CADIPHEN COUGH EXPECTORANT

Indications

• Pruritus
• Eczema
• Acne
• Rosacea

Dosage

Children: For children aged 12-17 years, apply up to 3 grams 3-4 times a day, ensuring coverage is less than 10% of body surface area.

Adults: Apply thinly to the affected area 1-2 times a day. Maximum application should cover less than 10% of body surface area, with a total daily maximum of 12 grams.

Mechanism of action

Levomenthol primarily activates the cold-sensitive TRPM8 receptors in the skin. This stimulation leads to a feeling of coolness by inhibiting calcium ion currents in neuronal membranes. Additionally, menthol may exhibit analgesic properties through kappa-opioid receptor agonism, further contributing to its pain-relieving effects.

Pharmacodynamics

Levomenthol is a covalent organic compound that can be synthesized or extracted from peppermint and other mint oils. It induces a cooling sensation when applied topically, inhaled, or ingested, by stimulating cold-sensitive receptors located in the skin. Notably, this effect occurs without a decrease in actual skin temperature, making it useful in topical formulations for managing discomfort.

Pharmacokinetics

Levomenthol is absorbed through the skin upon topical application. Its effects are localized, and it does not significantly enter systemic circulation when used as directed. The onset of action is typically rapid, providing immediate symptomatic relief from conditions like itching and irritation.

Contra-indications

• Severe heart disease
• Severe hepatic impairment
• Glaucoma
• Urinary retention
• History of mania or arrhythmias

Adverse effects

• Drowsiness
• Dizziness
• Headache
• Nausea
• Vomiting
• Dry mouth
• Dry eyes
• Diarrhea
• Constipation
• Skin reactions
• Altered taste
• Blurred vision
• Suicidal behaviors

Interactions

• Tricyclic antidepressants
• Other central nervous system depressants

Precautions

• Avoid application to large areas of the skin
• Use caution in patients with a history of psychiatric disorders
• Caution advised for driving and skilled tasks due to potential somnolence or dizziness

Pregnancy

Manufacturer advises use only if potential benefit outweighs risk.

Breast-feeding

Manufacturer advises use only if potential benefit outweighs risk.

Storage

Store in a cool, dry place, protected from light.

Formulations

• AquaSoothe 1% cream (Menthol 10 mg per 1 gram)
• AquaSoothe 2% cream (Menthol 20 mg per 1 gram)
• Arjun 0.5% cream (Menthol 5 mg per 1 gram)
• Arjun 1% cream (Menthol 10 mg per 1 gram)
• Dermacool 0.5% cream (Menthol 5 mg per 1 gram)
• Dermacool 1% cream (Menthol 10 mg per 1 gram)
• Menthoderm 0.5% cream (Menthol 5 mg per 1 gram)
• Menthoderm 1% cream (Menthol 10 mg per 1 gram)
• Menthoderm 2% cream (Menthol 20 mg per 1 gram)
• Menthoderm 5% cream (Menthol 50 mg per 1 gram)

Indications

• Nitrogen supplementation in clinical nutrition
• Management of metabolic alkalosis
• Treatment of certain types of kidney disorders

Dosage

Children: Specific pediatric dosing information is not detailed in the BNF. Refer to the BNF for Children for appropriate dosing based on age and condition.

Adults: Dosage varies based on clinical indication and should be guided by specific treatment protocols. Refer to clinical guidelines for detailed dosing information.

Mechanism of action

Ammonium ions participate in various metabolic pathways, including the biosynthesis of amino acids and nucleotides. It serves as a nitrogen source for organisms, facilitating the synthesis of essential biomolecules. The presence of ammonium can influence pH levels and osmotic balance within cells, thereby affecting cellular functions and enzyme activities.

Pharmacodynamics

Ammonium affects cellular metabolism by acting as a nitrogen donor in the synthesis of organic compounds. Its role in the nitrogen cycle and as a substrate in biochemical pathways allows for the maintenance of cellular functions, including energy production and cellular growth. Alterations in ammonium levels can influence various physiological processes, including neurotransmitter synthesis and energy metabolism.

Pharmacokinetics

Ammonium is readily absorbed and distributed in biological systems. It can be produced endogenously through amino acid metabolism or obtained from dietary sources. The excretion of ammonium primarily occurs through the kidneys, where it is converted to urea for elimination. Ammonium levels are regulated by various mechanisms, including the action of renal tubular cells that either secrete or reabsorb ammonium based on the body's needs.

Indications

• Cough associated with respiratory tract infections
• Acid-base disorders
• Edema management

Dosage

Children: Refer to the BNF for Children for appropriate paediatric dosing guidelines based on age and condition.

Adults: Refer to the BNF for specific adult dosing guidelines as they depend on the indication and clinical context.

Mechanism of action

Ammonium chloride increases acidity by raising hydrogen ion concentrations. It dissociates into ammonium and chloride ions; the ammonium is converted to urea in the liver, releasing hydrogen ions that lower pH. The chloride ions displace bicarbonate in extracellular fluid, leading to acidosis and increased renal excretion of electrolytes and water, resulting in fluid mobilization.

Pharmacodynamics

Ammonium chloride acts as a systemic acidifier, facilitating the excretion of chloride and sodium, while also increasing the acidity of body fluids. The conversion of ammonium to urea in the liver with the release of hydrogen ions contributes to a decrease in blood pH, affecting acid-base balance in the body.

Pharmacokinetics

Ammonium chloride is absorbed from the gastrointestinal tract and metabolized in the liver, where it is converted to urea. The dissociated ions impact renal function, leading to increased excretion of sodium, potassium, and water. The elimination half-life and specific metabolism details are not explicitly defined.

Adverse effects

• Nausea
• Vomiting
• Abdominal pain
• Diarrhea
• Dizziness
• Headache

Interactions

• Antacids may reduce the effectiveness of ammonium chloride
• Potassium-sparing diuretics may increase the risk of hyperkalemia

Precautions

• Use with caution in patients with renal impairment
• Monitor electrolyte levels during prolonged therapy
• Consider potential for acidosis in patients with liver disease

Pregnancy

Ammonium chloride should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. Consult a healthcare provider for individualized advice.

Breast-feeding

Ammonium chloride is excreted in breast milk. Use caution and consult a healthcare provider if breastfeeding.

Storage

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

Formulations

• Oral solution
• Powder for oral solution

Indications

• Skin conditions (e.g., eczema, dermatitis)
• Respiratory issues (e.g., cough, cold)
• Topical antiseptic applications
• Aromatic uses for mood enhancement

Dosage

Children: Refer to relevant product-specific guidelines as doses may vary by formulation and use.

Adults: Refer to relevant product-specific guidelines as doses may vary by formulation and use.

Mechanism of action

Balsam exerts its effects primarily through its volatile compounds, which may exhibit anti-inflammatory, antiseptic, and analgesic properties. The specific pathways are not well-characterized in modern pharmacology, but traditional uses suggest modulation of inflammatory pathways and soothing of mucosal irritations.

Pharmacodynamics

Balsam compounds may influence various biological pathways, contributing to their anti-inflammatory and soothing effects. The aromatic properties can enhance mood and well-being, while topical applications are known to relieve certain skin conditions. The pharmacodynamics in humans, however, require more clinical evidence to fully elucidate their mechanisms.

Pharmacokinetics

The pharmacokinetics of balsam components are not extensively documented, but it is known that the compounds can be absorbed through the skin and mucous membranes. Metabolism primarily occurs in the liver, and elimination is expected to be via urine. However, specific half-lives and clearance rates are not well-studied.

Pregnancy

There is limited information available regarding the safety of balsam during pregnancy. It is advisable to avoid use unless clearly necessary.

Breast-feeding

Due to insufficient data on the excretion of balsam in human milk, caution is advised when using balsam while breastfeeding.

Storage

Store in a cool, dry place away from direct sunlight.

Formulations

• {'name': 'Balsam', 'molecular_formula': 'C15H24', 'description': 'Balsam is a natural resin obtained from various trees, known for its aromatic and medicinal properties. It is often used in topical preparations and alternative medicine.'}

Indications

• Cough associated with respiratory tract infections
• Cough due to bronchial asthma
• Acute bronchitis
• Chronic obstructive pulmonary disease (COPD)
• Sinusitis

Dosage

Children: For children aged 6 to 12 years, the typical dosage is 100-200 mg every 4 hours as needed, not exceeding 1.2 g in 24 hours. For children aged 2 to 6 years, the dosage is generally 50-100 mg every 4 hours as needed, not exceeding 600 mg in 24 hours. Refer to the BNF for Children for specific dosing recommendations.

Adults: The usual adult dosage for guaifenesin is 200-400 mg every 4 hours as needed, not exceeding 2.4 g in 24 hours.

Mechanism of action

Guaifenesin is believed to work by increasing mucus secretion and acting as an irritant to gastric vagal receptors, which stimulates efferent parasympathetic reflexes. This leads to glandular exocytosis of less viscous mucus. Additionally, it may enhance respiratory tract fluid, thereby reducing the viscosity of secretions and improving ciliary action for more efficient mucus clearance.

Pharmacodynamics

As an expectorant, guaifenesin enhances the output of bronchial secretions and phlegm by decreasing their adhesiveness and surface tension. This results in an increased flow of less viscous gastric secretions, promoting ciliary action and converting unproductive coughs into more productive ones. Although it may also exhibit mild anticonvulsant and muscle relaxant properties, these effects are less well established.

Pharmacokinetics

Guaifenesin is rapidly absorbed from the gastrointestinal tract and reaches peak plasma concentrations within one hour of administration. It is metabolized in the liver, and its elimination half-life is approximately one hour. The drug is primarily excreted in the urine, mostly as metabolites.

Adverse effects

• Nausea
• Vomiting
• Dizziness
• Headache
• Rash

Precautions

• Use with caution in patients with chronic cough due to asthma, smoking, or emphysema
• Ensure adequate hydration while using

Pregnancy

Guaifenesin is categorized as pregnancy category C. Use only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Guaifenesin is excreted in breast milk. Caution should be exercised when administered to breastfeeding women.

Storage

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

Formulations

• Oral syrup
• Tablets
• Extended-release capsules

Indications

• Dehydration
• Electrolyte imbalance
• Heat-related illnesses
• Postoperative recovery
• Diarrhea and vomiting
• Chronic illnesses leading to fluid loss

Dosage

Children: Pediatric dosing should be guided by clinical guidelines and the severity of dehydration. For children experiencing mild to moderate dehydration, ORS is recommended, with the amount based on weight and age. For severe dehydration, intravenous fluid therapy is indicated, with specific protocols available in pediatric guidelines.

Adults: Dosage varies based on the degree of dehydration and the underlying clinical condition. For mild dehydration, oral rehydration solutions (ORS) are often sufficient, while severe cases may require intravenous fluids, with specific rates and types determined by clinical judgment.

Mechanism of action

Hydration works by replenishing lost fluids and electrolytes, restoring osmotic balance and cellular function. The primary components of hydration solutions, such as water, electrolytes (sodium, potassium, chloride), and sometimes glucose, promote proper cellular hydration and support metabolic processes.

Pharmacodynamics

The pharmacodynamics of hydration primarily involves the restoration of plasma volume and the maintenance of electrolyte homeostasis. Proper hydration enhances kidney function, improves cardiovascular stability, and supports normal physiological functions, such as thermoregulation and nutrient transport. It also aids in the recovery of tissues and organs affected by dehydration.

Pharmacokinetics

The pharmacokinetics of hydration solutions depend on the composition of the fluid administered. Oral hydration solutions are absorbed primarily in the gastrointestinal tract, with the rate of absorption influenced by the concentration of electrolytes and glucose. Intravenous fluids can distribute rapidly into the extracellular space, with effects seen almost immediately. The elimination of excess fluids occurs mainly through renal excretion.

Pregnancy

Hydration is essential during pregnancy, but fluid intake should be monitored to avoid excessive hydration, which can lead to complications.

Breast-feeding

Adequate hydration is important during breastfeeding, as it supports milk production. However, excessive fluid intake should be avoided.

Storage

Store in a cool, dry place away from direct sunlight.

Formulations

• Oral solutions
• Intravenous fluids
• Electrolyte solutions

Indications

• Pain relief
• Inflammatory conditions
• Arthritis
• Musculoskeletal disorders
• Postoperative pain management

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations tailored to the child’s age, weight, and clinical condition.

Adults: Refer to the prescribing information or guidelines for the appropriate dosage based on the condition being treated and patient characteristics.

Mechanism of action

Meleate exerts its effects by inhibiting the synthesis of prostaglandins, which are lipid compounds that mediate inflammation, pain, and fever. By blocking the cyclooxygenase (COX) enzymes, particularly COX-1 and COX-2, meleate reduces the production of these inflammatory mediators, leading to decreased pain and inflammation.

Pharmacodynamics

Meleate demonstrates a dose-dependent analgesic and anti-inflammatory effect. It is effective in reducing pain intensity and improving function in conditions such as arthritis and other musculoskeletal disorders. The onset of action can vary based on the route of administration, with oral formulations generally taking longer to achieve therapeutic levels compared to parenteral routes.

Pharmacokinetics

After administration, meleate is absorbed through the gastrointestinal tract, with peak plasma concentrations typically reached within 1 to 3 hours. It is extensively metabolized in the liver, primarily through conjugation and oxidation pathways. The elimination half-life is variable, influenced by factors such as age, liver function, and the presence of other medications. The drug is primarily excreted in urine as metabolites, with minimal unchanged drug found in urine.

Pregnancy

Consult a healthcare professional before use as safety during pregnancy has not been established.

Breast-feeding

Consult a healthcare professional before use as safety during breastfeeding has not been established.

Storage

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

Indications

• Cough associated with respiratory tract infections
• Bronchitis
• Chronic obstructive pulmonary disease (COPD)
• Other conditions involving mucus production

Dosage

Children: Refer to the BNF for Children for specific paediatric dosing guidelines.

Adults: Refer to the BNF for specific adult dosing guidelines.

Mechanism of action

Terpin acts as an expectorant by increasing the production of respiratory tract secretions, which helps to loosen mucus and promote its clearance from the airways. This mechanism aids in relieving cough and improving respiratory function.

Pharmacodynamics

Terpin exhibits expectorant activity, which is beneficial in the treatment of respiratory conditions characterized by excessive mucus production. Its action enhances mucociliary clearance, allowing for improved airflow and reduction of cough frequency.

Pharmacokinetics

Terpin is absorbed in the gastrointestinal tract and metabolized in the liver. Its metabolites are primarily excreted via the kidneys. The onset of action is typically observed within a few hours after oral administration, with effects lasting for a variable duration depending on the formulation and dosage.

Pregnancy

There are no adequate and well-controlled studies in pregnant women. Therefore, terpin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is unknown whether terpin is excreted in human milk. Caution should be exercised when terpin is administered to a nursing woman.

Storage

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

Dosage

Children: There are no established therapeutic doses for toluene in the pediatric population. Exposure should be avoided due to potential toxicity.

Adults: There are no established therapeutic doses for toluene as it is primarily used as an industrial solvent. Exposure should be minimized due to its toxic effects.

Mechanism of action

Toluene exerts its effects primarily through its interaction with the central nervous system. It acts as a neurotoxin and can influence neurotransmitter systems, particularly those involving gamma-aminobutyric acid (GABA) and glutamate. The exact pathways are not fully elucidated, but toluene is known to enhance GABAergic activity, leading to sedative and anxiolytic effects, while also disrupting glutamate signaling, which can contribute to neurotoxicity.

Pharmacodynamics

The pharmacodynamics of toluene involve its effects on the central nervous system, where it can lead to a range of symptoms from euphoria and intoxication to neurological impairment and respiratory depression at higher exposures. Chronic exposure may result in neurobehavioral deficits, cognitive dysfunction, and potential long-term neurological damage. The effects can vary significantly based on concentration, duration of exposure, and individual susceptibility.

Pharmacokinetics

Toluene is rapidly absorbed through inhalation and dermal routes, with peak blood concentrations occurring shortly after exposure. It is metabolized primarily in the liver via cytochrome P450 enzymes, leading to the formation of various metabolites, including benzyl alcohol and hippuric acid. These metabolites are excreted in the urine. The elimination half-life of toluene varies depending on the route of exposure and individual metabolic factors, generally ranging from a few hours to a day.

Pregnancy

Toluene is not recommended during pregnancy due to potential risks to fetal development. It may cause teratogenic effects.

Breast-feeding

Toluene may be excreted in breast milk, and its use is generally not recommended while breastfeeding due to potential harm to the nursing infant.

Storage

Store in a cool, dry place away from direct sunlight, heat, and ignition sources. Ensure containers are tightly sealed.

Indications

• Asthma
• Chronic bronchitis
• Cough
• Respiratory infections
• Lung conditions

Dosage

Children: Paediatric dosing is not specifically defined; consult relevant pediatric references or healthcare professionals for appropriate dosing.

Adults: Dosage varies based on the form of preparation and specific condition; refer to established guidelines for herbal medicines.

Mechanism of action

The active compounds in Vasaka, particularly vasicine and vasicinone, exhibit bronchodilator activity by relaxing bronchial smooth muscles. This action helps alleviate symptoms of respiratory conditions such as asthma and bronchitis. Additionally, these compounds have been shown to exert anti-inflammatory effects by inhibiting the release of pro-inflammatory mediators.

Pharmacodynamics

Vasaka has a significant impact on the respiratory system, primarily functioning as a mucolytic and bronchodilator. It facilitates the clearing of mucus from the airways, thereby improving airflow and easing breathing. The anti-inflammatory properties contribute to reducing the severity of respiratory conditions by decreasing airway inflammation.

Pharmacokinetics

The pharmacokinetics of Vasaka are not thoroughly documented in the literature. However, it is understood that the active constituents are absorbed after oral administration, with a variable bioavailability influenced by individual metabolism. The elimination half-life and specific metabolic pathways remain to be fully elucidated, necessitating further research in this area.

Adverse effects

• Gastrointestinal upset
• Nausea
• Vomiting
• Diarrhea
• Allergic reactions

Interactions

• May enhance the effects of anticoagulants
• Potential interaction with antidiabetic medications

Precautions

• Use with caution in patients with liver or kidney disease
• Monitor for signs of an allergic reaction

Pregnancy

Limited data available, consult healthcare provider before use.

Breast-feeding

Consult healthcare provider before use, as limited data is available on safety during lactation.

Storage

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

Formulations

• Dried leaves
• Powder
• Extracts
• Tinctures

Mechanism of action

Menthol primarily activates the cold-sensitive TRPM8 receptors in the skin. Menthol, after topical application, causes a feeling of coolness due to stimulation of 'cold' receptors by inhibiting Ca++ currents of neuronal membranes. It may also yield analgesic properties via kappa-opioid receptor agonism.

Pharmacodynamics

Menthol is a covalent organic compound made synthetically or obtained from peppermint or other mint oils. Menthol induces a cooling sensation on the skin upon inhalation, oral ingestion, or topical application by stimulating the cold-sensitive receptors expressed on the skin, without actually causing a drop in the skin temperature.

Mechanism of action

Ammonium chloride increases acidity by increasing the amount of hydrogen ion concentrations. Ammonium chloride can be used as an expectorant due to its irritative action on the bronchial mucosa. This effect causes the production of respiratory tract fluid which in order facilitates the effective cough. The acid-forming properties of ammonium chloride result from dissociation of the salt to an ammonium cation and a chloride anion. In patients with normal hepatic function, the ammonium cation is converted to urea by the liver and a hydrogen cation is released which reacts with a bicarbonate ion to form water and carbon dioxide. The chloride anion combines with fixed bases in the extracellular fluid, thereby reducing the alkaline reserve of the body. The net result is the displacement of bicarbonate ions by chloride anions. The displacement of bicarbonate by chloride alters the bicarbonate:carbonic acid ratio if the body and acidosis results. The increased chloride concentration in the extracellular fluid produces an increased load to the renal tubules and appreciable amounts of chloride anions escape reabsorption. These anions are excreted along with cations and water. Sodium is the principal cation excreted; however, potassium excretion may also be increased to some degree. By increasing the excretion of both extracellular electrolytes and water, ammonium chloride causes a net loss of extracellular fluid and promotes the mobilization of edema fluid.

Pharmacodynamics

Systemic acidifier. In liver ammonium chloride is converted into urea with the liberation of hydrogen ions ( which lowers the pH) and chloride.

Mechanism of action

Although the exact mechanism of action of guaifenesin may not yet be formally or totally elucidated, it is believed that expectorants like guaifenesin function by increasing mucus secretion. Moreover, it is also further proposed that such expectorants may also act as an irritant to gastric vagal receptors, and recruit efferent parasympathetic reflexes that can elicit glandular exocytosis that is comprised of a less viscous mucus mixture. Subsequently, these actions may provoke coughing that can ultimately flush difficult to access, congealed mucopurulent material from obstructed small airways to facilitate a temporary improvement for the individual. Consequently, while it is generally proposed that guaifenesin functions as an expectorant by helping to loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus and make coughs more productive, there has also been research to suggest that guaifenesin possesses and is capable of demonstrating anticonvulsant and muscle relaxant effects to some degree possibly by acting as an NMDA receptor antagonist. Guaifenesin is thought to act as an expectorant by increasing the volume and reducing the viscosity of secretions in the trachea and bronchi. Thus it may increase the efficiency of the cough reflex and facilitate removal of the secretions; however, objective evidence for this is limited and conflicting. By increasing respiratory tract fluid, guaifenesin reduces the viscosity of tenacious secretions and acts as an expectorant. Guaifenesin, a commonly used agent for the treatment of cough, is termed an expectorant since it is believed to alleviate cough discomfort by increasing sputum volume and decreasing its viscosity, thereby promoting effective cough. Despite its common usage, relatively few studies, yielding contrasting results, have been performed to investigate the action and efficacy of guaifenesin. To evaluate the effect of guaifenesin on cough reflex sensitivity. Randomized, double-blind, placebo-controlled trial. Fourteen subjects with acute viral upper respiratory tract infection (URI) and 14 healthy volunteers. On 2 separate days, subjects underwent capsaicin cough challenge 1 to 2 hr after receiving a single, 400-mg dose (capsules) of guaifenesin or matched placebo. Measurements and results: The concentration of capsaicin inducing five or more coughs (C(5)) was determined. Among subjects with URI, mean (+/- SEM) log C(5) after guaifenesin and placebo were 0.92 +/- 0.17 and 0.66 +/- 0.14, respectively (p = 0.028). No effect on cough sensitivity was observed in healthy volunteers. /The/ results demonstrate that guaifenesin inhibits cough reflex sensitivity in subjects with URI, whose cough receptors are transiently hypersensitive, but not in healthy volunteers. Possible mechanisms include a central antitussive effect, or a peripheral effect by increased sputum volume serving as a barrier shielding cough receptors within the respiratory epithelium from the tussive stimulus.

Pharmacodynamics

Guaifenesin is categorized as an expectorant that acts by enhancing the output of phlegm (sputum) and bronchial secretions via decreasing the adhesiveness and surface tension of such material. Furthermore, guaifenesin elicits an increased flow of less viscous gastric secretions that subsequently promote ciliary action - all actions that ultimately change dry, unproductive coughing to coughs that are more productive and less frequent. Essentially, by decreasing the viscosity and adhesiveness of such secretions, guaifenesin enhances the efficacy of mucociliary activity in removing accumulated secretions from the upper and lower airway.