chlorpheniramine/dextromethorphan/pseudoephedrine (OTC)

Brand and Other Names:Forte Kidkare Cough and Cold, Rescon DM, more...Pedia Relief
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Dosing & Uses

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Dosage Forms & Strengths

chlorpheniramine/dextromethorphan/pseudoephedrine

liquid

  • (1mg/5mg/15mg)/5mL
  • (4mg/20mg/20mg)/5mL
  • (2mg/15mg/15mg)/5mL
  • (2mg/10mg/30mg)/5mL

oral drops

  • (0.8mg/3mg/8mg)/1mL

tablet

  • 4mg/60mg/20mg

tablet chewable

  • 2mg/10mg/30mg

Relief of Cold & Flu Symptoms

10 mL [(2mg/15mg/15mg)/5mL] PO q6hr; not to exceed 40 mL/day

10 mL [(2mg/10mg/30mg)/5mL] PO q4-6hr; not to exceed 40 mL/day

5 mL [(4mg/20mg/20mg)/5mL] PO q4-6hr; not to exceed 30 mL/day

2 tabs [(2mg/10mg/30mg)/tab] PO q4-6hr; not to exceed 8 tabs/day

1 tab [(4mg/60mg/20mg)/tab] PO q4-6hr; not to exceed 4 tabs/day

Dosage Forms & Strengths

chlorpheniramine/dextromethorphan/pseudoephedrine

liquid

  • (1mg/5mg/15mg)/5mL
  • (4mg/20mg/20mg)/5mL
  • (2mg/15mg/15mg)/5mL
  • (2mg/10mg/30mg)/5mL

oral drops

  • (0.8mg/3mg/8mg)/1mL

tablet

  • 4mg/60mg/20mg

tablet chewable

  • 2mg/10mg/30mg

Relief of Cold & Flu Symptoms

<6 Years Old

  • Ask a pediatrician

6-12 Years Old

  • 2 mL [(0.8mg/3mg/8mg)/1mL] PO q4-6hr; not to exceed 8 mL/24hr
  • 10 mL [(1mg/5mg/15mg)/5mL] PO q4-6hr; not to exceed 40 mL/24hr
  • 5 mL [(2mg/15mg/15mg)/5mL] PO q4-6hr; not to exceed 20 mL/24hr
  • 2.5 mL [(4mg/20mg/20mg)/5mL] PO q4-6hr; not to exceed 15 mL/24hr
  • 1 tab [(2mg/10mg/30mg/tab)] PO q4-6hr; not to exceed 4 tabs/24hr
  • ½ tab [(4mg/60mg/20mg/tab)] PO q4-6hr; not to exceed 2 tabs/24hr

>12 Years Old

  • 10 mL [(2mg/15mg/15mg)/5mL] PO q6hr; not to exceed 40 mL/day
  • 10 mL [(2mg/10mg/30mg)/5mL] PO q4-6hr; not to exceed 40 mL/day
  • 5 mL [(4mg/20mg/20mg)/5mL] PO q4-6hr; not to exceed 30 mL/day
  • 2 tabs [(2mg/10mg/30mg)/tab] PO q4-6hr; not to exceed 8 tabs/day
  • 1 tab [(4mg/60mg/20mg)/tab] PO q4-6hr; not to exceed 4 tabs/day
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Interactions

Interaction Checker

and chlorpheniramine/dextromethorphan/pseudoephedrine

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            Contraindicated (15)

            • dihydroergotamine

              dihydroergotamine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

            • dihydroergotamine inhaled

              dihydroergotamine inhaled increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

            • ergoloid mesylates

              ergoloid mesylates increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

            • ergonovine

              ergonovine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

            • ergotamine

              ergotamine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

            • isocarboxazid

              isocarboxazid increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • linezolid

              linezolid increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • methylergonovine

              methylergonovine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

            • phenelzine

              phenelzine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • procarbazine

              procarbazine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • rasagiline

              rasagiline increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • selegiline

              selegiline increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • selegiline transdermal

              selegiline transdermal increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • tranylcypromine

              tranylcypromine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            Serious - Use Alternative (39)

            • abametapir

              abametapir will increase the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • amitriptyline

              amitriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • amoxapine

              amoxapine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • apalutamide

              apalutamide will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • cabergoline

              cabergoline, pseudoephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • calcium/magnesium/potassium/sodium oxybates

              chlorpheniramine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • clomipramine

              clomipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • cocaine

              cocaine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

            • desipramine

              desipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • desvenlafaxine

              desvenlafaxine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

            • doxapram

              doxapram increases effects of pseudoephedrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

            • doxepin

              doxepin increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • duloxetine

              duloxetine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

            • eluxadoline

              chlorpheniramine, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions.

            • fexinidazole

              fexinidazole will increase the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • idelalisib

              idelalisib will increase the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

            • imipramine

              imipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • iobenguane I 123

              pseudoephedrine decreases effects of iobenguane I 123 by receptor binding competition. Avoid or Use Alternate Drug. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results. Do not administer pseudoephedrine until at least 7 days after each iobenguane dose.

            • iobenguane I 131

              pseudoephedrine decreases effects of iobenguane I 131 by receptor binding competition. Avoid or Use Alternate Drug. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results. Do not administer pseudoephedrine until at least 7 days after each iobenguane dose.

            • isocarboxazid

              isocarboxazid increases effects of chlorpheniramine by Other (see comment). Avoid or Use Alternate Drug. Comment: Isocarboxazid should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

            • isoflurane

              isoflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • levomilnacipran

              levomilnacipran increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

            • lofepramine

              lofepramine, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • lonafarnib

              lonafarnib will increase the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

            • maprotiline

              maprotiline, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • methoxyflurane

              methoxyflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • metoclopramide intranasal

              chlorpheniramine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • milnacipran

              milnacipran increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

            • nortriptyline

              nortriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • ozanimod

              ozanimod increases toxicity of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

            • protriptyline

              protriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • sevoflurane

              sevoflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • sodium oxybate

              chlorpheniramine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • tranylcypromine

              tranylcypromine increases effects of chlorpheniramine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

            • trazodone

              trazodone, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • trimipramine

              trimipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • tucatinib

              tucatinib will increase the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

            • venlafaxine

              venlafaxine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

            • voxelotor

              voxelotor will increase the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            Monitor Closely (254)

            • acetazolamide

              acetazolamide will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • albuterol

              chlorpheniramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • alfentanil

              chlorpheniramine and alfentanil both increase sedation. Use Caution/Monitor.

            • alfuzosin

              pseudoephedrine decreases effects of alfuzosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • alprazolam

              chlorpheniramine and alprazolam both increase sedation. Use Caution/Monitor.

            • aluminum hydroxide

              aluminum hydroxide will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Caution advised with frequent or high dose antacids

            • amifampridine

              chlorpheniramine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

            • amitriptyline

              chlorpheniramine and amitriptyline both increase sedation. Use Caution/Monitor.

            • ammonium chloride

              ammonium chloride decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

            • amobarbital

              chlorpheniramine and amobarbital both increase sedation. Use Caution/Monitor.

              amobarbital will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • amoxapine

              chlorpheniramine and amoxapine both increase sedation. Use Caution/Monitor.

            • apomorphine

              chlorpheniramine and apomorphine both increase sedation. Use Caution/Monitor.

            • arformoterol

              chlorpheniramine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              arformoterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • aripiprazole

              chlorpheniramine and aripiprazole both increase sedation. Use Caution/Monitor.

            • benzphetamine

              benzphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • armodafinil

              chlorpheniramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • azelastine

              azelastine and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • baclofen

              chlorpheniramine and baclofen both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              chlorpheniramine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • belzutifan

              belzutifan will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

            • benperidol

              chlorpheniramine and benperidol both increase sedation. Use Caution/Monitor.

            • benzphetamine

              chlorpheniramine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brexanolone

              brexanolone, chlorpheniramine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • bromocriptine

              bromocriptine, pseudoephedrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.

            • brompheniramine

              brompheniramine and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • buprenorphine

              chlorpheniramine and buprenorphine both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              chlorpheniramine and buprenorphine buccal both increase sedation. Use Caution/Monitor.

            • butabarbital

              chlorpheniramine and butabarbital both increase sedation. Use Caution/Monitor.

            • butalbital

              chlorpheniramine and butalbital both increase sedation. Use Caution/Monitor.

            • butorphanol

              chlorpheniramine and butorphanol both increase sedation. Use Caution/Monitor.

            • caffeine

              chlorpheniramine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • carisoprodol

              chlorpheniramine and carisoprodol both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

              cenobamate, chlorpheniramine. Either increases effects of the other by sedation. Use Caution/Monitor.

            • chloral hydrate

              chlorpheniramine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlorpheniramine and chlordiazepoxide both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              chlorpheniramine and chlorpromazine both increase sedation. Use Caution/Monitor.

              chlorpromazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.

            • chlorzoxazone

              chlorpheniramine and chlorzoxazone both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              dexfenfluramine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • cinnarizine

              chlorpheniramine and cinnarizine both increase sedation. Use Caution/Monitor.

            • clemastine

              chlorpheniramine and clemastine both increase sedation. Use Caution/Monitor.

            • clobazam

              chlorpheniramine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              chlorpheniramine and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              chlorpheniramine and clonazepam both increase sedation. Use Caution/Monitor.

            • clorazepate

              chlorpheniramine and clorazepate both increase sedation. Use Caution/Monitor.

            • clozapine

              chlorpheniramine and clozapine both increase sedation. Use Caution/Monitor.

            • codeine

              chlorpheniramine and codeine both increase sedation. Use Caution/Monitor.

            • crofelemer

              crofelemer increases levels of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

            • cyclizine

              chlorpheniramine and cyclizine both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              chlorpheniramine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              chlorpheniramine and cyproheptadine both increase sedation. Use Caution/Monitor.

            • dabrafenib

              dabrafenib will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • dantrolene

              chlorpheniramine and dantrolene both increase sedation. Use Caution/Monitor.

            • desflurane

              desflurane and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • desipramine

              chlorpheniramine and desipramine both increase sedation. Use Caution/Monitor.

            • deutetrabenazine

              chlorpheniramine and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              chlorpheniramine and dexchlorpheniramine both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              chlorpheniramine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              chlorpheniramine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              dexmethylphenidate and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              chlorpheniramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              dextroamphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              chlorpheniramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextromoramide

              chlorpheniramine and dextromoramide both increase sedation. Use Caution/Monitor.

            • diethylpropion

              diethylpropion and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • diamorphine

              chlorpheniramine and diamorphine both increase sedation. Use Caution/Monitor.

            • diazepam

              chlorpheniramine and diazepam both increase sedation. Use Caution/Monitor.

            • diazepam intranasal

              diazepam intranasal, chlorpheniramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

            • diethylpropion

              chlorpheniramine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difenoxin hcl

              chlorpheniramine and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              chlorpheniramine and dimenhydrinate both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              chlorpheniramine and diphenhydramine both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              chlorpheniramine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • dipipanone

              chlorpheniramine and dipipanone both increase sedation. Use Caution/Monitor.

            • dobutamine

              chlorpheniramine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              dobutamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dopamine

              dopamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              chlorpheniramine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              dopexamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              chlorpheniramine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              chlorpheniramine and dosulepin both increase sedation. Use Caution/Monitor.

            • doxazosin

              pseudoephedrine decreases effects of doxazosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • doxepin

              chlorpheniramine and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              chlorpheniramine and doxylamine both increase sedation. Use Caution/Monitor.

            • droperidol

              chlorpheniramine and droperidol both increase sedation. Use Caution/Monitor.

            • droxidopa

              pseudoephedrine and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension

            • efavirenz

              efavirenz will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elagolix

              elagolix will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • ephedrine

              ephedrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, pseudoephedrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              chlorpheniramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              epinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              chlorpheniramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine inhaled

              pseudoephedrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine racemic

              chlorpheniramine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              epinephrine racemic and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, chlorpheniramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

              esketamine intranasal, pseudoephedrine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .

            • estazolam

              chlorpheniramine and estazolam both increase sedation. Use Caution/Monitor.

            • fenfluramine

              fenfluramine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • ethanol

              chlorpheniramine and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • fedratinib

              fedratinib will increase the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • fenfluramine

              chlorpheniramine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fentanyl

              fentanyl, chlorpheniramine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

            • fentanyl intranasal

              fentanyl intranasal, chlorpheniramine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

            • fentanyl transdermal

              fentanyl transdermal, chlorpheniramine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

            • fentanyl transmucosal

              fentanyl transmucosal, chlorpheniramine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

            • flibanserin

              chlorpheniramine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

            • fluphenazine

              chlorpheniramine and fluphenazine both increase sedation. Use Caution/Monitor.

              fluphenazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.

            • flurazepam

              chlorpheniramine and flurazepam both increase sedation. Use Caution/Monitor.

            • formoterol

              formoterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • formoterol

              chlorpheniramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • gabapentin

              gabapentin, chlorpheniramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gabapentin enacarbil

              gabapentin enacarbil, chlorpheniramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • glycopyrronium tosylate topical

              glycopyrronium tosylate topical, chlorpheniramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

            • gotu kola

              gotu kola increases effects of chlorpheniramine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • haloperidol

              chlorpheniramine and haloperidol both increase sedation. Use Caution/Monitor.

            • hawthorn

              hawthorn increases effects of chlorpheniramine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • hops

              hops increases effects of chlorpheniramine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • hyaluronidase

              chlorpheniramine decreases effects of hyaluronidase by Other (see comment). Use Caution/Monitor. Comment: Antihistamines, when given in large systemic doses, may render tissues partially resistant to the action of hyaluronidase. Patients may require larger amounts of hyaluronidase for equivalent dispersing effect.

            • hydralazine

              hydralazine, pseudoephedrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

            • hydromorphone

              chlorpheniramine and hydromorphone both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              chlorpheniramine and hydroxyzine both increase sedation. Use Caution/Monitor.

            • iloperidone

              chlorpheniramine and iloperidone both increase sedation. Use Caution/Monitor.

              iloperidone increases levels of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

            • imipramine

              chlorpheniramine and imipramine both increase sedation. Use Caution/Monitor.

            • insulin degludec

              pseudoephedrine decreases effects of insulin degludec by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • insulin degludec/insulin aspart

              pseudoephedrine decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • insulin detemir

              pseudoephedrine decreases effects of insulin detemir by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • insulin glargine

              pseudoephedrine decreases effects of insulin glargine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • insulin inhaled

              pseudoephedrine decreases effects of insulin inhaled by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • insulin regular human

              pseudoephedrine decreases effects of insulin regular human by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • isoproterenol

              chlorpheniramine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              isoproterenol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • istradefylline

              istradefylline will increase the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

            • levalbuterol

              levalbuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • kava

              kava increases effects of chlorpheniramine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • ketamine

              ketamine and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              chlorpheniramine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, chlorpheniramine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, chlorpheniramine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • letermovir

              letermovir increases levels of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • levalbuterol

              chlorpheniramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levorphanol

              chlorpheniramine and levorphanol both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              lisdexamfetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              chlorpheniramine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofepramine

              chlorpheniramine and lofepramine both increase sedation. Use Caution/Monitor.

            • metaproterenol

              metaproterenol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • lofexidine

              chlorpheniramine and lofexidine both increase sedation. Use Caution/Monitor.

            • loprazolam

              chlorpheniramine and loprazolam both increase sedation. Use Caution/Monitor.

            • lorazepam

              chlorpheniramine and lorazepam both increase sedation. Use Caution/Monitor.

            • lormetazepam

              chlorpheniramine and lormetazepam both increase sedation. Use Caution/Monitor.

            • loxapine

              chlorpheniramine and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              chlorpheniramine and loxapine inhaled both increase sedation. Use Caution/Monitor.

            • lurasidone

              lurasidone, chlorpheniramine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              chlorpheniramine and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              chlorpheniramine and marijuana both increase sedation. Use Caution/Monitor.

            • melatonin

              chlorpheniramine and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              chlorpheniramine and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              chlorpheniramine and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              chlorpheniramine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              chlorpheniramine and metaxalone both increase sedation. Use Caution/Monitor.

            • methadone

              chlorpheniramine and methadone both increase sedation. Use Caution/Monitor.

            • methamphetamine

              chlorpheniramine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              methamphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methenamine

              methenamine decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

            • methocarbamol

              chlorpheniramine and methocarbamol both increase sedation. Use Caution/Monitor.

            • methyldopa

              methyldopa increases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              chlorpheniramine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              methylenedioxymethamphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • midazolam

              chlorpheniramine and midazolam both increase sedation. Use Caution/Monitor.

            • midodrine

              midodrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, chlorpheniramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • midodrine

              chlorpheniramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mirtazapine

              chlorpheniramine and mirtazapine both increase sedation. Use Caution/Monitor.

            • mitotane

              mitotane decreases levels of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

            • modafinil

              chlorpheniramine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              chlorpheniramine and morphine both increase sedation. Use Caution/Monitor.

            • motherwort

              chlorpheniramine and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              chlorpheniramine and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              chlorpheniramine and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              chlorpheniramine and nalbuphine both increase sedation. Use Caution/Monitor.

            • nateglinide

              pseudoephedrine decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor. Coadministration may reduce nateglinide's hypoglycemic action.

            • norepinephrine

              norepinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              chlorpheniramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              chlorpheniramine and nortriptyline both increase sedation. Use Caution/Monitor.

            • olodaterol inhaled

              pseudoephedrine and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

            • olanzapine

              chlorpheniramine and olanzapine both increase sedation. Use Caution/Monitor.

            • opium tincture

              chlorpheniramine and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              chlorpheniramine and orphenadrine both increase sedation. Use Caution/Monitor.

            • oxazepam

              chlorpheniramine and oxazepam both increase sedation. Use Caution/Monitor.

            • oxycodone

              chlorpheniramine and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              chlorpheniramine and oxymorphone both increase sedation. Use Caution/Monitor.

            • oxytocin

              oxytocin increases effects of pseudoephedrine by pharmacodynamic synergism. Use Caution/Monitor.

            • paliperidone

              chlorpheniramine and paliperidone both increase sedation. Use Caution/Monitor.

            • papaveretum

              chlorpheniramine and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              chlorpheniramine and papaverine both increase sedation. Use Caution/Monitor.

            • passion flower

              passion flower increases effects of chlorpheniramine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • pentazocine

              chlorpheniramine and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              chlorpheniramine and pentobarbital both increase sedation. Use Caution/Monitor.

            • perphenazine

              perphenazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.

              chlorpheniramine and perphenazine both increase sedation. Use Caution/Monitor.

            • phendimetrazine

              phendimetrazine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              chlorpheniramine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenelzine

              phenelzine increases effects of chlorpheniramine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration of phenelzine and antihistamines may result in additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

            • phentermine

              phentermine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenobarbital

              chlorpheniramine and phenobarbital both increase sedation. Use Caution/Monitor.

            • phentermine

              chlorpheniramine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              phenylephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              chlorpheniramine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine PO

              chlorpheniramine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              phenylephrine PO and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pholcodine

              chlorpheniramine and pholcodine both increase sedation. Use Caution/Monitor.

            • pirbuterol

              pirbuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pimozide

              chlorpheniramine and pimozide both increase sedation. Use Caution/Monitor.

            • pirbuterol

              chlorpheniramine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • potassium phosphate

              potassium phosphate decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

            • pregabalin

              pregabalin, chlorpheniramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • primidone

              chlorpheniramine and primidone both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              chlorpheniramine and prochlorperazine both increase sedation. Use Caution/Monitor.

              prochlorperazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.

            • promazine

              promazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • promethazine

              chlorpheniramine and promethazine both increase sedation. Use Caution/Monitor.

            • promethazine

              promethazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • propofol

              propofol and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              propylhexedrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              chlorpheniramine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              chlorpheniramine and protriptyline both increase sedation. Use Caution/Monitor.

            • safinamide

              pseudoephedrine and safinamide both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Monitor patients for hypertension if safinamide is prescribed concomitantly with prescription or nonprescription sympathomimetics, including nasal, oral, or ophthalmic decongestants and cold remedies.

            • quazepam

              chlorpheniramine and quazepam both increase sedation. Use Caution/Monitor.

            • quetiapine

              chlorpheniramine and quetiapine both increase sedation. Use Caution/Monitor.

            • ramelteon

              chlorpheniramine and ramelteon both increase sedation. Use Caution/Monitor.

            • risperidone

              chlorpheniramine and risperidone both increase sedation. Use Caution/Monitor.

            • rucaparib

              rucaparib will increase the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • salmeterol

              chlorpheniramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              salmeterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • scullcap

              chlorpheniramine and scullcap both increase sedation. Use Caution/Monitor.

            • silodosin

              pseudoephedrine decreases effects of silodosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • secobarbital

              chlorpheniramine and secobarbital both increase sedation. Use Caution/Monitor.

            • sevoflurane

              sevoflurane and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              chlorpheniramine and shepherd's purse both increase sedation. Use Caution/Monitor.

            • sodium bicarbonate

              sodium bicarbonate will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Caution advised with frequent or high dose antacids

            • sodium citrate/citric acid

              sodium citrate/citric acid will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • sodium lactate

              sodium lactate will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • sodium phosphates, IV

              sodium phosphates, IV decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

            • solriamfetol

              pseudoephedrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • spironolactone

              spironolactone decreases effects of pseudoephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • stiripentol

              stiripentol, chlorpheniramine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

            • sufentanil

              chlorpheniramine and sufentanil both increase sedation. Use Caution/Monitor.

            • tamsulosin

              pseudoephedrine decreases effects of tamsulosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • tapentadol

              chlorpheniramine and tapentadol both increase sedation. Use Caution/Monitor.

            • tazemetostat

              tazemetostat will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • temazepam

              chlorpheniramine and temazepam both increase sedation. Use Caution/Monitor.

            • terazosin

              pseudoephedrine decreases effects of terazosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • terbutaline

              chlorpheniramine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              terbutaline and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • thioridazine

              thioridazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.

              chlorpheniramine and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              chlorpheniramine and thiothixene both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.

            • topiramate

              chlorpheniramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              chlorpheniramine and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              chlorpheniramine and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              chlorpheniramine and triazolam both increase sedation. Use Caution/Monitor.

            • triclofos

              chlorpheniramine and triclofos both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              chlorpheniramine and trifluoperazine both increase sedation. Use Caution/Monitor.

            • trimipramine

              chlorpheniramine and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              chlorpheniramine and triprolidine both increase sedation. Use Caution/Monitor.

            • valerian

              valerian increases effects of chlorpheniramine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • xylometazoline

              chlorpheniramine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              pseudoephedrine and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • yohimbine

              chlorpheniramine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              chlorpheniramine and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              chlorpheniramine and ziprasidone both increase sedation. Use Caution/Monitor.

            • zotepine

              chlorpheniramine and zotepine both increase sedation. Use Caution/Monitor.

            Minor (4)

            • ashwagandha

              ashwagandha increases effects of chlorpheniramine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

            • brimonidine

              brimonidine increases effects of chlorpheniramine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • desmopressin

              desmopressin increases effects of pseudoephedrine by pharmacodynamic synergism. Minor/Significance Unknown.

            • eucalyptus

              chlorpheniramine and eucalyptus both increase sedation. Minor/Significance Unknown.

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            Adverse Effects

            Frequency Not Defined

            Arrhythmia

            Hypotension

            Palpitations

            Tachycardia

            Confusion

            Convulsion

            Depression

            Distress

            Dizziness

            Drowsiness

            Euphoria

            Excitability

            Fatigue

            Headache

            Insomnia

            Irritability

            Sedation

            Tremors

            Weakness

            Anorexia

            GI disturbances

            Agranulocytosis

            Hemolytic anemia

            Thrombocytopenia

            Thickening of bronchial secretions

            Wheezing

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            Warnings

            Contraindications

            Contraindicated in documented hypersensitivity to the drugs or within 14 days of MAO inhibitor therapy; asthma attacks, narrow-angle glaucoma, symptomatic prostate hypertrophy, bladder-neck obstruction, and stenosing peptic ulcer

            Cautions

            Caution in cardiovascular disease, diabetes mellitus, prostatic hypertrophy and increased intraocular pressure when taking pseudoephedrine

            Do not take dextromethorphan for persistent or chronic cough associated with smoking, asthma, or emphysema, or if it is accompanied by excessive phlegm unless directed by a healthcare provider; may decrease respiration rate

            Chlorpheniramine may cause significant confusional symptoms; not for administration to premature or full-term neonates

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: excretion in milk unknown/not recommended

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Chlorpheniramine blocks muscle responses in histamine and acts as an antagonism of the constrictor effects of histamine on respiratory smooth muscle.

            Dextromethorphan is a cough suppressant that acts centrally on the cough center in medulla

            Pseudoephedrine stimulates the alpha-adrenergic receptors causing bronchodilation and vasoconstriction.

            Pharmacokinetics

            Chlorpheniramine

            • Vd: 4-7 L/kg (children); 6-12 L/kg (adults)
            • Protein binding: 33%
            • Half-life: 10-13 hr (children); 14-24 hr (adults)
            • Peak plasma time: 2-4 hr
            • Excretion: Urine

            Dextromethorphan

            • Onset: 15-30 min
            • Duration: 3-6 hr
            • Metabolism: Hepatic P450 enzyme CYP2D6
            • Excretion: Urine
            • Half-life: 2-4 hr (extensive metabolizers); 24 hr (poor metabolizers)
            • Peak plasma time: 2-3 hr

            Pseudoephedrine

            • Half-Life: 3 hr (children); 9-16 hr (adults)
            • Onset: 30 min (decongestant)Duration: 3-8 hr
            • Peak PlasmaTime: 1.97 hr
            • Concentration: 422 ng/mL
            • Metabolism: Liver, by N-demethylation
            • Metabolites: Inactive
            • Clearance: 7.3-7.6 mL/min/kg
            • Excretion: Urine (43-96%)
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            Images

            No images available for this drug.
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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.