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Chlorpheniramine and Phenylephrine


Pronunciation

 (klor fen IR a meen & fen il EF rin)


U.S. Brand Names

 Dallergy-JR®; Ed A-Hist®; Histatab® Plus [OTC] [DSC]; Rynatan®; Rynatan® Pediatric Suspension


Synonyms

 Chlorpheniramine Maleate and Phenylephrine Hydrochloride; Chlorpheniramine Tannate and Phenylephrine Tannate; Phenylephrine and Chlorpheniramine


Generic Available

 Yes: Tannate formulations


Use

 Temporary relief of nasal congestion and eustachian tube congestion as well as runny nose, sneezing, itching of nose or throat, itchy and watery eyes


Pregnancy Risk Factor

 C


Contraindications

 Hypersensitivity to chlorpheniramine, phenylephrine, or any component of the formulation; severe hypertension; severe cardiovascular disease; use with or within 2 weeks of discontinuing MAO inhibitor; narrow-angle glaucoma; urinary retention; peptic ulcer disease; breast-feeding


Warnings/Precautions

 Use caution with hypertension, diabetes, cardiovascular disease, hyperthyroidism, increased intraocular pressure, or prostatic hyperplasia. Causes sedation, caution must be used in performing tasks which require alertness (eg, operating machinery or driving). Sedative effects of CNS depressants or ethanol are potentiated. Use caution in elderly patients, risk of CNS depression may be increased.


Drug Interactions

 Chlorpheniramine: Substrate of CYP2D6 (minor), 3A4 (major); Inhibits CYP2D6 (weak)

Also see individual agents.


Ethanol/Nutrition/Herb Interactions

 Ethanol: Avoid ethanol (may increase CNS depression).


Pharmacodynamics/Kinetics

 See individual agents.


Dosage

 General dosing guidelines; consult specific product labeling. Antihistamine/decongestant: Oral:

Children:

2-6 years: Chlorpheniramine tannate 4.5 mg and phenylephrine tannate 5 mg per 5 mL: 2.5-5 mL every 12 hours

6-12 years:

Chlorpheniramine maleate 4 mg and phenylephrine hydrochloride 20 mg every 12 hours or

Chlorpheniramine tannate 4.5 mg and phenylephrine tannate 5 mg per 5 mL: 5-10 mL every 12 hours

12 years: Chlorpheniramine maleate 8 mg and phenylephrine hydrochloride 40 mg every 12 hours

Adults:

Chlorpheniramine maleate 8 mg and phenylephrine hydrochloride 40 mg every 12 hours or

Chlorpheniramine tannate 9 mg and phenylephrine tannate 25 mg every 12 hours


Patient Education

 May cause drowsiness. Avoid driving or operating machinery while taking this medication.


Dental Health: Effects on Dental Treatment

 Key adverse event(s) related to dental treatment:

Chlorpheniramine: Prolonged use will cause significant xerostomia (normal salivary flow resumes upon discontinuation).

Phenylephrine: Up to 10% of patients could experience tachycardia, palpitations, and xerostomia (prolonged use worsens); use vasoconstrictor with caution.


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 Use with caution since phenylephrine is a sympathomimetic amine which could interact with epinephrine to cause a pressor response


Mental Health: Effects on Mental Status

 Drowsiness is common; may cause excitability, nervousness, fatigue, or depression


Mental Health: Effects on Psychiatric Treatment

 Dry mouth and sedation may be exacerbated by concurrent psychotropic use


Dosage Forms

 [DSC] = Discontinued product

Caplet, prolonged release (Ed A-Hist®): Chlorpheniramine maleate 8 mg and phenylephrine hydrochloride 20 mg

Capsule, extended release (Dallergy-JR®): Chlorpheniramine maleate 4 mg and phenylephrine hydrochloride 20 mg

Liquid (Ed A-Hist®): Chlorpheniramine maleate 4 mg and phenylephrine hydrochloride 10 mg per 5 mL (480 mL) [sugar free; grape flavor]

Suspension, oral (Rynatan® Pediatric Suspension): Chlorpheniramine tannate 4.5 mg and phenylephrine tannate 5 mg per 5 mL (480 mL) [contains benzoic acid and tartrazine; strawberry flavor]

Tablet:

Histatab® Plus: Chlorpheniramine maleate 2 mg and phenylephrine hydrochloride 5 mg [DSC]

Rynatan®: Chlorpheniramine tannate 9 mg and phenylephrine tannate 25 mg


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