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Dextromethorphan Hydrobromide / Phenylephrine Hydrochloride / Chlorpheniramine Maleate

Pronouncation: (DEX-troe-meth-OR-fan HIGH-droe-BROE-mide/fen-ill-EFF-rin HIGH-droe-KLOR-ide/klor-fen-AIR-uh-meen MAL-ee-ate)
Class: Upper respiratory combination

Trade Names:
Alka-Seltzer Plus Cold & Cough
- Tablets 10 mg dextromethorphan, 5 mg phenylephrine, 2 mg chlorpheniramine

Trade Names:
Amerituss AD
- Liquid 15 mg dextromethorphan, 10 mg phenylephrine, 3 mg chlorpheniramine

Trade Names:
Father John's Medicine Plus
- Liquid 1.66 mg dextromethorphan, 1.66 mg phenylephrine, 0.66 mg chlorpheniramine

Trade Names:
Norel DM
- Liquid 15 mg dextromethorphan, 10ߙmg phenylephrine, 4 mg chlorpheniramine

Pharmacology

Dextromethorphan

Suppresses cough by central action on cough center in medulla.

Phenylephrine

Stimulates postsynaptic alpha-receptors, resulting in vasoconstriction, which reduces nasal congestion.

Chlorpheniramine

Competitively antagonizes histamine at H 1 receptor sites.

Indications and Usage

Temporary relief of coughs and upper respiratory symptoms, including nasal congestion, associated with allergy or common cold.

Slideshow: OTC Medication Use In Pregnancy: Wise or Worrisome?

Contraindications

Hypersensitivity to any ingredients of product; bronchial asthma; severe hypertension; severe coronary artery disease; narrow-angle glaucoma; urinary retention; peptic ulcer; MAOI therapy or for 2 wk after stopping MAOI therapy.

Dosage and Administration

Liquid doseforms
Adults and Children older than 12 yr of age

PO 2 tsp (10 mL) every 6 h.

Children 6 to 12 yr of age

PO 1 tsp (5 mL) every 6ߙh.

Children 2 to 6 yr of age

PO ½ tsp (2.5 mL) every 6ߙh.

Children younger than 2 yr of age

PO as directed by health care prover (max, 4 doses/24 h).

Tablets
Adults and Children 12 yr of age and older

2 tablets fully dissolved in 4 oz of water every 4 h (max, 8 tablets/24 h).

Children younger than 12 yr of age

Consult health care provider.

Storage/Stability

Store syrup at controlled room temperature (68° to 77°F).

Drug Interactions

CNS depressants (eg, hypnotics, sedatives, tranquilizers, antianxiety agents)

Effects of these agents may be enhanced.

MAOIs (eg, isocarboxazid)

Hypertensive crisis may occur. Do not use in patients receiving MAOI therapy or within 14 days of stopping such treatment. May prolong and intensify the effects of chlorpheniramine.

Laboratory Test Interactions

May interfere with diagnostic test results for skin tests using allergen extracts.

Adverse Reactions

Cardiovascular

Hypotension; hypertension; cardiac arrhythmias.

CNS

Sedation; dizziness; disturbed coordination; tremor; irritability; insomnia; weakness; nervousness; convulsions; headache; euphoria; dysphoria.

Dermatologic

Urticaria; rash; photosensitivity; pruritus.

EENT

Dryness of nose and throat; thickening of bronchial secretions; visual disturbances.

GI

Dryness of mouth; epigastric discomfort; anorexia; nausea; vomiting; diarrhea; constipation.

Genitourinary

Urinary frequency; difficult urination.

Hematologic

Hemolytic anemia; thrombocytopenia; agranulocytosis.

Respiratory

Tightness of chest; wheezing; shortness of breath.

Precautions

Monitor

Assess for allergy symptoms (eg, cough, rhinitis, nasal congestion, sneezing, itching, watery eyes) before and periodically throughout therapy. Monitor pulse and BP periodically during therapy. Monitor patient for nervousness, dizziness, and insomnia. If noted, hold therapy.


Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy in children younger than 2 yr of age not established.

Sodium and phenylalanine

Each effervescent Alka-Seltzer Plus Cold & Cough tablet contains sodium 504 mg and phenylalanine 11 mg.

Overdosage

Symptoms

Dextromethorphan

Drowsiness, ataxia, nystagmus, opisthotonos, convulsive seizures

Phenylephrine

Hypertension, headache, convulsions, cerebral hemorrhage, vomiting

Chlorpheniramine

CNS depression (eg, sedation, apnea, diminished mental alertness, CV collapse), CNS stimulation (eg, insomnia, hallucinations, tremors, convulsions), death

Patient Information

  • Advise patient to take dose every 6 h as needed, up to 4 times daily, as prescribed for liquid doseforms.
  • Advise patient to dissolve 2 effervescent tablets in 4 oz of water every 4 h and not to exceed 8 tablets in 24 h, or as prescribed.
  • Advise caregiver to use dosing spoon or syringe for children's doses.
  • 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.
  • Advise patient that each effervescent tablet contains sodium 504 mg and phenylalanine 11 mg.
  • 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.
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