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chlorpheniramine/dextromethorphan/phenylephrine (Father John's Medicine Plus Liquid, NeoTuss Plus Liquid)

 

Classes: Cough/Cold, Non-narcotic Combos; Antihistamines, Alkylamine Derivatives

Dosing and uses of Father John's Medicine Plus Liquid, NeoTuss Plus Liquid (chlorpheniramine/dextromethorphan/phenylephrine)

 

Adult dosage forms and strengths

chlorpheniramine/dextromethorphan/phenylephrine

oral drops

  • (1mg/3mg/3.5mg)/1mL
  • (1mg/2.5mg/2.5mg)/1mL
  • (1mg/3mg/2mg)/1mL
  • (0.75mg/2.75mg/1.75mg)/1mL

liquid

  • (4mg/15mg/10mg)/5mL
  • (2mg/15mg/10mg)/5mL
  • (2mg/15mg/5mg)/5mL
  • (2mg/5mg/5mg)/15mL

tablet

  • 4mg/20mg/10mg

 

Temporary Relief of Cough Associated with Allergies or the Common Cold

30 mL [(2mg/5mg/5mg)/15mL] PO q4hr; not to exceed 180 mL/day

5 mL [(2-4mg/15mg/5-10mg)/5mL] PO q4-6hr; not to exceed 20 mL/day

1 tab PO q4-6hr; not to exceed 6 tab/24hr

 

Pediatric dosage forms and strengths

chlorpheniramine/dextromethorphan/phenylephrine

oral drops

  • (1mg/3mg/3.5mg)/1mL
  • (1mg/2.5mg/2.5mg)/1mL
  • (1mg/3mg/2mg)/1mL
  • (0.75mg/2.75mg/1.75mg)/1mL

liquid

  • (4mg/15mg/10mg)/5mL
  • (2mg/15mg/10mg)/5mL
  • (2mg/15mg/5mg)/5mL
  • (2mg/5mg/5mg)/15mL

tablet

  • 4mg/20mg/10mg

 

Temporary Relief of Cough Associated with Allergies or the Common Cold

<6 Years Old

  • Ask a pediatrician

6-12 Years Old

  • 2 mL [(0.75mg/2.75mg/1.75mg)/1mL] PO q4-6hr; not to exceed 12 mL/day
  • 2 mL [(1mg/2.5-3mg/2-2.5mg)/1mL] PO q4-6hr; not to exceed 8 mL/day
  • 1 mL [(1mg/3mg/3.5mg)/1mL] PO q4-6hr; not to exceed 6 mL/day
  • 2.5mL [(2-4mg/15mg/5-10mg)/5mL PO q4-6hr; not to exceed 15mL/day
  • 1/2 tab PO q4-6hr; not to exceed 3 tabs/day

>12 Years Old

  • 30 mL [(2mg/5mg/5mg)/15mL] PO q4hr; not to exceed 180 mL/day
  • 5 mL [(2-4mg/15mg/5-10mg)/5mL] PO q4-6hr; not to exceed 20 mL/day
  • 1 tab PO q4-6hr; not to exceed 6 tab/24hr

 

Father John's Medicine Plus Liquid, NeoTuss Plus Liquid (chlorpheniramine/dextromethorphan/phenylephrine) adverse (side) effects

Frequency not defined

Hypertension

Hypotension

Palpitations

Reflex tachycardia

Severe peripheral and visceral vasoconstriction

Tachycardia

Confusion

Depression

Distress

Dizziness

Drowsiness

Excitability

Euphoria

Fatigue

Headache

Insomnia

Irritability

Restlessness

Sedation

Tremor

Anorexia

GI disturbances

Agranulocytosis

Hemolytic anemia

Thrombocytopenia

Thickening of bronchial secretions

Wheezing

 

Warnings

Contraindications

Contraindicated in documented hypersensitivity; asthma attacks, narrow-angle glaucoma, symptomatic prostate hypertrophy, bladder-neck obstruction, and stenosing peptic ulcer

 

Cautions

Caution in elderly patients, hyperthyroidism, myocardial disease, bradycardia, partial heart block or severe arteriosclerosis when administering phenylephrine; in hypovolemia, phenylephrine use is not a substitute for replacement of blood, fluids and electrolytes, and plasma (promptly restore with loss); dilute IV and administer via large vein; extravasation precautions required

Chlorpheniramine may cause significant confusional symptoms; not for administration to premature or full-term neonates

 

Pregnancy and lactation

Pregnancy category: C

Lactation: excretion in milk unknown/not recommended

 

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.

 

Pharmacology of Father John's Medicine Plus Liquid, NeoTuss Plus Liquid (chlorpheniramine/dextromethorphan/phenylephrine)

Mechanism of action

Chlorpheniramine blocks muscle responses in histamine and acts as an antagonism of the constrictor effects of histamine on respiratory smooth muscle.

Phenylephrine is a vasoconstrictor and a decongestant that relieves symptoms resulting from irritation of upper respiratory tract tissue. It shrinks swollen mucous membranes, reduces nasal congestion and tissue hyperemia.

Dextromethorphan is a cough suppressant that acts centrally on the cough center in the medulla.

 

Pharmacokinetics

Chlorpheniramine

  • Vd: 4-7 L/kg (children); 6-12 L/kg (adults)
  • Protein binding: 33%
  • Half-life: 10-13 hr (children); 14-24 hr (adults)
  • Peak plasma time: 2-4 hr
  • Excretion: Urine

Phenylephrine

  • Half-life: 2-3 hr
  • Onset: 10-15 min
  • Duration: 15 min
  • Bioavailability: < 38%
  • Excretion: Urine (80-90%)
  • Peak plasma time: 0.75-2 hr
  • Vd: 26-61 L
  • Vdss: 340 L

Dextromethorphan

  • Onset: 15-30 min
  • Duration: 3-6 hr
  • Metabolism: Hepatic P450 enzyme CYP2D6
  • Excretion: Urine
  • Half-life: 2-4 hr (extensive metabolizers); 24 hr (poor metabolizers)
  • Peak plasma time: 2-3 hr