and Dextromethorphan Hydrobromide 7.5 mg/5 mL	Triaminic Multi-Symptom Fever	Novartis
		1 mg/5 mL with Acetaminophen 160 mg/5 mL, Dextromethorphan Hydrobromide 5 mg/ 5 mL, and Phenylephrine Hydrochloride 2.5 mg/5 mL	Children’s Tylenol Plus Multi-Symptom Cold	McNeil
		1 mg/5 mL with Dextromethorphan Hydrobromide 7.5 mg/5 mL	Dimetapp Long Acting Cough Plus Cold	Pfizer
	Tablets	2 mg with Acetaminophen 325 mg	Coricidin HBP Cold & Flu	Schering-Plough
		2 mg with Acetaminophen 500 mg and Phenylephrine Hydrochloride 5 mg	Sine-Off Sinus/Cold Caplets	Gemini
		4 mg with Dextromethorphan Hydrobromide 30 mg	Coricidin HBP Cough & Cold	Schering-Plough
	Tablets, extended-release	8 mg with Acetaminophen 500 mg and Phenylephrine Hydrochloride 40 mg	Protid	Lunsco
	Tablets, film-coated	2 mg with Acetaminophen 325 mg and Phenylephrine Hydrochloride 5 mg	Dristan Cold	Pfizer
		2 mg with Acetaminophen 325 mg and Pseudoephedrine Hydrochloride 30 mg	Flu-Relief Caplets	Pfeiffer
			Kolephrin Caplets	Pfeiffer
		2 mg with Ibuprofen 200 mg and Pseudoephedrine Hydrochloride 30 mg	Advil Allergy Sinus Caplets	Pfizer

References

Only references cited for selected revisions after 1984 are available electronically.

101. Schering Plough. Chlor-Trimeton tablets prescribing information. In: PDR for Nonprescription Drugs and Dietary Supplements. Montvale, NJ: Medical Economics Company In; 2003.

102. Schering-Plough Corporation. Coricidin HBP Cough & Cold (chlorpheniramine maleate and dextromethorphan hydrobromide) tablets patient information. From Schering-Plough website. Accessed 2008 Feb 19. http://www.coricidinhbp.com/CoughAndCold/Default.htm

103. McNeil Consumer Healthcare. Tylenol Allergy Multi-symptom (acetaminophen, chlorpheniramine maleate, phenylephrine hydrochloride) gelcaps and caplets patient information. From McNeil Consumer website. Accessed 2008 Feb 18. http://www.tylenol.com

104. Wyeth Consumer Healthcare. Dimetapp Long Acting Cough Plus Cold (chlorpheniramine maleate and dextromethorphan hydrobromide) syrup patient information. From Wyeth Consumer Healthcare website. Accessed 2008 Feb 19. http://www.dimetapp.com/cold/lbl_lacc.asp

105. Wyeth Consumer Healthcare. Advil Allergy Sinus (chlorpheniramine maleate, ibuprofen, and pseudoephedrine hydrochloride) caplets patient information. From Wyeth Consumer Healthcare website. Accessed 2008 Feb 19. http://www.advil.com/products/aas/caplets_label.asp

106. Novartis Consumer Health, Inc. Triaminic Flu, Cough & Fever (acetaminophen, chlorpheniramine maleate, and dextromethorphan hydrobromide) syrup patient information. From Novartis Consumer Health website. Accessed 2008 Feb 19. http://www.triaminic.com

107. Cypress Pharmaceutical, Inc. CPM 8/PE 20/MSC 1.25 (chlorpheniramine maleate, phenylephrine hydrochloride, and methscopolamine nitrate) extended-release tablets prescribing information. Madison, MS; 2003 Dec.

108. Cypress Pharmaceutical, Inc. Chlor-Mes D (chlorpheniramine maleate, phenylephrine hydrochloride, and methscopolamine nitrate) syrup prescribing information. Madison, MS; 2006 Jan.

109. Silarx Pharmaceuticals, Inc. Chlorpheniramine/PhenylephrineDextromethorphan oral drops and syrup prescribing information. Spring Valley, NY; 2005 Nov.

110. Cypress Pharmaceutical, Inc. ChlorDex GP (dextromethorphan hydrobromide, chlorpheniramine maleate, phenylephrine hydrochloride, and guaifenesin) syrup prescribing information. Madison, MS; 2006 Oct.

111. Hogil Pharmaceutical Corporation. Sine-Off Sinus/Cold (acetaminophen, chlorpheniramine maleate, and phenylephrine hydrochloride) patient information. From Hogil Pharmaceutical website. Accessed 2008 Feb 20. http://www.sineoff.com/sinus_and_cold.php

112. Medpoint Pharmaceuticals. Rynatan(chlorpheniramine tannate and phenylephrine tannate) chewable pediatric tablets prescribing information. Somerset, NJ; 2006 Aug.

113. Auriga Pharmaceuticals, LLC. Extendryl DM (chlorpheniramine maleate, dextromethorphan, and methscopolamine nitrate) extended-release tablets prescribing information. Norcross, GA; 2005 Sep.

114. Auriga Pharmaceuticals, LLC. Extendryl JR (chlorpheniramine maleate, phenylephrine hydrochloride, and methscopolamine nitrate) tablets prescribing information. Norcross, GA; 2007 Mar.

115. Kenwood Therapeutics. Deconamine (chlorpheniramine maleate and d-pseudoephedrine hydrochloride) sustained-release capsules prescribing information. Fairfield, NJ; 2003 Oct.

116. Bayer Healthcare. Alka-Seltzer Plus Cough and Cold (acetaminophen, chlorpheniramine maleate, dextromethorphan hydrochloride, and phenylephrine hydrochloride) capsules patient information. From Alka-Seltzer website. Accessed 2008 Feb 21.

117. Hi-Tech Pharmacal. Tri-Hist (chlorphenirmaine tannate, phenylephrine tannate, pyrilamine tannate) suspension prescribing information. Amityville, NY; 2005 Aug.

118. Hi-Tech Pharmacal. Phenyl Chlor-Tan (chlorphenirmaine tannate, phenylephrine tannate) pediatric suspension prescribing information. Amityville, NY; 2004 Oct.

119. Auriga Pharmaceuticals, LLC. Extendryl (phenylephrine hydrochloride, methscopolamine nitrate, and dexchlorpheniramine maleate) syrup prescribing information. Norcross, GA; 2006 Nov.

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aaa. Food and Drug Administration. FDA news: FDA releases recommendations regarding use of over-the-counter cough and cold products. Rockville, MD; 2008 Jan 17. From the FDA web site. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008

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