Paracetamol + Diphenhydramine + Dextromethorphan

Indications

Paracetamol + Diphenhydramine + Dextromethorphan is used for: Cold & Flu

Adult Dose

Cold & Flu Indicated for relief of cold and flu symptoms 10 mL PO q4hr PRN; not to exceed 6 doses/24 hr

Child Dose

Cold & Flu Indicated for relief of cold and flu symptoms <6 years: Safety and efficacy not established 6-12 years: 5 mL PO q4hr PRN; not to exceed 6 doses/24 hr >12 years: As adults; 10 mL PO q4hr PRN; not to exceed 6 doses/24 hr

Renal Dose

Administration

Contra Indications

Hypersensitivity Hepatitis or hepatic/renal dysfunction, alcoholism Repeated administration in patients with anemia or cardiac, pulmonary, or renal disease Use within 14 days of MAO inhibitor therapy Lower respiratory disease, eg, asthma (controversial) Premature newborns and neonates Nursing women

Precautions

Paracetamol: Risk for rare, but serious skin reactions that can be fatal; these reactions include Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP); symptoms may include skin redness, blisters and rash Risk of hepatotoxicity is higher in alcoholics or with use of more than one acetaminophen-containing product G6PD deficiency Phenylketonuria (phenylalanine in orange flavoring) Driving or operating machinery Avoid alcohol Caution in narrow angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal obstruction, or bladder neck obstruction

Pregnancy-Lactation

Pregnancy Category Paracetamol: Class B Diphenhydramine: Class B Dextromethorphan: Class C Lactation Paracetamol: Excreted in breast milk; compatible with breastfeeding Diphenhydramine: Enters breast milk/contraindicated Dextromethorphan: Unknown if excreted in breast milk, use caution

Interactions

Adverse Effects

Side effects of Paracetamol + Diphenhydramine + Dextromethorphan : Frequency Not Defined Common Nausea/Vomiting Thick sputum Constipation Drowsiness Dizziness Sedation Blurred vision Nystagmus Less Common Angioedema, Laryngeal edema Disorientation, Dizziness, Sedation, Confusion, Decreased cognitive function in elderly Pruritic maculopapular rash, Rash, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Urticaria Agranulocytosis, Leukopenia, Neutropenia, Pancytopenia, Thrombocytopenia Thrombocytopenic purpura Hepatotoxicity, Liver failure Gastrointestinal hemorrhage, Nephrotoxicity, Pneumonitis, Anaphylactoid reactions Anticholinergic effects, Xerostomia, Dry nasal mucosa, Pharyngeal dryness

Mechanism of Action

Paracetamol blocks pain impulse generation peripherally and may inhibit the generation of prostaglandin in the CNS; reduces fever by inhibiting the hypothalamic heat-regulating center Diphenhydramine: competitively blocks histamine from binding to H1 receptors; significant antimuscarinic activity and penetrates CNS, which causes pronounced tendency to induce sedation Dextromethorphan is a cough suppressant that acts centrally on the cough center in the medulla