Balamine DM oral drops
Name: Balamine DM oral drops
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Antihistamine/Decongestant/Antitussive for oral use
BALAMINE DM ORAL DROPS
Each dropperful (1 mL) contains:
Carbinoxamine Maleate...........................2 mg
Pseudoephedrine Hydrochloride.............25 mg
Dextromethorphan Hydrobromide.........3.5 mg
BALAMINE DM SYRUP
Each teaspoonful (5 mL) contains:
Carbinoxamine Maleate............................4 mg
Pseudoephedrine Hydrochloride.............60 mg
Dextromethorphan Hydrobromide........12.5 mg
BALAMINE DM ORAL DROPS
Citric acid, D&C Red No. 33, FD&C Blue No. 1, glycerin, sodium benzoate, sodium citrate, sorbitol, purified water, flavoring and other ingredients.
BALAMINE DM SYRUP
Citric acid, D&C Red No. 33, FD&C Blue No. 1, glycerin, menthol, povidone, purified water, sodium benzoate, sodium citrate, sorbitol, and flavoring.
Carbinoxamine maleate (2-[p-Chloro-(alpha)-[2-(dimethylamino) ethoxyl] benzyl]pyridine maleate) is one of the ethanolamine class of H 1 antihistamines. Pseudoephedrine hydrochloride (Benzenemethanol,(alpha)-[1-(methylamino) ethyl]-,[S-R*,R*)]-, hydrochloride) is the hydrochloride of pseudoephedrine, a naturally occurring dextrorotatory stereoisomer of ephedrine. Dextromethorphan Hydrobromide (Morphinan, 3-methoxy-17-methyl-, (9(alpha), 13(alpha), 14(alpha))-, hydrobromide, monohydrate) is the hydrobromide of d-form racemethorphan.
Indications and Usage
For relief of coughs and upper respiratory symptoms, including nasal congestion, associated with allergy or the common cold.
Sympathomimetic amines should be used judiciously and sparingly in patients with hypertension, diabetes, ischemic heart disease, hyperthyroidism, increased intraocular pressure or prostatic hypertrophy. See Contraindications . Sympathomimetic amines may produce CNS stimulation with convulsions or cardiovascular collapse with accompanying hypotension. The elderly (60 years and older) are more likely to exhibit adverse reactions. Antihistamines may cause excitability, especially in children. At doses higher than the recommended dose, nervousness, dizziness, or sleeplessness may occur. Do not exceed recommended dosage. Administration of dextromethorphan may be accompanied by histamine release and should be used with caution in atopic children.
Before prescribing medication to suppress or modify cough, identify and provide therapy for the underlying cause of cough and take caution that modification of cough does not increase the risk of clinical or physiologic complications. Dextromethorphan should be used with caution in sedated or debilitated patients and in patients confined to supine positions.
Use with caution in patients with hypertension, heart disease, asthma, hyperthyroidism, increased intraocular pressure, diabetes mellitus and prostatic hypertrophy.
Information for Patients: Avoid alcohol and other CNS depressants while taking these products. Patients sensitive to antihistamines may experience moderate to severe drowsiness. Patients sensitive to sympathomimetic amines may note mild CNS stimulation. While taking these products, exercise care in driving or operating appliances, machinery, etc.
Drug Interactions: Antihistamines may enhance the effects of tricyclic antidepressants, barbiturates, alcohol, and other CNS depressants. MAO inhibitors prolong and intensify the anticholinergic effects of antihistamines.
Sympathomimetic amines may reduce the antihypertensive effects of reserpine, veratrum alkaloids, methyldopa and mecamylamine. Effects of sympathomimetics are increased with MAO inhibitors and beta-adrenergic blockers. The cough-suppressant action of dextromethorphan and narcotic antitussives are additive. Dextromethorphan is contraindicated with monoamine oxidase inhibitors (MAOI). See Contraindications section.
Pregnancy Category C: Animal reproduction studies have not been conducted with Balamine DM. It is also not known whether these products can cause fetal harm when administered to a pregnant woman or affect reproduction capacity. Give to pregnant women only if clearly needed.
Nursing Mothers: It is not known whether the drugs in Balamine DM are excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue the product, taking into account the importance of the drug to the mother.
No information is available as to specific results of an overdose of these products. The signs, symptoms and treatment described below are those of H 1 antihistamine, ephedrine and dextromethorphan overdose.
Symptoms: Should antihistamine effects predominate, central action constitutes the greatest danger. In the small child, predominant symptoms are excitation, hallucination, ataxia, incoordination, tremors, flushed face and fever.
Convulsions, fixed and dilated pupils, coma and death may occur in severe cases. In the adult, fever and flushing are uncommon; excitement leading to convulsions and postictal depression is often preceded by drowsiness and coma. Respiration is usually not seriously depressed; blood pressure is usually stable.
Should sympathomimetic symptoms predominate, central effects include restlessness, dizziness, tremor, hyperactive reflexes, talkativeness, irritability and insomnia. Cardiovascular and renal effects include difficulty in micturition, headache, flushing, palpitation, cardiac arrhythmias, hypertension with subsequent hypotension and circulatory collapse. Gastrointestinal effects include dry mouth, metallic taste, anorexia, nausea, vomiting, diarrhea, and abdominal cramps.
Dextromethorphan may cause respiratory depression with a large overdose.
Treatment: a) Evacuate stomach as condition warrants. Activated charcoal may be useful. b) Maintain a non-stimulating environment. c) Monitor cardiovascular status. d) Do not give stimulants. e) Reduce fever with cool sponging. f) Treat respiratory depression with naloxone if dextromethorphan toxicity is suspected. g) Use sedatives or anticonvulsants to control CNS excitation and convulsions. h) Physostigmine may reverse anticholinergic symptoms. i) Ammonium chloride may acidify the urine to increase urinary excretion of pseudoephedrine. j) Further care is symptomatic and supportive.