ASCORIL-D

Indications

• Cough
• Pseudobulbar affect

Dosage

Children: Refer to the BNF for Children for specific dosing information tailored to paediatric patients.

Adults: Refer to the BNF for specific dosing guidelines based on the formulation and clinical context.

Mechanism of action

Dextromethorphan acts as a low-affinity uncompetitive antagonist of NMDA receptors and as an agonist at sigma-1 receptors. It also antagonizes α3/β4 nicotinic receptors. The clinical effects are thought to arise from NMDA receptor blockade and serotonin (5-HT) uptake inhibition, which may lead to increased serotonin receptor stimulation. However, the precise mechanisms by which these actions translate into therapeutic effects remain incompletely understood.

Pharmacodynamics

Dextromethorphan is considered an opioid-like molecule with a moderate therapeutic window, indicating that while it is effective at standard doses, higher doses can lead to intoxication. It has a moderate duration of action, making it suitable for use in cough management. Due to its potential for abuse and risk of intoxication, patients are advised to use it cautiously.

Pharmacokinetics

Dextromethorphan is metabolized primarily in the liver through the cytochrome P450 enzyme system, leading to the formation of its active metabolite, dextrorphan. The pharmacokinetics may be influenced by individual variations in metabolic pathways, which can affect the drug's efficacy and safety profile.

Contra-indications

• Hypersensitivity to dextromethorphan or any of its components
• Concurrent use with monoamine oxidase inhibitors (MAOIs)
• Severe respiratory insufficiency or asthma
• Persistent cough due to smoking, emphysema, or chronic bronchitis

Adverse effects

• Dizziness
• Nausea
• Vomiting
• Drowsiness
• Confusion
• Constipation
• Abdominal discomfort
• Euphoria or dysphoria
• Serotonin syndrome (when used with serotonergic drugs)

Interactions

• May interact with MAOIs, leading to serious side effects
• Potential interactions with other CNS depressants, leading to increased sedation
• May enhance the effects of alcohol
• Can interact with medications that affect serotonin levels, increasing the risk of serotonin syndrome

Precautions

• Use with caution in patients with a history of substance abuse
• Monitor use in patients with hepatic impairment
• Caution advised in patients with a history of seizures
• Should not be used in children under 2 years unless directed by a physician

Pregnancy

Dextromethorphan should be used during pregnancy only if clearly needed. Consult a healthcare provider for advice.

Breast-feeding

Dextromethorphan is excreted in breast milk. Caution is advised when administered to nursing mothers.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Oral syrup
• Tablets
• Capsules
• Lozenges

Indications

• Respiratory conditions (e.g., asthma, chronic obstructive pulmonary disease)
• Cough (e.g., as an antitussive)
• Anxiety and sleep disorders (when associated with specific formulations)

Dosage

Children: Refer to the BNF for Children for appropriate dosing information, as it is determined based on weight and age for the specific formulation.

Adults: Refer to the specific product monograph for dosing information, as it varies based on the drug formulation and indication.

Mechanism of action

Hydrobromides often act as competitive antagonists or agonists at specific receptor sites, depending on the drug involved. The exact mechanism can vary widely, but many hydrobromide-containing drugs modulate neurotransmitter activity, impacting various pathways in the body such as those involved in the central nervous system or respiratory function. The metabolic pathways include Phase I reactions primarily mediated by cytochrome P450 enzymes, which facilitate the functionalization and clearance of these compounds.

Pharmacodynamics

The pharmacodynamics of hydrobromide salts are largely determined by the specific drug they are associated with. Generally, hydrobromides may exhibit effects such as sedation, bronchodilation, or antitussive actions. The efficacy and adverse effects are influenced by the drug's receptor selectivity, affinity, and the pharmacological properties inherent to the parent compound.

Pharmacokinetics

Hydrobromides typically exhibit variable pharmacokinetic profiles depending on the specific drug formulation. They are generally absorbed rapidly following oral administration, with peak plasma concentrations occurring within a few hours. Metabolism primarily occurs in the liver through cytochrome P450 enzymes, particularly CYP2E1, among others. The elimination half-life varies but is often in the range of several hours, allowing for once or twice-daily dosing in many formulations. Excretion is usually via the kidneys, with metabolites being eliminated in urine.

Pregnancy

There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits justify the potential risks to the fetus.

Breast-feeding

Caution is advised; consider the importance of the drug to the mother against potential risks to the breastfeeding infant.

Storage

Store in a cool, dry place away from light. Keep out of reach of children.

Dosage

Children: Refer to the specific drug's prescribing information for detailed dosage.

Adults: Refer to the specific drug's prescribing information for detailed dosage.

Mechanism of action

The mechanism of action varies depending on the specific drug that is in hydrochloride form. Generally, hydrochloride salts dissociate in solution to release the active drug, which then interacts with specific receptors or enzymes in the body to exert its pharmacological effects.

Pharmacodynamics

Pharmacodynamics will depend on the specific active ingredient in the hydrochloride formulation. Typically, the pharmacodynamics involve the interaction of the drug with its target receptors, leading to a physiological response. This can include altering neurotransmitter levels, inhibiting enzymes, or blocking receptors, among other actions.

Pharmacokinetics

Pharmacokinetics will also vary based on the specific drug. Generally, hydrochloride salts are well absorbed after oral administration, with peak plasma concentrations occurring within a few hours. They may undergo first-pass metabolism in the liver, and their elimination half-life can vary widely depending on the drug's characteristics.

Pregnancy

Consult with healthcare provider before use; risk versus benefit should be evaluated.

Breast-feeding

Use with caution; monitor for potential adverse effects in the infant.

Storage

Store in a cool, dry place away from light; keep out of reach of children.

Indications

• Topical pain relief for muscle and joint pain
• Relief of minor aches and pains associated with arthritis
• Cough suppressant in throat lozenges
• Respiratory relief in nasal decongestants

Dosage

Children: For paediatric use, refer to specific product guidelines and consult a healthcare professional for dosing recommendations based on age and weight.

Adults: For topical formulations, apply a thin layer of menthol to the affected area not more than 3 to 4 times daily. For products containing menthol as a cough suppressant, follow the dosing instructions on the product label.

Mechanism of action

Menthol acts primarily as a natural analgesic and counterirritant. It exerts its effects by stimulating the TRPM8 (transient receptor potential cation channel subfamily M member 8) receptors on sensory neurons, which are responsible for the sensation of coolness. This stimulation leads to a sensation of cooling and can help to alleviate pain and discomfort. Additionally, menthol can help to open up nasal passages, enhancing airflow and providing relief from congestion.

Pharmacodynamics

Menthol displays local analgesic properties by inducing a cooling effect on the skin and mucous membranes. This cooling sensation can distract from underlying pain by activating cold-sensitive receptors. Moreover, menthol may enhance the absorption of other topical medications and is often included in formulations to improve their efficacy and comfort during application.

Pharmacokinetics

Menthol is well-absorbed when applied topically or ingested. It undergoes extensive first-pass metabolism in the liver when ingested, resulting in lower systemic bioavailability. The half-life of menthol is relatively short, and it is primarily eliminated through hepatic metabolism followed by renal excretion. The onset of action is usually rapid when applied topically, providing immediate cooling and pain-relief effects.

Pregnancy

There is limited information regarding the safety of methol during pregnancy. It is recommended to use caution and consult a healthcare professional before use.

Breast-feeding

Methol is generally considered safe during breastfeeding, but it is advisable to consult a healthcare professional before use.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Indications

• Nasal congestion due to colds
• Allergic rhinitis
• Sinusitis
• Eustachian tube dysfunction

Dosage

Children: Refer to BNF for Children for specific dosing recommendations.

Adults: Refer to BNF or local guidelines for specific dosing recommendations.

Mechanism of action

Pseudoephedrine primarily functions as an alpha-adrenergic agonist. It stimulates alpha-1 adrenergic receptors on vascular smooth muscle, leading to vasoconstriction. This action decreases blood flow to the nasal mucosa, resulting in reduced edema and congestion.

Pharmacodynamics

The pharmacodynamic effects of pseudoephedrine include its ability to alleviate nasal congestion and pressure. By reducing nasal mucosal swelling and promoting airflow, pseudoephedrine provides symptomatic relief in conditions associated with upper respiratory tract congestion. Its effects typically appear within 30 minutes and can last for several hours.

Pharmacokinetics

Pseudoephedrine is well absorbed after oral administration. It is metabolized in the liver and has a half-life of approximately 6 hours. The drug is excreted primarily in the urine, with about 55% of a dose being eliminated unchanged. Renal function can affect the elimination of pseudoephedrine, necessitating dosage adjustments in patients with renal impairment.

Contra-indications

• Severe hypertension
• Severe coronary artery disease
• Concurrent use of monoamine oxidase inhibitors (MAOIs)
• Hypersensitivity to pseudoephedrine or any component of the formulation

Adverse effects

• Insomnia
• Nervousness
• Dizziness
• Increased blood pressure
• Tachycardia
• Dry mouth
• Nausea
• Headache

Interactions

• Monoamine oxidase inhibitors (MAOIs) may increase the risk of hypertensive crisis
• Other sympathomimetics may exacerbate cardiovascular side effects
• Antihypertensive agents may have reduced effectiveness

Precautions

• Use with caution in patients with hypertension, heart disease, diabetes, hyperthyroidism, or prostatic hypertrophy
• Monitor blood pressure regularly during treatment
• Use in caution in elderly patients

Pregnancy

Pseudoephedrine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult healthcare provider for guidance.

Breast-feeding

Pseudoephedrine is excreted in breast milk; caution is advised when administering to nursing mothers. Consult healthcare provider.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Tablets
• Extended-release tablets
• Liquid formulations
• Combination products with antihistamines or analgesics

Indications

• Allergic rhinitis (hay fever)
• Allergic conjunctivitis
• Urticaria (hives)
• Other upper respiratory allergies

Dosage

Children: For children aged 2 to 6 years, the recommended dose is 1.25 mg to 2.5 mg taken

Adults: The usual adult dose for triprolidine is 2.5 mg to 5 mg taken orally, one to three times daily, as needed. Refer to the BNF for specific dosing recommendations.

Mechanism of action

Triprolidine binds to the histamine H1 receptor, inhibiting the action of endogenous histamine. By competing with histamine for H1-receptor sites on effector cells, it prevents the physiological responses mediated by histamine, such as pruritus, urticaria, and bronchoconstriction. The drug's anticholinergic effects also contribute to reduced secretion in the nasal mucosa.

Pharmacodynamics

In allergic reactions, allergens interact with surface IgE antibodies on mast cells, leading to degranulation and release of histamine. Histamine acts on H1-receptors to produce various effects, including itching, vasodilatation, and increased vascular permeability. Triprolidine, as an H1 antagonist, competes with histamine for receptor binding, effectively blocking these reactions and providing relief from allergy symptoms.

Pharmacokinetics

Triprolidine is absorbed well following oral administration, with peak plasma concentrations typically occurring within 2 to 4 hours. It has a relatively long half-life, allowing for sustained effects. The drug is metabolized in the liver and primarily excreted via urine. Due to its ability to cross the blood-brain barrier, triprolidine may also cause sedation as a side effect.

Adverse effects

• Drowsiness
• Dizziness
• Dry mouth
• Blurred vision
• Constipation

Precautions

• Use with caution in patients with a history of glaucoma
• May exacerbate urinary retention in patients with prostatic hypertrophy
• Caution in driving or operating machinery due to sedative effects

Pregnancy

Triprolidine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult with a healthcare provider.

Breast-feeding

It is not known whether triprolidine is excreted in human milk. Caution is advised when administering to nursing mothers.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Tablets
• Syrup

Mechanism of action

Dextromethorphan is a low-affinity uncompetitive NMDA antagonist and sigma-1 receptor agonist. It is also an antagonist of α3/β4 nicotinic receptors. However, the mechanism by which dextromethorphan's receptor agonism and antagonism translate to a clinical effect is not well understood. Dextromethorphan (DXM) is the dextro isomer of levomethorphan, a semisynthetic morphine derivative. Although structurally similar to other /CNS depressants/, DXM does not act as a mu receptor opioid (eg, morphine, heroin). DXM and its metabolite, dextrorphan, act as potent blockers of the N-methyl-d-aspartate (NMDA) receptor. Amantadine and dextromethorphan suppress levodopa (L-DOPA)-induced dyskinesia (LID) in patients with Parkinson's disease (PD) and abnormal involuntary movements (AIMs) in the unilateral 6-hydroxydopamine (6-OHDA) rat model. These effects have been attributed to N-methyl-d-aspartate (NMDA) antagonism. However, amantadine and dextromethorphan are also thought to block serotonin (5-HT) uptake and cause 5-HT overflow, leading to stimulation of 5-HT(1A) receptors, which has been shown to reduce LID. We undertook a study in 6-OHDA rats to determine whether the anti-dyskinetic effects of these two compounds are mediated by NMDA antagonism and/or 5-HT(1A) agonism. In addition, we assessed the sensorimotor effects of these drugs using the Vibrissae-Stimulated Forelimb Placement and Cylinder tests. Our data show that the AIM-suppressing effect of amantadine was not affected by the 5-HT(1A) antagonist WAY-100635, but was partially reversed by the NMDA agonist d-cycloserine. Conversely, the AIM-suppressing effect of dextromethorphan was prevented by WAY-100635 but not by d-cycloserine. Neither amantadine nor dextromethorphan affected the therapeutic effects of L-DOPA in sensorimotor tests. We conclude that the anti-dyskinetic effect of amantadine is partially dependent on NMDA antagonism, while dextromethorphan suppresses AIMs via indirect 5-HT(1A) agonism. Combined with previous work from our group, our results support the investigation of 5-HT(1A) agonists as pharmacotherapies for LID in PD patients. Dextromethorphan (DM) is a dextrorotatory morphinan and an over-the-counter non-opioid cough suppressant. We have previously shown that DM protects against LPS-induced dopaminergic neurodegeneration through inhibition of microglia activation. Here, we investigated protective effects of DM against endotoxin shock induced by lipopolysaccharide/d-galactosamine (LPS/GalN) in mice and the mechanism underlying its protective effect. Mice were given multiple injections of DM (12.5 mg/kg, s.c.) 30 min before and 2, 4 hr after an injection of LPS/GalN (20 ug/700 mg/kg). DM administration decreased LPS/GalN-induced mortality and hepatotoxicity, as evidenced by increased survival rate, decreased serum alanine aminotransferase activity and improved pathology. Furthermore, DM was also effective when it was given 30 min after LPS/GalN injection. The protection was likely associated with reduced serum and liver tumor necrosis factor alpha (TNF-alpha) levels. DM also attenuated production of superoxide and intracellular reactive oxygen species in Kupffer cells and neutrophils. Real-time RT-PCR analysis revealed that DM administration suppressed the expression of a variety of inflammation-related genes such as macrophage inflammatory protein-2, CXC chemokine, thrombospondin-1, intercellular adhesion molecular-1 and interleukin-6. DM also decreased the expression of genes related to cell-death pathways, such as the DNA damage protein genes GADD45 and GADD153. In summary, DM is effective in protecting mice against LPS/GalN-induced hepatotoxicity, and the mechanism is likely through a faster TNF-alpha clearance, and decrease of superoxide production and inflammation and cell-death related components. This study not only extends neuroprotective effect of DM, but also suggests that DM may be a novel compound for the therapeutic intervention for sepsis. /The

Pharmacodynamics

Dextromethorphan is an opioid-like molecule indicated in combination with other medication in the treatment of coughs and pseudobulbar affect. It has a moderate therapeutic window, as intoxication can occur at higher doses. Dextromethorphan has a moderate duration of action. Patients should be counselled regarding the risk of intoxication.

Mechanism of action

Triprolidine binds to the histamine H1 receptor. This blocks the action of endogenous histamine, which subsequently leads to temporary relief of the negative symptoms brought on by histamine. Antihistamines used in the treatment of allergy act by competing with histamine for H1-receptor sites on effector cells. They thereby prevent, but do not reverse, responses mediated by histamine alone. Antihistamines antagonize, in varying degrees, most of the pharmacological effects of histamine, including urticaria and pruritus. Also, the anticholinergic actions of most antihistamines provide a drying effect on the nasal mucosa. /Antihistamines/ Antihistamines used in the treatment of allergy act by competing with histamine for H1-receptor sites on effector cells. They thereby prevent, but do not reverse, responses mediated by histamine alone. Antihistamines antagonize, in varying degrees, most of the pharmacological effects of histamine, including urticaria and pruritus. Also, the anticholinergic actions of most antihistamines provide a drying effect on the nasal mucosa. /Antihistamines/ H1 antagonists inhibit most responses of smooth muscle to histamine. Antagonism of the constrictor action of histamine on respiratory smooth muscle is easily shown in vivo and in vitro. /Histamine Antagonists: H1 Antagonists/ /SRP:/ The action of histamine results in increased permeability and formation of edema and wheal. H1 antagonists block that action. For more Mechanism of Action (Complete) data for TRIPROLIDINE (7 total), please visit the HSDB record page.

Pharmacodynamics

In allergic reactions an allergen interacts with and cross-links surface IgE antibodies on mast cells and basophils. Once the mast cell-antibody-antigen complex is formed, a complex series of events occurs that eventually leads to cell-degranulation and the release of histamine (and other chemical mediators) from the mast cell or basophil. Once released, histamine can react with local or widespread tissues through histamine receptors. Histamine, acting on H1-receptors, produces pruritis, vasodilatation, hypotension, flushing, headache, tachycardia, and bronchoconstriction. Histamine also increases vascular permeability and potentiates pain. Triprolidine, is a histamine H1 antagonist that competes with histamine for the normal H1-receptor sites on effector cells of the gastrointestinal tract, blood vessels and respiratory tract. It provides effective, temporary relief of sneezing, watery and itchy eyes, and runny nose due to hay fever and other upper respiratory allergies. Triprolidine has anticholinergic and sedative effects.