Kofarest

Chlorpheniramine Maleate (2mg/5ml) + Phenylephrine (5mg/5ml)
Price: ₹55 - ₹85 for 100ml bottle
Mfr: Macleods Pharmaceuticals Ltd. | Form: Syrup

📋 Clinical Overview

A fixed-dose combination oral liquid containing a first-generation alkylamine antihistamine (Chlorpheniramine Maleate) and a direct-acting sympathomimetic amine (Phenylephrine). It is primarily indicated for the symptomatic relief of upper respiratory tract conditions associated with allergic rhinitis and the common cold. The combination provides decongestant and anti-allergic effects, targeting nasal congestion, rhinorrhea, sneezing, and itchy/watery eyes.

💊 Dosage & Administration

Adult: 10 ml (2 teaspoonfuls) every 4 to 6 hours. Do not exceed 40 ml (4 doses) in 24 hours.

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 potential GI upset. Do not use for more than 7 days for cold symptoms or more than a few weeks for allergic rhinitis without medical advice.

⚠️ Contraindications

  • Hypersensitivity to Chlorpheniramine, Phenylephrine, or any component
  • Concurrent use or within 14 days of MAO inhibitor therapy (risk of hypertensive crisis)
  • Severe hypertension or severe coronary artery disease
  • Narrow-angle glaucoma
  • Urinary retention due to bladder neck obstruction (e.g., prostatic hypertrophy)

🔬 Mechanism of Action

The combination works synergistically. Chlorpheniramine competitively antagonizes histamine at the H1-receptor sites, inhibiting the physiological effects of histamine (vasodilation, increased capillary permeability, smooth muscle contraction). Phenylephrine is a selective alpha-1 adrenergic receptor agonist that causes vasoconstriction of the dilated arterioles in the nasal mucosa, reducing tissue hyperemia, edema, and nasal congestion.

🤕 Side Effects

  • Drowsiness, sedation
  • Dry mouth, nose, or throat
  • Dizziness
  • Gastrointestinal disturbances (nausea, epigastric distress)
  • Headache
  • Mild nervousness or restlessness

🤰 Special Populations

Pregnancy: Category C (US FDA). Animal studies show risk, human data inadequate. Use only if potential benefit justifies potential fetal risk. Avoid in first trimester. Phenylephrine may reduce placental blood flow.

Driving: NOT ADVISABLE. Chlorpheniramine causes significant drowsiness and impairs cognitive and motor functions. Do not operate machinery or drive until effect is known.

🔄 Drug Interactions

Monoamine Oxidase Inhibitors (MAOIs) - e.g., Phenelzine, TranylcypromineRisk of severe hypertensive crisis, hyperpyrexia. Contraindicated.Contraindicated
Beta-blockers (e.g., Propranolol)Unopposed alpha-adrenergic stimulation can lead to severe hypertension and bradycardia.Major
Other CNS Depressants (Alcohol, Benzodiazepines, Opioids, Tricyclic Antidepressants)Additive CNS depression, increased sedation, impaired psychomotor performance.Major
Anticholinergic drugs (e.g., Atropine, TCAs, Antipsychotics)Additive anticholinergic effects (dry mouth, urinary retention, constipation, blurred vision).Moderate
Sympathomimetics (e.g., Pseudoephedrine, Decongestants in other cold preps)Additive cardiovascular effects (hypertension, tachycardia).Major
DigoxinPhenylephrine may increase risk of cardiac arrhythmias.Moderate
Ergot alkaloids (e.g., Ergotamine)Increased vasoconstrictive effects, risk of peripheral ischemia.Major
Guanethidine, ReserpineDecreased antihypertensive effect; paradoxical hypertension possible.Moderate

🔁 Alternatives to Kofarest

Same composition (Chlorpheniramine Maleate (2mg/5ml) + Phenylephrine (5mg/5ml)), different brands:

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