Dextromethorphan + Paracetamol + Phenylephrine + Chlorphenamine - instructions for use, dose, side effects, contraindications

Clinical and pharmacological group: & nbsp

Anilides

Included in the formulation

Toff plus

capsules inwards

Panacea Biotech Co., Ltd. India

Included in the list (Order of the Government of the Russian Federation No. 2782-r of 30.12.2014):

VED

ONLS

Minimal chemist's assortment

АТХ:

N.02.B.E Anilides

Pharmacodynamics:

Paracetamol inhibits cyclooxygenase in the central nervous system, resulting in reduced synthesis of prostaglandins, which has an analgesic and antipyretic effect.

Dextromethorphan blocks glutamatergic NMDA receptors in various structures of the brain, including in the cough center (noncompetitive blockade of the ion channel) of the brainstem, the agonist σ₁- and σ₂receptors of the brain (a hallucinogenic effect), as a result, suppresses the excitability of the cough center in the brain, inhibiting the cough reflex.

Chlorphenamine is a blocker H1-gistaminovyh receptors, the drug narrows the vessels of the nose, sinuses, nasopharynx, reduces the symptoms of allergic rhinitis, exudative manifestations.

Phenylephrine - adrenomimetic, stimulates mainly α₁-adrenoreceptors, has a vasoconstrictive effect, reducing the mucosal discharge in the runny nose.

Pharmacokinetics:

Paracetamol is evenly distributed in tissues, poorly bound to plasma proteins, metabolized in the liver, eliminated by the kidneys. The elimination half-life is 1-3 hours.Complete elimination of the drug occurs within a day.

Dextromethorphan is also metabolized in the liver, excreted by the kidneys in an unchanged form and in the form of metabolites.

Phenylephrine is poorly digested in the gastrointestinal tract, metabolized in the wall of the intestine and liver. When applied topically, it also undergoes systemic absorption.

Chlorphenamine is poorly absorbed from the gastrointestinal tract, binding to plasma proteins is 70%, metabolized in the liver, excreted in the urine both in the form of metabolites, and unchanged. The half-life period reaches 43 hours, in children the half-life is less than in adults.

Indications:

Acute respiratory viral infections, influenza, rhinorrhea, rhinitis, allergic rhinitis, fever.

ICD-10

X.J00-J06.J00 Acute nasopharyngitis (runny nose)

X.J00-J06 Acute respiratory infections of the upper respiratory tract

X.J10-J18.J11 Influenza, virus not identified

X.J30-J39.J30.4 Allergic rhinitis, unspecified

X.J30-J39.J34.8 Other specified diseases of nose and nasal sinuses

XVIII.R50-R69.R50 Fever of unknown origin

Contraindications:

Closed-angle glaucoma; dglucose-6-phosphate dehydrogenase;blood diseases; hypersensitivity; prostate adenoma; chronic liver / kidney disease; arterial hypertension; breast-feeding; pregnancy; age up to 14 years; bronchial asthma, bronchitis; thyrotoxicosis; diabetes; pheochromocytoma.

Carefully:

Age over 65 years; giptotropic obstructive cardiomyopathy; angina pectoris.

Pregnancy and lactation:Category Food and Drug Administration (US Food and Drug Administration) - C. Contraindicated in pregnancy and lactation.

Dosing and Administration:

Adults one capsule (1 capsule contains paracetamol 500 mg, chlorpheniramine 2 mg, dextromethorphan 15 mg, phenylephrine 10 mg) every 4-6 hours. The maximum dose is 4 capsules per day. Taking the drug requires an obligatory medical consultation.

Side effects:

From the nervous system: dizziness, drowsiness, increased excitability.

From the gastrointestinal tract: nausea, vomiting, dry mouth, epigastric pain, hepatotoxic effect.

From the viewpoint: increased intraocular pressure, paresis of accommodation.

From the cardiovascular system and hematopoiesis: hemolytic and aplastic anemia, hypertension, thrombocytopenia.

Respiratory: bronchial obstruction.

From the side of the urinary system: nephrotoxicity.

Allergic reactions: skin rash, itching, angioedema, bronchial obstruction.

Overdose:

Symptoms (due to paracetamol, appear after taking more than 10-15 g): pallor of the skin, anorexia, nausea, vomiting, hepatonecrosis, increased activity of hepatic transaminases, increased prothrombin time.

Treatment: gastric lavage followed by the appointment of activated charcoal, symptomatic therapy.

Interaction:

Do not allow simultaneous reception of other drugs containing paracetamol, dextromethorphan, phenylephrine, chlorphenamine.

Strengthens the effects of monoamine oxidase inhibitors, sedatives, ethanol.

Antidepressants, antiparkinsonics, antipsychotics, phenothiazine derivatives increase the risk of urinary retention, dry mouth, constipation.

Glucocorticosteroids increase the risk of developing glaucoma.

Paracetamol reduces the effectiveness of uricosuric drugs.

Chlorphenamine, administered concurrently with monoamine oxidase inhibitors and furazolidone, can lead to the development of hypertensive crisis, psychomotor agitation, and fever.

Tricyclic antidepressants enhance the sympathomimetic effect, the simultaneous administration of halothane increases the risk of ventricular arrhythmia.

Reduces the hypotensive effect of guanethidine, which, in turn, enhances the alpha-adrenostimulating activity of phenylephrine.

The drug is not compatible with alcohol.

Special instructions:

In patients who suffer from chronic alcoholism, therapeutic doses of the drug can cause severe hepatic insufficiency.

Impact on the ability to drive vehicles and manage mechanisms

During the treatment period it is necessary to refrain from driving motor vehicles and practicing other potentially dangerous activities that require an increased concentration of attention and speed of psychomotor reactions.

Instructions

Dextromethorphan + Paracetamol + Phenylephrine + Chlorphenamine (Dextromethorphanum + Paracetamolum + Phenylephrinum + Chlorphenaminum)