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Note: When using this recommendation, be sure to compare with the weight-based dosage listed above as the age-based dosage may exceed 0.4 mg/kg/day in some individuals): Palgic®: 2-3 years: 2 mg (2.5 mL) 3-4 times/day 3-6 years: 2-4 mg (2.5-5 mL) 3-4 times/day >6 years: 4-6 mg (5-7.5 mL) 3-4 times/day Adults: 4-8 mg 3-4 times/day Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Solution, oral, as maleate: 4 mg/5 mL (118 mL, 473 mL) Arbinoxa™: 4 mg/5 mL (480 mL) [contains propylene glycol; bubblegum flavor] Palgic®: 4 mg/5 mL (480 mL) [contains propylene glycol; bubblegum flavor] Tablet, oral, as maleate: 4 mg Arbinoxa™: 4 mg [scored] Palgic®: 4 mg [scored] Generic Equivalent Available: U.S. Yes Administration Oral: Administer without regard to food Stability Store at controlled room temperature of 15°C to 30°C (59°F to 86°F). Use Relief of symptoms of seasonal and perennial allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis, urticaria, angioedema, and dermatographism Medication Safety Issues BEERS Criteria medication: This drug may be potentially inappropriate for use in geriatric patients (Quality of evidence - moderate; Strength of recommendation - strong). Adverse Reactions Cardiovascular: Extrasystoles, hypotension, palpitation, tachycardia Central nervous system: Chills, confusion, coordination impaired (most frequent), dizziness (most frequent), euphoria, excitability, fatigue, headache, hysteria, insomnia, irritability, nervousness, neuritis, restlessness, sedation (most frequent), seizure, sleepiness (most frequent), vertigo Dermatologic: Photosensitivity, rash, urticaria Endocrine & metabolic: Early menses Gastrointestinal: Anorexia, constipation, diarrhea, epigastric distress (most frequent), nausea, vomiting, xerostomia Genitourinary: Difficult urination, urinary frequency, urinary retention Hematologic: Agranulocytosis, hemolytic anemia, thrombocytopenia Neuromuscular & skeletal: Paresthesia, tremor Ocular: Blurred vision, diplopia Otic: Labyrinthitis, tinnitus Respiratory: Bronchial secretions thickening (most frequent), chest tightness, nasal congestion, nasopharyngeal dryness, wheezing Miscellaneous: Diaphoresis, hypersensitivity reactions (including anaphylactic shock)

Hematologic: Agranulocytosis, hemolytic anemia, thrombocytopenia Neuromuscular & skeletal: Paresthesia, tremor Ocular: Blurred vision, diplopia Otic: Labyrinthitis, tinnitus Respiratory: Bronchial secretions thickening (most frequent), chest tightness, nasal congestion, nasopharyngeal dryness, wheezing Miscellaneous: Diaphoresis, hypersensitivity reactions (including anaphylactic shock) Contraindications Hypersensitivity to carbinoxamine or any component of the formulation; use with or within 14 days of MAO inhibitor therapy; children <2 years of age Precautions Use with caution in patients with mild to moderate hypertension, cardiovascular disease, diabetes, asthma, thyroid disease, increased intraocular pressure, GU or GI obstruction or symptomatic prostatic hypertrophy. May cause paradoxical excitation in young children. Warnings Safety and efficacy for the use of cough and cold products in children <2 years of age is limited. Serious adverse effects including death have been reported. The FDA notes that there are no approved OTC uses for these products in children <2 years of age. Healthcare providers are reminded to ask caregivers about the use of OTC cough and cold products in order to avoid exposure to multiple medications containing the same ingredient. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) Acetylcholinesterase Inhibitors (Central): Anticholinergics may diminish the therapeutic effect of Acetylcholinesterase Inhibitors (Central). Acetylcholinesterase Inhibitors (Central) may diminish the therapeutic effect of Anticholinergics. If the anticholinergic action is a side effect of the agent, the result may be beneficial. Risk C: Monitor therapy Aclidinium: May enhance the anticholinergic effect of Anticholinergics. Risk X: Avoid combination Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy Amphetamines: May diminish the sedative effect of Antihistamines. Risk C: Monitor therapy Anticholinergics: May enhance the adverse/toxic effect of other Anticholinergics.

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Risk D: Consider therapy modification Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy Pramlintide: May enhance the anticholinergic effect of Anticholinergics. These effects are specific to the GI tract. Risk D: Consider therapy modification ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Risk C: Monitor therapy Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Risk C: Monitor therapy Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Risk C: Monitor therapy Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. Risk D: Consider therapy modification Tiotropium: Anticholinergics may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider therapy modification Pregnancy Risk Factor C ( show table ) Pregnancy Implications Animal reproduction studies have not been conducted. Maternal antihistamine use has generally not resulted in an increased risk of birth defects; however, information specific for the use of carbinoxamine during pregnancy has not been located. Although antihistamines are recommended for some indications in pregnant women, the use of other agents with specific pregnancy data may be preferred.

Pregnancy Implications Animal reproduction studies have not been conducted. Maternal antihistamine use has generally not resulted in an increased risk of birth defects; however, information specific for the use of carbinoxamine during pregnancy has not been located. Although antihistamines are recommended for some indications in pregnant women, the use of other agents with specific pregnancy data may be preferred. Mechanism of Action Carbinoxamine competes with histamine for H 1 -receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract. Pharmacodynamics Duration: 3-6 hours Pharmacokinetics (Adult data unless noted) Half-life: Adults: 10-20 hours Patient Information (For additional information see "Carbinoxamine: Patient drug information" ) May cause drowsiness or impair ability to perform activities requiring mental alertness or physical coordination; may cause blurred vision; may also cause CNS excitation and difficulty sleeping; may cause dry mouth; avoid alcohol; may rarely cause photosensitivity reactions (eg, exposure to sunlight may cause severe sunburn, skin rash, redness, or itching); avoid direct exposure to sunlight Use of UpToDate is subject to the Subscription and License Agreement . Topic 12920 Version 42.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.4 - C21.36 Licensed to: Southeast Alabama Med Ctr | Support Tag: [0604-118.195.65.248-FDF33D9AD5-S244013.14]