A fixed-dose combination oral liquid primarily indicated for the symptomatic relief of cough and associated symptoms of upper respiratory tract infections and allergic conditions. It combines a decongestant (Phenylephrine), a first-generation sedating antihistamine (Chlorpheniramine), and a centrally-acting antitussive (Dextromethorphan). This combination is widely used in the Indian market for managing productive and non-productive cough with nasal congestion, rhinorrhea, and sneezing.
Adult: 10 ml (2 teaspoonfuls) three to four times daily. Maximum: 40 ml per day.
Note: Shake the bottle well before use. Use the measuring cup or spoon provided. Can be taken with or without food. Taking with food may reduce GI upset. Maintain adequate hydration.
The combination works synergistically to relieve multiple symptoms of cough and cold. Phenylephrine acts as a selective alpha-1 adrenergic receptor agonist, causing vasoconstriction in the nasal mucosa, reducing edema and congestion. Chlorpheniramine is a competitive inverse agonist at peripheral and central H1 receptors, inhibiting histamine-mediated symptoms like sneezing and rhinorrhea, and causing sedation. Dextromethorphan acts centrally on the cough center in the medulla oblongata, raising the threshold for coughing, likely through NMDA receptor antagonism and sigma-1 receptor agonism.
Pregnancy: Category C (US FDA). Animal studies show risk, human data inadequate. Use only if potential benefit justifies potential fetal risk, especially in first trimester. Phenylephrine may reduce uterine blood flow. Avoid in third trimester due to risk of neonatal complications.
Driving: NOT ADVISABLE. Chlorpheniramine causes significant drowsiness and impairs cognitive and motor functions. Patients should not drive or operate heavy machinery until effect is known.
| Monoamine Oxidase Inhibitors (e.g., Phenelzine, Selegiline) | Risk of severe hypertensive crisis, hyperpyrexia, serotonin syndrome. | Contraindicated |
| Other CNS Depressants (Alcohol, Benzodiazepines, Opioids) | Additive sedation, respiratory depression, impaired psychomotor performance. | Major |
| Selective Serotonin Reuptake Inhibitors (SSRIs e.g., Fluoxetine, Sertraline) | Increased risk of serotonin syndrome due to Dextromethorphan. | Major |
| Beta-blockers (e.g., Propranolol) | Unopposed alpha-adrenergic activity leading to severe hypertension and bradycardia. | Major |
| Antihypertensives | Phenylephrine may antagonize the blood pressure-lowering effect. | Moderate |
| Anticholinergics (e.g., Atropine, Tricyclic Antidepressants) | Additive anticholinergic side effects (dry mouth, urinary retention, constipation). | Moderate |
| CYP2D6 Inhibitors (e.g., Quinidine, Paroxetine) | Markedly increased Dextromethorphan levels, risk of toxicity and serotonin syndrome. | Moderate |
| Sympathomimetics (e.g., Pseudoephedrine, Salbutamol) | Additive cardiovascular effects (tachycardia, hypertension). | Moderate |