Chlorpheniramine Dihydrocodeine; Phenylephrine

Chlorpheniramine Dihydrocodeine; Phenylephrine Brand Names

Baltussin | ColdCough PD | DiHydro-PE | Duohist DH | Novahistine DH | Pancof PD | Tusscough DHC

What is Chlorpheniramine Dihydrocodeine; Phenylephrine

Chlorpheniramine dihydrocodeine phenylephrine are used together in an oral preparation that is marketed to control cough and provide for temporary relief from congestion associated with the upper respiratory tract.

Chlorpheniramine is a sedating antihistamine (H1-blocker) of the alkylamine class. Dihydrocodeine is an opiate antitussive used for cough suppression. It is structurally related to codeine and has similar pharmacologic activity and complex metabolism.

Dihydrocodeine metabolism is highly variable and unpredictable, particularly in children younger than 12 years; therapeutic response to recommended doses can range from lack of effect in poor metabolizers to fatality in ultra-rapid metabolizers.

Phenylephrine is a sympathomimetic agent that relieves nasal and sinus congestion.

Chlorpheniramine dihydrocodeine phenylephrine formulations are available by prescription only; however, cough/cold products that contain dihydrocodeine have not been evaluated by the FDA for safety and efficacy, and many products are no longer marketed since they are considered unapproved drugs in the U.S.

Opioid cough and cold medicines that contain dihydrocodeine are not indicated in pediatric patients under 18 years of age.

These products are contraindicated in neonates, infants and children less than 12 years of age; risks of opioid-containing cough and cold medicines outweigh their benefits in patients younger than 18 years.

Chlorpheniramine dihydrocodeine phenylephrine is also contraindicated in adolescent pediatric patients 12 to 18 years of age after tonsillectomy or adenoidectomy

Indications

  1. allergic rhinitis
  2. common cold
  3. cough
  4. nasal congestion

For the temporary relief of cough and nasal congestion associated with upper respiratory tract infections (e.g., common cold) and allergies (i.e., allergic rhinitis)

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. anaphylactoid reactions
  4. angina
  5. anorexia
  6. anxiety
  7. aplastic anemia
  8. arrhythmia exacerbation
  9. ataxia
  10. blurred vision
  11. colitis
  12. confusion
  13. constipation
  14. contact dermatitis
  15. cyanosis
  16. diarrhea
  17. dizziness
  18. drowsiness
  19. dyspepsia
  20. dyspnea
  21. dysuria
  22. erythema
  23. fatigue
  24. flushing
  25. hallucinations
  26. headache
  27. impaired cognition
  28. increased intracranial pressure
  29. insomnia
  30. interstitial nephritis
  31. irritability
  32. myocardial infarction
  33. nausea
  34. neonatal opioid withdrawal syndrome
  35. neonatal respiratory depression
  36. ocular hypertension
  37. photophobia
  38. physiological dependence
  39. premature ventricular contractions (PVCs)
  40. pruritus
  41. psychological dependence
  42. psychosis
  43. pulmonary edema
  44. rash
  45. renal failure (unspecified)
  46. respiratory arrest
  47. respiratory depression
  48. restlessness
  49. seizures
  50. sinus tachycardia
  51. stroke
  52. supraventricular tachycardia (SVT)
  53. thrombocytopenia
  54. urinary retention
  55. vomiting
  56. weakness
  57. withdrawal
  58. xerophthalmia
  59. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • abrupt discontinuation
  • accidental exposure
  • acute abdomen
  • acute myocardial infarction
  • adenoidectomy
  • adrenal insufficiency
  • alcoholism
  • angina
  • Asian patients
  • asthma
  • biliary tract disease
  • Black patients
  • bladder obstruction
  • brain tumor
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cardiomyopathy
  • Caucasian patients
  • children
  • chronic obstructive pulmonary disease (COPD)
  • closed-angle glaucoma
  • coadministration with other CNS depressants
  • coma
  • constipation
  • contact lenses
  • cor pulmonale
  • coronary artery disease
  • dehydration
  • depression
  • diabetes mellitus
  • diarrhea
  • driving or operating machinery
  • ethanol ingestion
  • ethanol intoxication
  • gallbladder disease
  • geriatric
  • GI disease
  • GI obstruction
  • head trauma
  • hepatic disease
  • Hispanic patients
  • hypertension
  • hyperthyroidism
  • hypotension
  • hypothyroidism
  • hypovolemia
  • hypoxemia
  • ileus
  • increased intracranial pressure
  • infants
  • inflammatory bowel disease
  • labor
  • MAOI therapy
  • myocardial infarction
  • myxedema
  • neonatal opioid withdrawal syndrome
  • neonates
  • neuromuscular disease
  • obesity
  • obstetric delivery
  • opiate agonist hypersensitivity
  • orthostatic hypotension
  • pancreatitis
  • peripheral vascular disease
  • poor metabolizers
  • potential for overdose or poisoning
  • pregnancy
  • prostatic hypertrophy
  • pulmonary disease
  • renal failure
  • renal impairment
  • respiratory depression
  • respiratory infection
  • respiratory insufficiency
  • scoliosis
  • seizure disorder
  • seizures
  • shock
  • sleep apnea
  • status asthmaticus
  • substance abuse
  • syncope
  • tonsillectomy
  • ulcerative colitis
  • urethral stricture
  • urinary retention

Interactions

  • Abiraterone
  • Acarbose
  • Acebutolol
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Aclidinium; Formoterol
  • Acrivastine; Pseudoephedrine
  • Albiglutide
  • Albuterol
  • Albuterol; Ipratropium
  • Aldesleukin, IL-2
  • Alfentanil
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Almotriptan
  • Alogliptin; Metformin
  • Alogliptin; Pioglitazone
  • Alosetron
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  • Amlodipine; Celecoxib
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  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
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  • Carbamazepine
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  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cardiac glycosides
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  • Chloral Hydrate
  • Chloramphenicol
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  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chloroprocaine
  • Chlorothiazide
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Chlorthalidone
  • Chlorthalidone; Clonidine
  • Chlorzoxazone
  • Ciclesonide
  • Cimetidine
  • Cinacalcet
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clemastine
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  • Clopidogrel
  • Clorazepate
  • Clozapine
  • Cobicistat
  • Cocaine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Colchicine
  • Colchicine; Probenecid
  • COMT inhibitors
  • Conivaptan
  • Corticosteroids
  • Cortisone
  • Crizotinib
  • Crofelemer
  • Cyclizine
  • Cyclobenzaprine
  • Cyclosporine
  • Cyproheptadine
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  • Daratumumab; Hyaluronidase
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  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
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  • Deferasirox
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  • Delavirdine
  • Desflurane
  • Desipramine
  • Desloratadine
  • Desloratadine; Pseudoephedrine
  • Desmopressin
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  • Deutetrabenazine
  • Dexamethasone
  • Dexchlorpheniramine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmedetomidine
  • Dexmethylphenidate
  • Dexpanthenol
  • Dextroamphetamine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Diazepam
  • Dicyclomine
  • Diethylpropion
  • Digitoxin
  • Digoxin
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Dihydroergotamine
  • Diltiazem
  • Dimenhydrinate
  • Dipeptidyl Peptidase-4 Inhibitors
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Disopyramide
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  • Donepezil
  • Donepezil; Memantine
  • Dorzolamide; Timolol
  • Doxazosin
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  • Doxylamine; Pyridoxine
  • Dronabinol
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  • Elagolix
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  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Encorafenib
  • Enflurane
  • Entacapone
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  • Epinephrine
  • Epoprostenol
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Ergoloid Mesylates
  • Ergonovine
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  • Ergotamine
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  • Erythromycin
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  • Escitalopram
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  • Glyburide; Metformin
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Granisetron
  • grapefruit juice
  • Green Tea
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Pseudoephedrine
  • Guanabenz
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  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
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  • Oxytocin
  • Ozanimod
  • Palbociclib
  • Paliperidone
  • Palonosetron
  • Panobinostat
  • Papaverine
  • Paromomycin
  • Paroxetine
  • Pazopanib
  • Peginterferon Alfa-2b
  • Pegvisomant
  • Penbutolol
  • Pentazocine
  • Pentazocine; Naloxone
  • Pentobarbital
  • Perampanel
  • Pergolide
  • Perindopril; Amlodipine
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phendimetrazine
  • Phenelzine
  • Phenobarbital
  • Phenothiazines
  • Phenoxybenzamine
  • Phentermine
  • Phentermine; Topiramate
  • Phentolamine
  • Phenylephrine; Promethazine
  • Phenytoin
  • Phosphodiesterase inhibitors
  • Pimozide
  • Pindolol
  • Pioglitazone
  • Pirbuterol
  • Pitolisant
  • Plazomicin
  • Posaconazole
  • Potassium-sparing diuretics
  • Pramipexole
  • Pramlintide
  • Prasugrel
  • Prazosin
  • Prednisolone
  • Prednisone
  • Pregabalin
  • Prilocaine
  • Prilocaine; Epinephrine
  • Primidone
  • Procaine
  • Procarbazine
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Propantheline
  • Propofol
  • Propoxyphene
  • Propranolol
  • Protriptyline
  • Pseudoephedrine
  • Quazepam
  • Quetiapine
  • Quinidine
  • Quinine
  • Racepinephrine
  • Ramelteon
  • Ranolazine
  • Rasagiline
  • Remifentanil
  • Reserpine
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifamycins
  • Rifapentine
  • Rifaximin
  • Riociguat
  • Risperidone
  • Ritonavir
  • Rituximab; Hyaluronidase
  • Rivastigmine
  • Rizatriptan
  • Rolapitant
  • Ropinirole
  • Ropivacaine
  • Rosiglitazone
  • Rotigotine
  • Rucaparib
  • Safinamide
  • Salmeterol
  • Saquinavir
  • Scopolamine
  • Secobarbital
  • Selegiline
  • Selexipag
  • Selpercatinib
  • Semaglutide
  • Serotonin-Receptor Agonists
  • Serotonin-Receptor Antagonists
  • Sertraline
  • Sevoflurane
  • SGLT2 Inhibitors
  • Sibutramine
  • Sildenafil
  • Sincalide
  • Skeletal Muscle Relaxants
  • Sodium Iodide
  • Sodium Oxybate
  • Solifenacin
  • Solriamfetol
  • Sotalol
  • Spironolactone
  • St. John’s Wort, Hypericum perforatum
  • Streptogramins
  • Streptomycin
  • Sufentanil
  • Sulfonylureas
  • Sumatriptan
  • Suvorexant
  • Tacrine
  • Tadalafil
  • Tamsulosin
  • Tapentadol
  • Tasimelteon
  • Telithromycin
  • Telotristat Ethyl
  • Temazepam
  • Terazosin
  • Terbinafine
  • Terbutaline
  • Tetrabenazine
  • Tetracaine
  • Tezacaftor; Ivacaftor
  • Thalidomide
  • Theophylline, Aminophylline
  • Thiazide diuretics
  • Thiazolidinediones
  • Thiopental
  • Thioridazine
  • Thiothixene
  • Thyroid hormones
  • Ticagrelor
  • Timolol
  • Tipranavir
  • Tizanidine
  • Tobramycin
  • Tolcapone
  • Tolterodine
  • Topiramate
  • Torsemide
  • Tramadol
  • Trandolapril; Verapamil
  • Tranylcypromine
  • Trastuzumab; Hyaluronidase
  • Trazodone
  • Treprostinil
  • Triamcinolone
  • Triamterene
  • Triazolam
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trihexyphenidyl
  • Trimethobenzamide
  • Trimipramine
  • Triprolidine
  • Trospium
  • Tucatinib
  • Umeclidinium; Vilanterol
  • Valerian, Valeriana officinalis
  • Valproic Acid, Divalproex Sodium
  • Vardenafil
  • Vasodilators
  • Vemurafenib
  • Venlafaxine
  • Verapamil
  • Vigabatrin
  • Vilazodone
  • Voriconazole
  • Vortioxetine
  • Yohimbine
  • Zafirlukast
  • Zaleplon
  • Ziconotide
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
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