Drug Guide
Chlorpheniramine Maleate, Ibuprofen, Pseudoephedrine Hydrochloride
Classification
Therapeutic: Allergy relief and decongestion
Pharmacological: Antihistamine, Nonsteroidal Anti-inflammatory Drug (NSAID), Sympathomimetic
FDA Approved Indications
- Relief of allergy symptoms, cold and sinus congestion, nasal congestion, headache, and fever
Mechanism of Action
Chlorpheniramine maleate blocks H1 histamine receptors, reducing allergy symptoms; Ibuprofen inhibits cyclooxygenase enzymes (COX-1 and COX-2), decreasing prostaglandin synthesis, leading to analgesic and anti-inflammatory effects; Pseudoephedrine stimulates alpha-adrenergic receptors, leading to vasoconstriction of nasal blood vessels, reducing nasal congestion.
Dosage and Administration
Adult: Follow package instructions; typically, 1-2 tablets every 4-6 hours as needed, not exceeding labeled maximums.
Pediatric: Consult specific product packaging; typically, dosing is based on age and weight, not exceeding recommended doses.
Geriatric: Use with caution; monitor for adverse effects, considering potential renal, hepatic, or cardiovascular issues.
Renal Impairment: Use with caution; dose adjustment may be necessary.
Hepatic Impairment: Use with caution; monitor hepatic function.
Pharmacokinetics
Absorption: Readily absorbed from the gastrointestinal tract.
Distribution: Wide distribution; crosses the blood-brain barrier (chlorpheniramine).
Metabolism: Chlorpheniramine is metabolized in the liver; ibuprofen is partially metabolized in the liver.
Excretion: Renally excreted; ibuprofen mainly excreted in urine.
Half Life: Chlorpheniramine: approximately 20 hours; ibuprofen: 2-4 hours; pseudoephedrine: about 6-12 hours.
Contraindications
- Hypersensitivity to any component; narrow-angle glaucoma; hypertension; heart disease; concurrent use of MAO inhibitors.
Precautions
- Use cautiously in patients with cardiovascular disease, hypertension, hyperthyroidism, diabetes, or prostatic hypertrophy; may cause sedation, dizziness, or hypertension.
Adverse Reactions - Common
- Drowsiness, dry mouth, dizziness (Common)
- Nausea, gastrointestinal discomfort (Common)
Adverse Reactions - Serious
- Arrhythmias, hypertension, urinary retention, allergic reactions (Rare)
Drug-Drug Interactions
- MAO inhibitors (risk of hypertensive crisis), other antihypertensives, other CNS depressants.
Drug-Food Interactions
- Alcohol may enhance sedative effects.
Drug-Herb Interactions
- St. John's Wort may increase photosensitivity.
Nursing Implications
Assessment: Assess for allergy symptoms, blood pressure, signs of CNS depression.
Diagnoses:
- Risk for injury related to dizziness or sedation.
- Ineffective airway clearance due to increased mucus viscosity.
Implementation: Administer with food or milk to minimize gastrointestinal upset; monitor blood pressure and cardiovascular status; educate patient on potential drowsiness.
Evaluation: Monitor symptom relief, adverse effects, blood pressure, and patient compliance.
Patient/Family Teaching
- Do not operate heavy machinery until response is known.
- Avoid alcohol and other CNS depressants.
- Notify provider if symptoms worsen or if adverse reactions occur.
- Use as directed, do not exceed recommended dosage.
Special Considerations
Black Box Warnings:
- Not applicable for this combination in FDA labeling.
Genetic Factors: CYP2D6 metabolism affects chlorpheniramine clearance.
Lab Test Interference: May interfere with certain blood or urine tests.
Overdose Management
Signs/Symptoms: Seizures, hallucinations, severe hypotension, respiratory depression, gastrointestinal symptoms.
Treatment: Supportive care, activated charcoal if ingestion is recent, intravenous fluids, cardiac monitoring, and symptomatic treatment as needed.
Storage and Handling
Storage: Store at room temperature, away from moisture, heat, and light.
Stability: Stable for shelf life as indicated by manufacturer.