Diphenhydramine + Ammonium chloride + Menthol
Indications
Diphenhydramine + Ammonium chloride + Menthol is used for:
For the symptomatic relief of dry, unproductive cough associated with upper respiratory tract congestion
Adult Dose
Based on oral liquid formulation containing Diphenhydramine 14 mg, Ammonium Chloride 135 mg and Menthol 1.1 mg per 5 mL.
Oral
Syrup
ADULT: 5-10 mL PO q4-6hr; Not to exceed 40 mL/24 hr
Do not exceed the recommended dose
Child Dose
Based on oral liquid formulation containing Diphenhydramine 14 mg, Ammonium Chloride 135 mg and Menthol 1.1 mg per 5 mL.
Oral
Syrup
Child (6-12 years): 5 mL 4 times a day.
Child (<6 years): Avoid use
Renal Dose
Ammonium chloride is contraindicated in severe hepatic or renal impairment.
Exercise caution in patient with mild to moderate renal or hepatic impairment
Administration
Contra Indications
Hypersensitivity to any of the ingredients.
Children <6 years.
Impaired hepatic or renal function because drug retention and subsequent ammonium toxicity or hepatic coma can occur in these patients.
Avoid the use of antihistamines and codeine in the treatment of lower respiratory tract symptoms, including asthma
Concurrent use of diphenhydramine and monoamine oxidase inhibitor (MAOI) therapy or within the last 14 days should be avoided, anticholinergic properties of diphenhydramine can be intensified by MAOIs.
Known or suspected gastrointestinal obstruction, including paralytic ileus.
Metabolic acidosis or respiratory acidosis due to possible worsening of these conditions
Precautions
Concomitant use of diphenhydramine with benzodiazepines, or other CNS depressants, including alcohol, may result in profound sedation. Avoid such combinations.
Drugs having anticholinergic properties (e.g. Diphenhydramine) should be used with caution in patients with epilepsy, severe hypertension and cardiovascular disease, raised intra-ocular pressure including glaucoma; prostatic hypertrophy; bronchitis, bronchiectasis and bronchial asthma.
Caution patient about driving or operating machinery while on this medication as it may cause drowsiness, dizziness, blurred vision and psychomotor impairment.
Children and the elderly are more likely to experience neurological anticholinergic effects and paradoxical excitation (e.g. increased energy, restlessness, nervousness). Avoid use in elderly patients with confusion.
Pregnancy:
The use of this medication is not recommended in pregnant women as safety in human pregnancy is not established.
Lactation:
There is no information on effects of this combination product on milk production; because of the potential for serious adverse reactions (including excess sedation) in a breastfed infant, breastfeeding is not recommended during treatment
Pregnancy-Lactation
Interactions
Other CNS depressants (including benzodiazepines, opioid analgesics, alcohol): Additive CNS depressant effects.
Other anticholinergic drugs (e.g., atropine, TCAs): Concurrent use may cause additive anti-muscarinic effects. Diphenhydramine has anticholinergic property.
Monoamine oxidase inhibitors (MAOIs): Anticholinergic properties of diphenhydramine can be intensified by MAOIs
Adverse Effects
Side effects of Diphenhydramine + Ammonium chloride + Menthol :
Common:
CNS effects such as drowsiness (paradoxical stimulation may occur, especially with high doses of diphenhydramine or in children and the elderly); dizziness, headache, impaired mental and physical performance.
Gastrointestinal disturbances such as nausea, vomiting, diarrhoea
Anticholinergic effects such as urinary retention, dry mouth, blurred vision, difficulty in micturition, thickened respiratory tract secretions.
Rare:
Hypotension, extrapyramidal effects, confusion, depression, sleep disturbances, tremor, convulsions, palpitation, arrhythmia, hypersensitivity reactions, blood disorders and liver dysfunction