Chlorpheniramine Maleate/Phenylephrine Hydrochloride/Methscopolamine Nitrate
Pronouncation: (klor-fen-AIR-uh-meen MAL-ee-ate/Fen-ill-EFF-rin HIGH-droe-KLOR-ide/meth-skoe-PAHL-uh-meen NYE-trate)
Class: Antihistamine, Decongestant, Anticholinergic
Trade Names:
AH-chew
- Tablets 10 mg phenylephrine, 2 mg chlorpheniramine, 1.25 mg methscopolamine
Trade Names:
Dallergy
- Syrup 10 mg phenylephrine, 2 mg chlorpheniramine, 0.625 mg methscopolamine
- Tablets 10 mg phenylephrine, 4 mg chlorpheniramine, 1.25 mg methscopolamine
- Tablets 20 mg phenylephrine, 12 mg chlorpheniramine, 2.5 mg methscopolamine
Trade Names:
Dehistine
- Syrup 10 mg phenylephrine, 2 mg chlorpheniramine, 1.25 mg methscopolamine
Trade Names:
DriHist
- SR Tablets 20 mg phenylephrine, 8 mg chlorpheniramine, 2.5 mg methscopolamine
Trade Names:
Duradryl
- Syrup 10 mg phenylephrine, 2 mg chlorpheniramine, 1.25 mg methscopolamine
Trade Names:
Ex-Histine
- Syrup 10 mg phenylephrine, 2 mg chlorpheniramine, 1.25 mg methscopolamine
Trade Names:
Extendryl
- Chewable Tablets 10 mg phenylephrine, 2 mg chlorpheniramine, 1.25 mg methscopolamine
- SR Capsules 20 mg phenylephrine, 8 mg chlorpheniramine, 2.5 mg methscopolamine
- Syrup 10 mg phenylephrine, 2 mg chlorpheniramine, 1.25 mg methscopolamine
Trade Names:
Hista-Vent DA
- Tablets 20 mg phenylephrine, 8 mg chlorpheniramine, 2.5 mg methscopolamine
Trade Names:
Omnihist L.A.
- Tablets 20 mg phenylephrine, 8 mg chlorpheniramine, 2.5 mg methscopolamine
Trade Names:
Pre-Hist-D
- Tablets 20 mg phenylephrine, 8 mg chlorpheniramine, 2.5 mg methscopolamine
Mechanism of Action
Pharmacology
Chlorpheniramine
Competitively antagonizes histamine at H 1 receptor sites.
Phenylephrine
Stimulates postsynaptic alpha-receptors, resulting in vasoconstriction, which reduces congestion.
Methscopolamine
Competitively inhibits action of acetylcholine at muscarinic receptors.
Indications and Usage
Temporary relief of symptoms of allergic rhinitis, vasomotor rhinitis, sinusitis, and the common cold.
Contraindications
Hypersensitivity or idiosyncratic reaction to any ingredients of product; severe hypertension; severe coronary artery disease; narrow-angle glaucoma; urinary retention; hyperthyroidism; peptic ulcer; asthma attack; MAOI therapy or for 2 wk after stopping MAOI therapy.
Dosage and Administration
Extended-Release Formulations
Adults and Children (12 yr of age and older)
PO 1 tablet/capsule every 12 h.
Children 6 to 12 yr of age
PO ½ tablet/capsule every 12 h.
Chewable Tablets
Adults and Children (12 yr of age and older)
PO 1 to 2 tablets every 4 h.
Children 6 to 12 yr of age
PO 1 tablet every 4 h.
Children younger than 6 yr of age
PO As recommended by health care provider.
Syrup
Adults
PO 1 to 2 tsp (5 to 10 mL) every 3 to 4 h.
Children 6 to 12 yr of age
PO ½ to 1 tsp (2.5 to 5 mL), depending on weight of child; may repeat every 4 h.
Children younger than 6 yr of age
PO As recommended by health care provider.
PreHist-D / Hista-Vent DA
Adults and children 12 yr of age and older
PO 1 tablet every 12 h.
Children 6 to 12 yr of age
PO ½ tablet every 12 h.
General Advice
- Syrup
- Give with food or milk if GI upset occurs.
- Use dosing spoon or syringe for pediatric doses of syrup.
- Chewable tablets
- Give with food or milk if GI upset occurs.
- Extended-release formulations
- Caplets may be broken in half but should not be crushed or chewed.
- Give with food or milk if GI upset occurs.
Storage/Stability
Syrup
Store at controlled room temperature. Keep syrup tightly capped and protect from freezing.
Chewable tablets
Store at controlled room temperature (69° to 77°F).
Extended-release formulations
Store at controlled room temperature (69° to 77°F).
Drug Interactions
Alcohol, barbiturates (eg, phenobarbital), tricyclic antidepressants (eg, amitriptyline), other CNS depressants
Effects may be enhanced by chlorpheniramine.
MAOIs (eg, isocarboxazid)
May prolong and intensify the effects of chlorpheniramine and increase the effects of phenylephrine.
Mecamylamine, methyldopa, reserpine, veratrum alkaloids
Antihypertensive effects may be reduced by phenylephrine.
Laboratory Test Interactions
May interfere with diagnostic test results for skin tests using allergen extracts.
Adverse Reactions
Cardiovascular
Phenylephrine
Tachycardia; palpitations; arrhythmias; CV collapse; hypotension.
CNS
Chlorpheniramine
Drowsiness; dizziness.
Phenylephrine
Nervousness; insomnia; restlessness; headache; fear; anxiety; tremor; weakness; insomnia; hallucinations; convulsions; CNS depression; irritability; tenseness.
Dermatologic
Phenylephrine
Pallor.
EENT
Chlorpheniramine
Blurred vision; nose, throat, and mouth dryness.
GI
Phenylephrine
Gastric irritation and irritability.
Genitourinary
Chlorpheniramine
Urinary retention.
Phenylephrine
Dysuria; urinary retention.
Respiratory
Phenylephrine
Respiratory difficulty.
Precautions
Monitor
Allergy symptoms
Assess for allergy symptoms (eg, rhinitis, nasal congestion, sneezing, itching, watery eyes) before and periodically throughout therapy.
CNS symptoms
Monitor patient for nervousness, dizziness, and insomnia. If noted, hold therapy and notify health care provider.
Excitability
Monitor children for antihistamine-induced excitability.
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Pregnancy
Category C .
Lactation
Undetermined.
Children
Safety and efficacy in children younger than 6 yr of age not established. Antihistamines may cause excitability in children.
Elderly
Patients 60 yr of age and older more likely to exhibit adverse reactions.
Special Risk Patients
Use with caution in patients with hypertension, heart disease, asthma, hyperthyroidism, increased IOP, diabetes mellitus, and prostatic hypertrophy.
Overdosage
Symptoms
Dry mouth, dilated pupils, hallucinations, severe hypertension, ventricular extrasystoles, short paroxysms of ventricular tachycardia, CNS depression, CNS stimulation, somnolence, convulsions, shock, death.
Patient Information
- Review dosing schedule for prescribed dose form (eg, syrup, chewable tablet, extended-release tablet).
- Advise caregiver to use dosing spoon or syringe when giving syrup to children.
- Caution patient that extended-release tablet can be broken in half but that dose should be swallowed whole and not crushed or chewed.
- 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 because of 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: nervousness, dizziness, sleeplessness.
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