chlorpheniramine/dextromethorphan/pseudoephedrine (Forte Kidkare Cough and Cold, Rescon DM, Pedia Relief)

Dosing and uses of Forte Kidkare Cough and Cold, Rescon DM (chlorpheniramine/dextromethorphan/pseudoephedrine)

• Adult
• Pediatric

 

Adult dosage forms and strengths

chlorpheniramine/dextromethorphan/pseudoephedrine

liquid

• (1mg/5mg/15mg)/5mL
• (4mg/20mg/20mg)/5mL
• (2mg/15mg/15mg)/5mL
• (2mg/10mg/30mg)/5mL

oral drops

• (0.8mg/3mg/8mg)/1mL

tablet

• 4mg/60mg/20mg

tablet chewable

• 2mg/10mg/30mg

 

Relief of Cold & Flu Symptoms

10 mL [(2mg/15mg/15mg)/5mL] PO q6hr; not to exceed 40 mL/day

10 mL [(2mg/10mg/30mg)/5mL] PO q4-6hr; not to exceed 40 mL/day

5 mL [(4mg/20mg/20mg)/5mL] PO q4-6hr; not to exceed 30 mL/day

2 tabs [(2mg/10mg/30mg)/tab] PO q4-6hr; not to exceed 8 tabs/day

1 tab [(4mg/60mg/20mg)/tab] PO q4-6hr; not to exceed 4 tabs/day

 

Pediatric dosage forms and strengths

chlorpheniramine/dextromethorphan/pseudoephedrine

liquid

• (1mg/5mg/15mg)/5mL
• (4mg/20mg/20mg)/5mL
• (2mg/15mg/15mg)/5mL
• (2mg/10mg/30mg)/5mL

oral drops

• (0.8mg/3mg/8mg)/1mL

tablet

• 4mg/60mg/20mg

tablet chewable

• 2mg/10mg/30mg

 

Relief of Cold & Flu Symptoms

<6 Years Old

• Ask a pediatrician

6-12 Years Old

• 2 mL [(0.8mg/3mg/8mg)/1mL] PO q4-6hr; not to exceed 8 mL/24hr
• 10 mL [(1mg/5mg/15mg)/5mL] PO q4-6hr; not to exceed 40 mL/24hr
• 5 mL [(2mg/15mg/15mg)/5mL] PO q4-6hr; not to exceed 20 mL/24hr
• 2.5 mL [(4mg/20mg/20mg)/5mL] PO q4-6hr; not to exceed 15 mL/24hr
• 1 tab [(2mg/10mg/30mg/tab)] PO q4-6hr; not to exceed 4 tabs/24hr
• ½ tab [(4mg/60mg/20mg/tab)] PO q4-6hr; not to exceed 2 tabs/24hr

>12 Years Old

• 10 mL [(2mg/15mg/15mg)/5mL] PO q6hr; not to exceed 40 mL/day
• 10 mL [(2mg/10mg/30mg)/5mL] PO q4-6hr; not to exceed 40 mL/day
• 5 mL [(4mg/20mg/20mg)/5mL] PO q4-6hr; not to exceed 30 mL/day
• 2 tabs [(2mg/10mg/30mg)/tab] PO q4-6hr; not to exceed 8 tabs/day
• 1 tab [(4mg/60mg/20mg)/tab] PO q4-6hr; not to exceed 4 tabs/day

 

Forte Kidkare Cough and Cold, Rescon DM (chlorpheniramine/dextromethorphan/pseudoephedrine) adverse (side) effects

Frequency not defined

Arrhythmia

Hypotension

Palpitations

Tachycardia

Confusion

Convulsion

Depression

Distress

Dizziness

Drowsiness

Euphoria

Excitability

Fatigue

Headache

Insomnia

Irritability

Sedation

Tremors

Weakness

Anorexia

GI disturbances

Agranulocytosis

Hemolytic anemia

Thrombocytopenia

Thickening of bronchial secretions

Wheezing

 

Warnings

Contraindications

Contraindicated in documented hypersensitivity to the drugs or within 14 days of MAO inhibitor therapy; asthma attacks, narrow-angle glaucoma, symptomatic prostate hypertrophy, bladder-neck obstruction, and stenosing peptic ulcer

 

Cautions

Caution in cardiovascular disease, diabetes mellitus, prostatic hypertrophy and increased intraocular pressure when taking pseudoephedrine

Do not take dextromethorphan for persistent or chronic cough associated with smoking, asthma, or emphysema, or if it is accompanied by excessive phlegm unless directed by a healthcare provider; may decrease respiration rate

Chlorpheniramine may cause significant confusional symptoms; not for administration to premature or full-term neonates

 

Pregnancy and lactation

Pregnancy category: C

Lactation: excretion in milk unknown/not recommended

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of Forte Kidkare Cough and Cold, Rescon DM (chlorpheniramine/dextromethorphan/pseudoephedrine)

Mechanism of action

Chlorpheniramine blocks muscle responses in histamine and acts as an antagonism of the constrictor effects of histamine on respiratory smooth muscle.

Dextromethorphan is a cough suppressant that acts centrally on the cough center in medulla

Pseudoephedrine stimulates the alpha-adrenergic receptors causing bronchodilation and vasoconstriction.

 

Pharmacokinetics

Chlorpheniramine

• Vd: 4-7 L/kg (children); 6-12 L/kg (adults)
• Protein binding: 33%
• Half-life: 10-13 hr (children); 14-24 hr (adults)
• Peak plasma time: 2-4 hr
• Excretion: Urine

Dextromethorphan

• Onset: 15-30 min
• Duration: 3-6 hr
• Metabolism: Hepatic P450 enzyme CYP2D6
• Excretion: Urine
• Half-life: 2-4 hr (extensive metabolizers); 24 hr (poor metabolizers)
• Peak plasma time: 2-3 hr

Pseudoephedrine

• Half-Life: 3 hr (children); 9-16 hr (adults)
• Onset: 30 min (decongestant)Duration: 3-8 hr  
• Peak PlasmaTime: 1.97 hr
• Concentration: 422 ng/mL
• Metabolism: Liver, by N-demethylation
• Metabolites: Inactive
• Clearance: 7.3-7.6 mL/min/kg
• Excretion: Urine (43-96%)