strategy planning stage Dexchlorpheniramine and Pseudoephedrine Pronunciation (deks klor fen EER a meen & soo doe e FED rin) Index Terms Pseudoephedrine Hydrochloride and Dexchlorpheniramine Maleate Dosage Forms Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Tablet, Oral: Rescon: Dexchlorpheniramine maleate 2 mg and pseudoephedrine hydrochloride 60 mg Brand Names: U.S. Rescon [OTC] Pharmacologic Category Alkylamine Derivative Alpha/Beta Agonist Decongestant Histamine H 1 Antagonist Histamine H 1 Antagonist, First Generation Pharmacology Dexchlorpheniramine: Competes with histamine for H 1 -receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract. Dexchlorpheniramine is the predominant active isomer of chlorpheniramine and is approximately twice as active as the racemic compound (Moreno 2010). Pseudoephedrine: Directly stimulates alpha-adrenergic receptors of respiratory mucosa causing vasoconstriction; directly stimulates beta-adrenergic receptors causing bronchial relaxation, increased heart rate and contractility. Use: Labeled Indications Upper respiratory allergies: Temporary relief of nasal congestion, runny nose, sneezing, itching of nose or throat and itchy, watery eyes caused by hay fever or other upper respiratory allergies. Contraindications OTC labeling: When used for self-medication, do not use with or within 2 weeks of discontinuing an MAO inhibitor or if you have emphysema or chronic bronchitis. Dosing: Adult Upper respiratory allergies: Oral: Dexchlorpheniramine 2 mg/pseudoephedrine 60 mg per tablet: 1 tablet every 4 to 6 hours (maximum: 4 tablets [dexchlorpheniramine 8 mg/pseudoephedrine 240 mg] per 24 hours). Dosing: Geriatric Refer to adult dosing. Dosing: Pediatric Upper respiratory allergies: Children 12 years and Adolescents: Oral: Refer to adult dosing. Dosing: Renal Impairment There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Dosing: Hepatic Impairment There are no dosage adjustments provided in the manufacturer's labeling. Storage Store at 20 C to 25 C (68 F to 77 F). Drug Interactions AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Monitor therapy Alkalinizing Agents: May increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists may antagonize Alpha1-Blocker vasodilation. Monitor therapy Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy Amifampridine: May diminish the anticholinergic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Amifampridine. Monitor therapy Amphetamines: May diminish the sedative effect of Antihistamines. Monitor therapy Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Avoid combination 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: Alpha-/Beta-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. Consider therapy modification Betahistine: Antihistamines may diminish the therapeutic effect of Betahistine. Monitor therapy Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Consider therapy modification Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine patches (Butrans brand) at 5 mcg/hr in adults when used with other CNS depressants. Consider therapy modification Cannabis: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Carbonic Anhydrase Inhibitors: May increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Monitor therapy Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Consider therapy modification Chloroprocaine: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Monitor therapy Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Monitor therapy Cocaine: May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Consider therapy modification Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Monitor therapy Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Monitor therapy Dronabinol: May enhance the CNS depressant effect of CNS Depressants. 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 Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination Ergot Derivatives: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Exceptions: Ergoloid Mesylates; Nicergoline. Avoid combination Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Consider therapy modification Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Monitor therapy Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. 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 HYDROcodone: CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. 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 Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Consider therapy modification Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy 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 Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy Minocycline: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy Mirtazapine: CNS Depressants may enhance the CNS depressant effect of Mirtazapine. Monitor therapy Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of Alpha-/Beta-Agonists (Indirect-Acting). While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Exceptions: Linezolid; Tedizolid. Avoid combination Nabilone: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Monitor therapy OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy Opioid Analgesics: CNS Depressants may enhance the CNS depressant effect of Opioid Analgesics. Management: Avoid concomitant use of opioid analgesics and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Avoid combination Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Avoid combination OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Avoid combination Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Consider therapy modification Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Monitor therapy Pitolisant: Antihistamines may diminish the therapeutic effect of Pitolisant. Monitor therapy Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Avoid combination Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Monitor therapy Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Monitor therapy Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Monitor therapy Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Monitor therapy Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration 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 Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the tachycardic effect of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitors may enhance the vasopressor effect of Alpha-/Beta-Agonists. Consider therapy modification Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. Consider therapy modification Spironolactone: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Monitor therapy Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Consider therapy modification Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy Tapentadol: May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Monitor therapy Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Avoid combination Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Urinary Acidifying Agents: May decrease the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult 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 Adverse Reactions There are no adverse reactions listed in the manufacturer s labeling. See individual agents. Warnings/Precautions Concerns related to adverse effects: CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery, driving). Disease-related concerns: Cardiovascular disease: Use with caution in patients with cardiovascular disease (including hypertension and ischemic heart disease). Diabetes: Use with caution in patients with diabetes mellitus. Increased intraocular pressure/glaucoma: Use with caution in patients with increased intraocular pressure or angle closure glaucoma. Prostatic hyperplasia/urinary stricture: Use with caution in patients with prostatic hyperplasia and/or GU obstruction. Pyloroduodenal obstruction: Use with caution in patients with pyloroduodenal obstruction (including stenotic peptic ulcer). Renal impairment: Use caution in patients with renal impairment. Seizure disorder: Use with caution in patients with seizure disorder; pseudoephedrine may produce CNS stimulation. Thyroid dysfunction: Use with caution in patients with thyroid dysfunction. Concurrent drug therapy issues: Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Special populations: Elderly: Use with caution in elderly patients; may be more sensitive to adverse effects. Pediatrics: Antihistamines may cause excitation in young children. Other warnings/precautions: Self-medication (OTC use): When used for self-medication (OTC), discontinue use and notify a health care provider if symptoms do not improve within 7 days or are accompanied by fever or if nervousness, dizziness, or sleeplessness occur. Pregnancy Considerations Refer to individual agents. Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience dizziness, anxiety, insomnia, or fatigue (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. 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generally Dexchlorpheniramine and Pseudoephedrine all of a sudden
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