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ANTIHISTAMINES, DECONGESTANTS, AND ANTICHOLINERGICS (Systemic)†
Some commonly used brand names are:
In the U.S.—
Antihistamine, decongestant, and anticholinergic combinations are used to treat the nasal congestion (stuffy nose) and runny nose caused by allergies and/or the common cold.
Antihistamines work by preventing the effects of a substance called histamine, which is produced by the body. Histamine can cause itching, sneezing, runny nose, and watery eyes. The antihistamine contained in these combinations is chlorpheniramine.
The decongestants in these combinations, phenylephrine, and pseudoephedrine produce a narrowing of blood vessels. This leads to clearing of nasal congestion, but it may also cause an increase in blood pressure in patients who have high blood pressure.
Anticholinergics, such as atropine, hyoscyamine, methscopolamine, and scopolamine may help produce a drying effect in the nose and chest.
These combinations are available only with your doctor"s prescription in the following dosage forms:
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For antihistamine, decongestant, and anticholinergic combinations, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reactions to antihistamines or anticholinergics, or to amphetamine, dextroamphetamine (e.g., Dexedrine), ephedrine (e.g., Ephed II), epinephrine (e.g., Adrenalin), isoproterenol (e.g., Isuprel), metaproterenol (e.g., Alupent), methamphetamine (e.g., Desoxyn), norepinephrine (e.g., Levophed), phenylephrine (e.g., Neo-Synephrine), pseudoephedrine (e.g., Sudafed), or terbutaline (e.g., Brethine). Also, tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy—For the individual ingredients of these combinations, the following apply:
Breast-feeding—Small amounts of antihistamines, decongestants, and anticholinergics may pass into the breast milk. Use is not recommended since this medicine may cause side effects, such as unusual excitement or irritability, in the nursing baby. Also, since this medicine tends to decrease the secretions of the body, it is possible that the flow of breast milk may be reduced in some women.
Children—Very young children are usually more sensitive than adults to the effects of this medicine. Increases in blood pressure, nightmares or unusual excitement, nervousness, restlessness, or irritability may be more likely to occur in children. Also, when anticholinergics are given to children during hot weather, a rapid increase in body temperature may occur, which may lead to heat stroke. In infants and children, especially those with spastic paralysis or brain damage, this medicine may be especially likely to cause severe side effects.
Older adults—Confusion or memory loss, difficult and painful urination, dizziness, drowsiness, dryness of mouth, or convulsions (seizures) may be more likely to occur in the elderly, who are usually more sensitive than younger adults to the effects of this medicine. Also, nightmares or unusual excitement, nervousness, restlessness, or irritability may be more likely to occur in elderly patients. In addition, eye pain may occur, which may be a sign of glaucoma.
Other medicines—Although certain medicines should not be used together at all, in other cases different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine it is especially important that your health care professional know if you are taking any of the following:
Other medical problems—The presence of other medical problems may affect the use of antihistamine, decongestant, and anticholinergic combinations. Make sure you tell your doctor if you have any other medical problems, especially:
Proper Use of This Medicine
Take this medicine only as directed . Do not take more of it and do not take it more often than recommended on the label, unless otherwise directed by your doctor. To do so may increase the chance of side effects.
If this medicine irritates your stomach, you may take it with food or a glass of water or milk, to lessen the irritation.
For patients taking the extended-release capsule or extended-release tablet form of this medicine :
Dosing—The dose of these combination medicines will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses for these combinations. If your dose is different, do not change it unless your doctor tells you to do so.
The number of capsules or tablets or teaspoonfuls of syrup that you take depends on the strength of the medicine. Also, the number of doses you take each day and the time between doses depend on whether you are taking a short-acting or a long-acting form of this medicine.
Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage—To store this medicine:
Precautions While Using This Medicine
Check with your doctor if your symptoms do not improve or become worse, or if you have a high fever.
Before you have any skin tests for allergies, tell the doctor in charge that you are taking this medicine. The results of the test may be affected by the antihistamine in this medicine.
These medicines may make you sweat less, causing your body temperature to increase. Use extra care not to become overheated during exercise or hot weather while you are taking this medicine , since overheating may result in heat stroke. Also hot baths or saunas may make you dizzy or faint while you are taking this medicine.
The anticholinergic contained in this medicine may cause some people to have blurred vision. Make sure your vision is clear before you drive or do anything else that could be dangerous if you are not able to see well . These medicines may also cause your eyes to become more sensitive to light than they are normally. Wearing sunglasses may help lessen the discomfort from bright light.
These medicines may cause some people to become dizzy or drowsy. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert .
The decongestant in this medicine may cause some people to be nervous or restless or to have trouble in sleeping. If you have trouble in sleeping, take the last dose of this medicine for each day a few hours before bedtime . If you have any questions about this, check with your doctor.
Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine.
This medicine may cause dryness of the mouth, nose, and throat. For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.
If you think you or someone else may have taken an overdose, get emergency help at once . Taking an overdose of this medicine or taking this medicine with alcohol or other CNS depressants may lead to unconsciousness and possibly death.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Get emergency help immediately if any of the following symptoms of overdose occur :
Clumsiness or unsteadiness; convulsions (seizures); drowsiness (severe); dryness of mouth, nose, or throat (severe); fast heartbeat; flushing or redness of face; hallucinations (seeing, hearing, or feeling things that are not there); headache (continuing); shortness of breath or troubled breathing; trouble in sleeping
For pseudoephedrine onlyUnusual nervousness, restlessness, or excitement
Also, check with your doctor as soon as possible if any of the following side effects occur:
Irregular or slow heartbeat; mood or mental changes; skin rash, hives, or itching; sore throat and fever; tightness in chest; unusual bleeding or bruising; unusual tiredness or weakness
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your health care professional if any of the following side effects continue or are bothersome:
Drowsiness; nervousness; restlessness; thickening of mucus; trouble in sleeping
Less common—more common with high doses
Blurred vision; confusion; difficult or painful urination; dizziness; dryness of mouth, nose, or throat; fast or pounding heartbeat; headache; increased sweating; loss of appetite; nausea or vomiting; nightmares; ringing or buzzing in ears; trembling; unusual excitement, nervousness, restlessness, or irritability; unusual paleness; weakness
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
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