Pedicof D

Uses

Dextromethorphan is used for Chronic dry cough or unproductive cough; Acute dry cough which is interfering with normal function or sleep.

Loratadine provides faster relief from the symptoms of hay fever, allergic rhinitis such as sneezing, nasal discharge, itching, ocular itching and burning, nasal and ocular sign and symptoms are relieved rapidly after oral administration.

Loratadine is also effective in idiopathic chronic urticaria. In children over 2 years, Loratadine is used for the symptomatic relief of seasonal allergic rhinitis and allergic skin conditions such as urticaria nettle rash.

Pedicof D is also used to associated treatment for these conditions: Allergic cough, Common Cold, Common Cold/Flu, Cough, Cough caused by Common Cold, Coughing caused by Allergies, Coughing caused by Bronchitis, Coughing caused by Flu caused by Influenza, Fever, Flu caused by Influenza, Headache, Irritative cough, Itching of the nose, Itching of the throat, Nasal Congestion, Pseudobulbar affect, Rhinorrhoea, Sneezing, Upper respiratory symptoms, Watery itchy eyes, Airway secretion clearance therapy, Bronchodilation, Oropharyngeal antisepsisAllergic Dermatologic Disorders, Allergic Rhinitis (AR), Allergies, Chronic Urticaria, Common Cold, Eye pruritus, Fever, Nasal Congestion, Nasal Itching, Pain, Perennial Allergic Rhinitis (PAR), Perennial Rhinitis, Pollen Allergy, Pruritus, Rhinorrhoea, Seasonal Allergic Rhinitis, Sneezing, Sensation of burning in the eyes, Watery eyes, Watery itchy eyes

How Pedicof D works

Dextromethorphan is an agonist of NMDA and sigma-1 receptors. It is also an antagonist of α3/β4 nicotinic receptors.[A10589] However, the mechanism by which dextromethorphan's receptor agonism and antagonism translates to a clinical effect is not well understood.

Histamine release is a key mediator in allergic rhinitis and urticaria. As a result, loratadine exerts it's effect by targeting H1 histamine receptors.

Loratadine binds to H1 histamine receptors found on the surface of epithelial cells, endothelial cells, eosinophils, neutrophils, airway cells, and vascular smooth muscle cells among others. H1 histamine receptors fall under the wider umbrella of G-protein coupled receptors, and exist in a state of equilibrium between the active and inactive forms. Histamine binding to the H1-receptor facilitates cross linking between transmembrane domains III and V, stabilizing the active form of the receptor. On the other hand, antihistamines bind to a different site on the H1 receptor favouring the inactive form.

Hence, loratadine can more accurately be classified as an "inverse agonist" as opposed to a "histamine antagonist", and can prevent or reduce the severity of histamine mediated symptoms.

Dosage

Pedicof D dosage

Adults and Children over 12 years: 15 to 30 mg three to four times per day. However, 60 mg doses up to four times per day have been used without increased side effects.

Children between 6 and 12 years: 5-15 mg up to four times per day.

Children between 2 and 6 years: 2.5-5 mg up to four times per day.

Adult & children over 12 years of age: One Loratadine 10 mg tablet once daily (usually in the morning).

Children:

• 2-12 years (body weight more than 30 Kg): 10 mg Loratadine once daily.
• 2-12 years (body weight less than 30 Kg): 5 mg Loratadine once daily.
• Below 2 years of age: Safety and efficacy of Loratadine have not been established.

Liver & renal impairment: Patients with liver impairment and renal insufficiency (GFR <30 ml/min) should be given a lower initial dose (10 mg every other day).

Side Effects

Adverse effects with Dextromethorphan are rare, but nausea and dizziness sometimes occur. The drug produces no analgesia or addiction and little or no CNS depression. Excitation, confusion and respiratory depression may occur after overdosage.

Fatigue, nausea and headache were reported rarely. Scientific studies showed that Loratadine does not cause drowsiness. It does not affect performance and ability to drive or tasks requiring concentration.

Toxicity

A dextromethorphan overdose may present as nausea, vomiting, stupor, coma, respiratory depression, seizures, tachycardia, hyperexcitability, toxic psychosis, ataxia, nystagmus, dystonia, blurred vision, changes in muscle reflexes, and serotonin syndrome. Overdose should be managed through symptomatic and supportive measures.

Second generation antihistamines such as loratadine have very few adverse effects; however, insomnia, headache, fatigue, drowsiness and rash have been reported. Symptoms of loratadine overdose include gastrointestinal side effects, agitation, drowsiness, tachycardia, and headache. It is advised to obtain an ECG in the event of loratadine overdose.

Precaution

Do not use Dextromethorphan to control a cough that is associated with smoking, asthma, or emphysema, or a cough that is productive (produces sputum or phlegm).

Patients with liver impairment and renal insufficiency (GFR <30 ml/min) should be given a lower initial dose (10 mg every other day).

Interaction

The following medicines should be taken carefully while concomitantly use with Dextromethorphan: Amiodarone, Fluoexetine, Quinidine, CNS depressants and Monoamine oxidase (MAO) inhibitors.

When administered concurrently with alcohol, Loratadine has no potentiating effect as measured by psychomotor performance studies. Interactions with other drugs have not been reported.

Volume of Distribution

The volume of distribution of dextromethorphan is 5-6.7L/kg.

The volume of distribution of loratadine is 120 L/Kg.

Elimination Route

A 30mg oral dose of dextromethorphan reaches a C_max of 2.9 ng/mL, with a T_max of 2.86 h, and an AUC of 17.8 ng*h/mL.

Loratadine is rapidly absorbed and achieves peak plasma concentration in 1-2 hours, while it's main metabolite achieves peak plasma concentration in 3-4 hours.

In the rapid dissolve formulation, the pharmacokinetic parameters of loratadine are as follows: Cmax = 2.56 ng/ml, Tmax = 1.14 hrs, AUC = 6.14 ng x hr/ml.

In the rapid dissolve formulation, the pharmacokinetic parameters of descarboethoxyloratadine are as follows: Cmax = 3.72 ng/ml, Tmax = 1.97 hr, AUC = 49.1 ng x hr/ml.

In the conventional formulation, the pharmacokinetic parameters of loratadine are as follows: Cmax = 2.11 ng/ml, Tmax = 1.00 hr, AUC = 4.64 ng x hr/ml

In the conventional formulation, the pharmacokinetic parameters of descarboethoxyloratadine are as follows: Cmax = 3.66 ng/ml, Tmax = 1.97 hr, AUC = 48.4 ng x hr/ml

Half Life

Dextromethorphan has a half life of 3-30 hours.

The elimination half life is approximately 10 hours for loratadine and 20 hours for descarboethoxyloratadine.

Clearance

The clearance of loratadine after single oral doses of 20 mg and 40 mg are 12 L/h/kg and 9 L/h/kg respectively. P-glycoprotein is involved in the clearance of many 2nd generation antihistamines, including loratadine, from the central nervous system. 1st generation antihistamines are not cleared by P-glycoprotein, which may help explain why they have a different central nervous system adverse effect profile compared to their 2nd generation counterparts. It appears that an antihistamine with higher affinity for p-glycoprotein will have a lower incidence of CNS adverse effects.

Elimination Route

Over a 10 day period, 40% of loratadine is excreted in the urine, and 42% is eliminated in the faeces.

Pregnancy & Breastfeeding use

Pregnancy: Adequate and well-controlled studies in human have not been done. However, Dextromethorphan has not been reported to cause birth defects.

Lactation: It is not known whether dextromethorphan passes into breast milk. However, Dextromethorphan has not been reported to cause problems in nursing babies.

Use in pregnancy: There is no experience of the use of Loratadine in human pregnancy, hence it should not be used during pregnancy.

Use in lactation: Loratadine is excreted in breast milk, so it should not be administered to lactating mother.

Contraindication

Hypersensitivity to Dextromethorphan or any other component.

Loratadine is contraindicated in patients who have shown hypersensitivity or idiosyncracy to their components.

Acute Overdose

Symptoms: In mild overdose, tachycardia, hypertension, vomiting, mydriasis, diaphoresis, nystagmus, euphoria, loss of motor coordination, and giggling; in moderate intoxication, in addition to those listed above, hallucinations and a plodding ataxic gait; in severely intoxication, agitation or somnolence.

Management: treatment is symptomatic and supportive. Naloxone may be useful in reversing toxicity.

Symptoms: Somnolence, tachycardia headache, drowsiness, extrapyramidal manifestations and palpitations.

Management: Symptomatic and supportive treatment. Immediately empty stomach by inducing emesis with ipecac syrup. Admin of activated charcoal after emesis may be useful. If induction of vomiting is unsuccessful or contraindicated (e.g. patient is comatose, having seizures or lacks gag reflex), gastric lavage with NaCl 0.9% soln may be performed to prevent aspiration of gastric contents. Saline cathartics may be useful to rapidly dilute bowel contents.

Storage Condition

Store at 15-30° C

Store between 20-25° C.

Innovators Monograph

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