Pseudoephedrine Hydrochloride / Guaifenesin / Dextromethorphan Hydrobromide
Pronouncation: (SUE-doe-eh-FED-rin HIGH-droe-KLOR-ide/GWHY-fen-ah-sin/DEX-troe-meth-OR-fan HIGH-droe-BROE-mide)Class: Antitussive and expectorant combination
Trade Names:
PanMist-DM
- Syrup 15 mg dextromethorphan hydrobromide, 100 mg guaifenesin, 40 mg pseudoephedrine hydrochloride per 5 mL
- Tablets 32 mg dextromethorphan hydrobromide, 595 mg guaifenesin, 48 mg pseudoephedrine hydrochloride
Pharmacology
Feedback for Pseudoephedrine HCl/Guaifenesin/Dextromethorphan HBr
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Causes vasoconstriction and subsequent shrinkage of nasal mucous membranes by alpha-adrenergic stimulation, which promotes nasal drainage.
GuaifenesinMay enhance output of respiratory tract fluid by reducing adhesiveness and surface tension, enhancing removal of viscous mucus and making nonproductive coughs more productive and less frequent.
DextromethorphanSuppresses cough by central action on cough center in medulla.
Indications and Usage
Temporary relief of nasal congestion and cough associated with respiratory tract infections and related conditions, such as sinusitis, pharyngitis, bronchitis, and asthma, when these conditions are complicated by tenacious mucus or mucus plugs and congestion.
Contraindications
Hypertension; severe coronary artery disease; MAOI therapy; pregnancy; nursing; hypersensitivity to any component of product or idiosyncrasy to sympathomimetic amines, which may manifest as insomnia, dizziness, weakness, tremor, or arrhythmias.
Dosage and Administration
Adults and Children older than 12 yr of agePO 1 or 2 tablets every 12 h (max, 4 tablets in 24 h) or up to 2 tsp of syrup 3 to 4 times daily.
Children 6 to 12 yr of agePO 1 tablet every 12 h (max, 2 tablets in 24 h) or up to 1 tsp 3 to 4 times daily, not to exceed 4 mg per kilogram of body weight of pseudoephedrine in 24 h.
General Advice
- Tablets may be broken in half for ease of administration. Do not crush or chew tablets or half-tablets.
- Administer without regard to meals. Administer with food if GI upset occurs.
- Measure and administer prescribed dose of syrup using dosing syringe, dosing spoon, or dosing cup.
Storage/Stability
Store tablets and syrup at controlled room temperature (59° to 86°F).
Drug Interactions
DigitalisEctopic pacemaker activity may be increased by pseudoephedrine.
Guanethidine, mecamylamine, methyldopa, reserpine, veratrum alkaloidsAntihypertensive effects may be reduced by pseudoephedrine.
KaolinMay increase pseudoephedrine absorption.
MAOIs (eg, isocarboxazid)May increase the effects of pseudoephedrine. Dextromethorphan is contraindicated with MAOIs.
Laboratory Test Interactions
Guaifenesin may interfere with the interpretation of the test for urinary 5-hydroxyindoleacetic acid for the diagnosis of carcinoid syndrome.
Adverse Reactions
Cardiovascular
Tachycardia; palpitations; arrhythmias; CV collapse with hypotension.
CNS
Headache; dizziness; fear; anxiety; nervousness; restlessness; tremor; weakness; insomnia; hallucinations; convulsions; CNS depression.
GI
Nausea.
Genitourinary
Dysuria.
Respiratory
Respiratory difficulty.
Miscellaneous
Pallor.
Precautions
Pregnancy
Category C .
Lactation
Contraindicated in nursing women.
Children
Safety and efficacy in children younger than 6 yr of age not established for tablets and in children younger than 2 yr of age for syrup.
Elderly
Geriatric patients are more likely to exhibit adverse reactions, such as confusion or CNS depression.
Special Risk Patients
Use with caution in patients with hypertension, heart disease, asthma, hyperthyroidism, increased IOP, diabetes mellitus, prostatic hypertrophy.
Cough
To determine that appropriate therapy for the primary disease is instituted, ascertain underlying cause of cough prior to use of cough suppressants.
Drug abuse
Has abuse potential.
Overdosage
Symptoms
PseudoephedrineExcessive CNS stimulation (eg, excitement, tremor, restlessness, insomnia), tachycardia, hypertension, pallor, mydriasis, hyperglycemia, urinary retention, tachypnea, hyperpnea, hallucinations, convulsions, delirium, arrhythmias, hypotension, circulatory collapse, hypokalemia
DextromethorphanDrowsiness, ataxia, nystagmus, opisthotonos, convulsive disorders
Patient Information
- Advise patient to take prescribed dose every 12 h as needed.
- Advise patient to take with food if GI upset occurs.
- 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 not to double the dose to catch up.
- Instruct patient to discontinue use and report any of these symptoms to health care provider: nervousness, dizziness, sleeplessness.
- Advise patient that if symptoms are not controlled, not to increase the dose of medication but to inform health care provider.
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