Chlorpheniramine Maleate / Pseudoephedrine Hydrochloride / Codeine Phosphate
Pronouncation: (klor-fen-AIR-uh-meen MAL-ee-ate/SUE-doe-eh-FED-rin HIGH-droe-KLOR-ide/KOE-deen FOSS-fate)Class: Antitussive combination
Trade Names:
Dihistine DH
- Liquid 10 mg codeine phosphate, 2 mg chlorpheniramine maleate, 30 mg pseudoephedrine hydrochloride
Pharmacology
Feedback for Chlorpheniramine Maleate/Pseudoephedrine Hydrochloride/Codeine Phosphate
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Competitively antagonizes histamine at H 1 receptor sites.
PseudoephedrineCauses vasoconstriction and subsequent shrinkage of nasal mucous membranes by alpha-adrenergic stimulation, which promotes nasal drainage.
CodeineSuppresses cough reflex.
Indications and Usage
Temporary relief of runny nose, sneezing, and itchy, watery eyes due to hay fever (allergic rhinitis); temporary relief of cough due to minor bronchial irritation and nasal congestion caused by common cold; temporary relief of sinus congestion and pressure.
Contraindications
Hypersensitivity or idiosyncratic reaction to any ingredients of product; severe hypertension; severe coronary artery disease; narrow-angle glaucoma; urinary retention; peptic ulcer; asthma attack; MAOI therapy or for 2 wk after stopping MAOI therapy.
Dosage and Administration
Adults and Children 12 yr of age and olderPO 2 tsp (10 mL) every 6 h, not to exceed 4 doses/24 h.
Children 6 to younger than 12 yr of agePO 1 tsp (5 mL) every 6 h, not to exceed 4 doses/24 h.
Children younger than 6 yr of ageConsult health care provider.
General Advice
- Give with food or milk if GI upset occurs.
- Use dosing spoon or syringe for pediatric doses.
Storage/Stability
Store elixir at controlled room temperature (68° to 77°F). Keep tightly capped.
Drug Interactions
Alcohol, barbiturates (eg, phenobarbital), tricyclic antidepressants (eg, amitriptyline), other CNS depressantsEffects may be enhanced by carbinoxamine.
MAOIs (eg, isocarboxazid)May prolong and intensify the effects of chlorpheniramine and increase the effects of pseudoephedrine.
Mecamylamine, methyldopa, reserpine, veratrum alkaloidsAntihypertensive effects may be reduced by pseudoephedrine.
Laboratory Test Interactions
May interfere with diagnostic test results for skin tests using allergen extracts.
Adverse Reactions
Cardiovascular
PseudoephedrineCardiac arrhythmia; increased heart rate; increased BP.
CNS
ChlorpheniramineSedation; dizziness; headache; nervousness; rare excitability in children.
PseudoephedrineConvulsions; CNS stimulation; hallucinations; tremors; nervousness; insomnia.
CodeineLightheadedness; disorientation; drowsiness; dizziness.
EENT
CodeineMiosis.
GI
ChlorpheniramineVomiting; diarrhea; dry mouth; nausea; anorexia; heartburn.
CodeineNausea; vomiting; constipation; abdominal pain; anorexia; biliary tract spasm.
Genitourinary
ChlorpheniraminePolyuria; dysuria; urinary retention in patients with prostatic hypertrophy.
PseudoephedrineDysuria.
Respiratory
PseudoephedrineRespiratory difficulties.
Miscellaneous
PseudoephedrinePallor.
Precautions
MonitorAllergy symptomsAssess for allergy symptoms (eg, cough, rhinitis, nasal congestion, sneezing, itching, watery eyes) before and periodically throughout therapy. Adverse reactionsMonitor patient for nervousness, dizziness, and insomnia. If noted, hold therapy and notify health care provider. |
Pregnancy
Consult health care provider before use.
Lactation
Consult health care provider before use.
Special Risk Patients
Use with caution in patients with hypertension, heart disease, asthma, hyperthyroidism, increased IOP, diabetes mellitus, prostatic hypertrophy.
Overdosage
Symptoms
ChlorpheniramineDecreased mental alertness, ataxia, hallucinations, convulsions, death
PseudoephedrineSomnolence, sedation, profuse sweating, hypotension, shock, coma, elderly patients may experience hallucinations, seizures, CNS depression, death
CodeineMiosis, respiratory and CNS depression, circulatory collapse, seizures, cardiopulmonary arrest, death
Patient Information
- Advise patient to take prescribed dose every 6 h as needed, up to 4 times daily.
- Advise caregiver to use dosing spoon or syringe when giving elixir to children.
- Advise patient to take with food or milk if GI upset occurs.
- Advise patient to take last dose late in the afternoon or early evening to reduce chance of drug causing sleeplessness.
- Advise patient that if a dose is missed to take as soon as remembered unless it is nearing time for the next dose. Caution patient to not double the dose to catch up.
- Advise patient that if allergy symptoms are not controlled, not to increase the dose of medication but to inform health care provider.
- Caution patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined.
- Advise patient to avoid alcohol and other CNS depressants due to risk of excessive sedation.
- Caution patient not to take any OTC antihistamines or decongestants while taking this medication unless advised by health care provider.
- If patient is to have allergy skin testing, advise to not take the medication for at least 6 days before the skin testing.
- Instruct patient to stop taking drug and immediately report any of the following symptoms to health care provider if occurring: nervousness, dizziness, sleeplessness.
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