Ammonium Chloride/ Panthenol/ Dextromethorphan

Registered South African indications:

• Relief of productive or non-productive bronchial cough in colds, bronchitis and other respiratory tract disorders

Registered South African contraindications

• Hypersensitivity to the active ingredient or any of the excipients in this combination product
• Children under the age of 6 years
• Renal impairment (Ammonium salts)
• Hepatic impairment (Ammonium salts)
• Haemophiliacs (Dexpanthenol)
• Patients with ileus due to mechanical obstruction (Dexpanthenol)
• During an acute asthma attack (Dextromethorphan)
• Patients at risk of developing respiratory failure (Dextromethorphan)
• Patients taking monoamine oxidase inhibitors (MAOIs), or for 2 weeks after stopping the MAOI medicine
• Patients taking serotonin reuptake inhibitors

South African recommendations

• Pregnancy
• Breastfeeding
• Elderly

Respiratory conditions

• Dextromethorphan, should not be given to patients at risk of developing respiratory failure (see Contraindications)
• Caution is advised in patients with a history of asthma; it should not be used during an acute asthma attack (see Contraindications)
• Use with care in patients with bronchitis, emphysema, or other conditions associated with chronic or persistent cough

Sugar content and metabolic disorders

• Contains 5.77 g sucrose per 10ml, which should be considered in patients with diabetes mellitus
• Should not be used in patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency

Allergens

• Contains methyl hydroxybenzoate, which may cause allergic reactions (possibly delayed)
• There have been a few reports of allergic reactions possibly associated with dexpanthenol

Abuse and dependence potential

• Cases of dextromethorphan abuse and associated dependence have been reported
• Caution is especially recommended in adolescents, young adults, and patients with a history of drug abuse or psychoactive substance use

CYP2D6 metabolism

• Dextromethorphan is metabolised by hepatic cytochrome P450 2D6
• Approximately 10% of the general population are poor metabolisers of CYP2D6
• Poor metabolisers or those using CYP2D6 inhibitors may experience exaggerated or prolonged effects

Serotonergic interactions and serotonin syndrome

• If a patient is a known slow metaboliser of CYP2D6 or is using serotonergic medicines (e.g. SSRIs or MAOIs) or CYP2D6 inhibitors, a doctor or pharmacist should be consulted before use (see Contraindications)
• Serotonergic effects, including potentially life-threatening serotonin syndrome, have been reported with dextromethorphan when used concomitantly with serotonergic medicines

Use in smokers

• Since ammonium chloride/panthenol/dextromethorphan suppresses coughing, it may hinder the expulsion of mucus from the lungs and airways in smokers

Effects on ability to drive and use machines

• Dextromethorphan hydrobromide may cause somnolence and dizziness, which may impair the patient’s ability to drive and use machines safely

Forms avail. in SA and covered in this monograph: syr

South African registered indications and dosages

Relief of productive or non-productive bronchial cough in colds, bronchitis and other respiratory tract disorders

Ammonium Chloride/ Panthenol/ Dextromethorphan
180/100/30 (mg/10ml)

• Oral (syr): 10ml, 2-4 times dly

Ammonium chloride/ panthenol/ dextromethorphan may be taken undiluted or diluted with water, milk, tea, fruit juices, etc., preferably after meals

Paed. forms avail. in SA and covered in this monograph: syr 

South African registered indications and dosages

Relief of productive or non-productive bronchial cough in colds, bronchitis and other respiratory tract disorders

Ammonium Chloride/ Panthenol/ Dextromethorphan
180/100/30 (mg/10ml)

Younger than 6 years

• Contraindicated

Between 6-12 years

• Oral (syr): 5ml, 2-4 times dly

Ammonium chloride/ panthenol/ dextromethorphan may be taken undiluted or diluted with water, milk, tea, fruit juices, etc., preferably after meals 

Pregnancy

South African recommendations

• Caution
• The safety of ammonium chloride/ panthenol/ dextromethorphan in pregnancy has not been established
• The established medical principle of prescribing medicaments in early pregnancy, only when absolutely indicated, should be observed

Breastfeeding

South African recommendations

• Caution
• The safety of ammonium chloride/ panthenol/ dextromethorphan in lactation has not been established

Fertility

South African recommendations

• No information available

South African recommendations

• Contraindicated

South African recommendations

• Contraindicated

South African recommendations

• Caution; no information available

Combination products may have additional pharmacological effects not accounted for by the action of the individual ingredients

Dextromethorphan

Central Nervous System Disorders

Frequency not specified

• Drowsiness

Gastrointestinal Disorders

Frequency not specified

• Gastrointestinal upsets

Combination products may have additional pharmacological effects not accounted for by the action of the individual ingredients

• Amiodarone
• Fluoxetine
• Haloperidol
• Paroxetine
• Propafenone
• Quinidine
• Thioridazine
• Central nervous system (CNS) depressants
• Monoamine oxidase inhibitors

Other interactions

• Smoking tobacco

Dextromethorphan hydrobromide

• Monoamine oxidase inhibitors (MAOIs)
• Furazolidone
• Phenelzine
• Procarbazine
• Selegiline
• Tranylcypromine

None routine 

Ammonium chloride/ panthenol/ dextromethorphan provides the specific cough-suppressing action of dextromethorphan hydrobromide plus the expectorant effect of ammonium chloride.

Dextromethorphan hydrobromide
Dextromethorphan hydrobromide is a well-tolerated powerful cough suppressant with an action similar to that of codeine but with the important advantage of not being a narcotic. It is centrally acting with a direct action on the cough centre in the medulla. It could stop bronchial cough for up to 8 hours on a single dose.

Ammonium chloride
Ammonium chloride promotes the liquefaction of mucosal secretions and facilitates expectoration.

COMBINATION PREPARATIONS

Ammonium/ Panthenol/ Dextromethorphan

Syrup (per 10ml) 180mg/100mg/30mg

• Broncol cough syrup (Cipla Medpro) originator