chlorpheniramine/dextromethorphan (OTC)

Brand and Other Names:Children's Robitussin Cough & Cold Long-Acting, St. Joseph Cough & Cold
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

chlorpheniramine/dextromethorphan

softchew tablet

  • 1mg/5mg

oral syrup

  • (1mg/7.5mg)/5mL
  • (2mg/15mg)/5mL

tablet

  • 4mg/30mg
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Cough & Cold

4mg chlorpheniramine/30mg dextromethorphan PO q6hr PRN

Dosage Forms & Strengths

chlorpheniramine/dextromethorphan

softchew tablet

  • 1mg/5mg

oral syrup

  • (1mg/7.5mg)/5mL
  • (2mg/15mg)/5mL

tablet

  • 4mg/30mg
more...

Cough & Cold

<6 years

  • Safety and efficacy not established

6-12 years

  • Syrup: 2 mg chlorpheniramine/15 mg dextromethorphan PO q6hr
  • Softchew tablet: 2 mg chlorpheniramine/10 mg dextromethorphan PO q4-6hr

>12 years

  • 4mg chlorpheniramine/30mg dextromethorphan PO q6hr PRN
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Interactions

Interaction Checker

and chlorpheniramine/dextromethorphan

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Sedation ranging from mild drowsiness to deep sleep

            CNS depression

            Excitability may occur in children

            Dizziness

            Impaired coordination

            Muscular weakness

            Anorexia

            Nausea

            Vomiting

            Urinary retention

            Blurred vision

            Xerostomia

            Restlessness, insomnia, tremors, euphoria, nervousness, delirium, palpitations, seizures reported infrequently

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            Warnings

            Contraindications

            Hypersensitivity

            Within 2 wk of taking a monoamine oxidase (MAO) inhibitor

            Sedation of children

            Cautions

            Caution in children younger than 6 years

            Benign prostatic hypertrophy

            Glaucoma

            Caution in productive cough (do not suppress expectoration of phlegm)

            Chronic respiratory conditions (eg, asthma, COPD)

            Alcohol consumption or other CNS depressants may increase risk for drowsiness

            May impair ability to safely drive vehicle or operate machinery

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Unknown whether distributed in breast milk, caution advised

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Chlorpheniramine: Histamine H1-receptor antagonist; sedative effect is low; antihistamine and anticholinergic activity is moderate

            Dextromethorphan: Antitussive; derivative of levorphanol; acts on cough center in medulla

            Absorption

            Peak Plasma Time: 2-6 hr (chlorpheniramine); 2-3 hr (dextromethorphan)

            Onset: 15-30 min (dextromethorphan)

            Duration: 3-6 hr (dextromethorphan)

            Distribution

            Protein Bound: 69-72% (chlorpheniramine)

            Vd: 2.5-3.2 L/kg (chlorpheniramine)

            Metabolism

            Metabolism: GI mucosa, liver (chlorpheniramine); hepatic P450 enzyme CYP2D6 (dextromethorphan)

            Metabolites: Monodesmethylchlorpheniramine, didesmethylchlorpheniramine

            Elimination

            Half-Life: 12-43 hr (chlorpheniramine); 2-4 hr (extensive dextromethorphan metabolizers); 24 hr (poor dextromethorphan metabolizers)

            Excretion: Predominantly urine (chlorpheniramine and dextromethorphan)

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