(klor fen IR a meen, fen il EF rin, & meth skoe POL a meen)
Treatment of upper respiratory symptoms such as respiratory congestion, allergic rhinitis, vasomotor rhinitis, sinusitis, and allergic skin reactions of urticaria and angioedema
Hypersensitivity to chlorpheniramine, methscopolamine, phenylephrine, or any component of the formulation; patients with severe hypertension, severe coronary artery disease, narrow-angle glaucoma, urinary retention, peptic ulcer, hyperthyroidism; patients on MAO inhibitors or beta-blockers; not for use during asthma exacerbation
Note: If disturbances in urination occur in patients without renal impairment, medication should be discontinued for 1-2 days and should then be restarted at a lower dose
Relief of respiratory symptoms: Oral:
aeroKid ¢ „ ¢: 5-10 mL every 3-4 hours
Ah-Chew ‚ ® suspension: 5-10 mL every 12 hours
Dallergy ‚ ®, OMNIhist ‚ ® II L.A., Rescon ‚ ® MX: One capsule/tablet every 12 hours
Duradryl ‚ ® syrup: 5-10 mL every 3-4 hours (4 times/day)
Use with caution; elderly may have increased adverse reactions.
Relief of respiratory symptoms: Oral:
Children 6-11 years:
aeroKid ¢ „ ¢: 2.5-5 mL every 4 hours
Ah-Chew ‚ ® suspension: 2.5-5 mL every 12 hours
Dallergy ‚ ®, OMNIhist ‚ ® II L.A., Rescon ‚ ® MX: One-half caplet/tablet every 12 hours
Duradryl ‚ ® syrup: 2.5-5 mL, may repeat up to every 4 hours depending on age and body weight
Children ≥12 years: Refer to adult dosing.
Avoid use.
Store at controlled room temperature.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Caplet, extended release:
aerohist plus ¢ „ ¢: Chlorpheniramine maleate 8 mg, phenylephrine hydrochloride 20 mg, and methscopolamine nitrate 2.5 mg [DSC]
Dallergy ‚ ®: Chlorpheniramine maleate 12 mg, phenylephrine hydrochloride 20 mg, and methscopolamine nitrate 2.5 mg [scored] [DSC]
Liquid:
Chlor-Mes-D: Chlorpheniramine maleate 2 mg, phenylephrine hydrochloride 10 mg, and methscopolamine nitrate 0.625 mg per 5 mL (480 mL) [grape flavor] [DSC]
Suspension:
AH-Chew ‚ ®: Chlorpheniramine tannate [equivalent to chlorpheniramine maleate 2 mg], phenylephrine tannate [equivalent to phenylephrine hydrochloride 10 mg], and methscopalamine nitrate 1.5 mg per 5 mL (120 mL) [grape flavor] [DSC]
Syrup:
aeroKid ¢ „ ¢: Chlorpheniramine maleate 4 mg, phenylephrine hydrochloride 10 mg, and methscopolamine nitrate 1.25 mg per 5 mL (120 mL, 480 mL) [contains propylene glycol; blue raspberry flavor]
Dallergy: Chlorpheniramine maleate 2 mg, phenylephrine hydrochloride 8 mg, and methscopolamine nitrate 0.75 mg per 5 mL (480 mL) [contains propylene glycol; grape flavor] [DSC]
Dehistine: Chlorpheniramine maleate 2 mg, phenylephrine hydrochloride 10 mg, and methscopolamine nitrate 1.25 mg per 5 mL (480 mL) [root beer flavor] [DSC]
DryMax: Chlorpheniramine maleate 4 mg, phenylephrine hydrochloride 15 mg, and methscopolamine nitrate 1.25 mg per 5 mL (120 mL) [contains propylene glycol; alcohol free; grape flavor]
Duradryl ‚ ®: Chlorpheniramine maleate 2 mg, phenylephrine hydrochloride 10 mg, and methscopolamine nitrate 1.25 mg per 5 mL (480 mL) [contains sodium benzoate; cherry flavor]
Triall ¢ „ ¢: Chlorpheniramine maleate 2 mg, phenylephrine hydrochloride 8 mg, and methscopolamine nitrate 0.75 mg per 5 mL (473 mL) [contains sodium benzoate; alcohol free; grape flavor] [DSC]
Tablet [scored]:
Dallergy ‚ ®: Chlorpheniramine maleate 4 mg, phenylephrine hydrochloride 10 mg, and methscopolamine nitrate 1.25 mg [DSC]
Tablet, chewable:
AH-Chew ¢ „ ¢ Ultra: Chlorpheniramine tannate [equivalent to chlorpheniramine maleate 2 mg], phenylephrine tannate [equivalent to phenylephrine hydrochloride 10 mg], and methscopolamine nitrate 1.5 mg [scored; grape flavor] [DSC]
Tablet, long acting [scored]:
OMNIhist ‚ ® II L.A.: Chlorpheniramine maleate 8 mg, phenylephrine hydrochloride 25 mg, and methscopolamine nitrate 2.5 mg [DSC]
AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy
Acetylcholinesterase Inhibitors (Central): Anticholinergics may diminish the therapeutic effect of Acetylcholinesterase Inhibitors (Central). Acetylcholinesterase Inhibitors (Central) may diminish the therapeutic effect of Anticholinergics. If the anticholinergic action is a side effect of the agent, the result may be beneficial. Monitor therapy
Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Monitor therapy
Amphetamines: May diminish the sedative effect of Antihistamines. Monitor therapy
Anticholinergics: May enhance the adverse/toxic effect of other Anticholinergics. Exceptions: Levocabastine (Nasal); Paliperidone. Monitor therapy
ARIPiprazole: CYP2D6 Inhibitors (Weak) may increase the serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy and/or indication. Consult product labeling for specific recommendations. Monitor therapy
Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy
Benzylpenicilloyl Polylysine: Antihistamines may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Suspend systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing and delay testing until systemic antihistaminic effects have dissipated. A histamine skin test may be used to assess persistent antihistaminic effects. Consider therapy modification
Benzylpenicilloyl Polylysine: Alpha1-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider use of a histamine skin test as a positive control to assess a patients ability to mount a wheal and flare response. Consider therapy modification
Betahistine: Antihistamines may diminish the therapeutic effect of Betahistine. Monitor therapy
Cannabinoids: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoids. Monitor therapy
CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Exceptions: Levocabastine (Nasal). Monitor therapy
Conivaptan: May increase the serum concentration of CYP3A4 Substrates. Avoid combination
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Consider therapy modification
Dasatinib: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (e.g., opioids, barbiturates) with concomitant use. Consider therapy modification
Ergot Derivatives: May enhance the hypertensive effect of Alpha1-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha1-Agonists. Exceptions: Ergoloid Mesylates. Avoid combination
FentaNYL: Alpha1-Agonists may decrease the serum concentration of FentaNYL. Specifically, fentanyl nasal spray serum concentrations may decrease and onset of effect may be delayed. Monitor therapy
Hyaluronidase: Antihistamines may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving antihistamines (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Consider therapy modification
HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy
Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Avoid combination
Ioflupane I 123: Phenylephrine may diminish the diagnostic effect of Ioflupane I 123. Monitor therapy
Ivacaftor: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
MAO Inhibitors: May enhance the hypertensive effect of Alpha1-Agonists. Avoid combination
Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. Consider therapy modification
Metyrosine: CNS Depressants may enhance the sedative effect of Metyrosine. Monitor therapy
Mifepristone: May increase the serum concentration of CYP3A4 Substrates. Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus. Consider therapy modification
OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy
Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Monitor therapy
Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Consider therapy modification
Pramlintide: May enhance the anticholinergic effect of Anticholinergics. These effects are specific to the GI tract. Consider therapy modification
RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Consider therapy modification
Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Monitor therapy
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy
Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
Tricyclic Antidepressants: May enhance the vasopressor effect of Alpha1-Agonists. Consider therapy modification
Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Consider therapy modification
See individual agents.
Frequency not defined.
Cardiovascular: Arrhythmias, bradycardia, cardiovascular collapse, flushing, hypotension, pallor, palpitation, tachycardia
Central nervous system: Anxiety, convulsions, CNS depression, dizziness, drowsiness, excitability, fear, giddiness, hallucinations, headache, insomnia, irritability, lassitude, restlessness, tenseness, tremor
Gastrointestinal: Constipation, dysphagia, gastric irritation, nausea, xerostomia
Genitourinary: Dysuria, urinary retention
Neuromuscular & skeletal: Weakness
Ocular: Blurred vision, mydriasis
Respiratory: Dry nose, dry throat, respiratory difficulty
Concerns related to adverse effects:
- CNS depression: May cause CNS depression and blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).
Disease-related concerns:
- Cardiovascular disease: Use with caution in patients with cardiovascular disease (including hypertension and ischemic heart disease); contraindicated with severe disease.
- Diabetes: Use with caution in patients with diabetes mellitus.
- Hepatic impairment: Use with caution in patients with hepatic impairment.
- Increased intraocular pressure: Use with caution in patients with increased intraocular pressure.
- Neuropathy: Use with caution in patients with autonomic neuropathy.
- Prostatic hyperplasia/urinary obstruction: Use with caution in patients with prostatic hyperplasia and/or GU obstruction.
- Renal impairment: Use with caution in patients with renal impairment.
- Ulcerative colitis: Use with caution in patients with ulcerative colitis.
Concurrent drug therapy issues:
- Sedatives: Effects may be potentiated when used with other sedative drugs or ethanol.
Special populations:
- Elderly: Use with caution in the elderly; may be more sensitive to adverse effects.
- Pediatrics: Antihistamines may cause excitation in young children. Safety and efficacy have not been established in children <6 years of age.
C
Reproduction studies with this combination have not been conducted; see individual agents.
Chlorpheniramine maleate: Antihistamine
Phenylephrine hydrochloride: Sympathomimetic agent (primarily alpha), decongestant
Methscopolamine nitrate: Derivative of scopolamine, antisecretory effects
See individual agents.