carbinoxamine


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carbinoxamine

 [kahr″bĭ-nok´sah-mēn]
an antihistamine with sedative and anticholinergic effects; used as the maleate salt in the treatment of nasal, eye, and skin manifestations of allergic reactions, including allergic rhinitis, conjunctivitis, and itching, and also as an ingredient in some cough and cold preparations, administered orally.

carbinoxamine

(car-bi-nox-a-meen) ,

Karbinal ER

(trade name)

Classification

Therapeutic: allergy cold cough remedies
Pharmacologic: antihistamines
Pregnancy Category: C

Indications

Relief of allergic symptoms caused by histamine release including seasonal/perennial allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis (due to inhalant allergens or foods), mild/uncomplicated allergic skin conditions (urticaria or angioedema), dermatographism, as adjunctive management (with epinephrine and other standard acute treatments) of anaphylaxis, and to decrease severity of allergic reactions to blood/plasma

Action

Antagonizes the effects of histamine at H1–receptor sites; does not bind to or inactivate histamine. Significant CNS depressant and anticholinergic properties.

Therapeutic effects

Decreased symptoms of histamine excess (sneezing, rhinorrhea, nasal/ocular pruritus, ocular tearing/redness and skin itching/urticaria).

Pharmacokinetics

Absorption: Well absorbed following oral administration
Distribution: Unk
Metabolism and Excretion: Extensively metabolized by the liver, inactive metabolites excreted in urine. Negligable renal elimination of unchanged drug.
Half-life: 17 hr

Time/action profile (antihistaminic effects)

ROUTEONSETPEAKDURATION
POunk6.7 hr12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity, including sulfite allergy; Lactation: Avoid if breast-feeding (risk of death in infant); Concurrent use of MAOIs; Pediatric: Children < 2 yr (deaths have been reported).
Use Cautiously in: Increased intraocular pressure or narrow angle glaucoma; Hyperthyroidism; Cardiovascular disease including hypertension; Stenosing peptic ulcer or pyloroduodenal obstruction; Symptomatic prostatic hypertrophy or bladder neck obstruction; Geriatric: Elderly may be more susceptible to adverse reactions; Obstetric: Use in pregnancy only if clearly needed; Pediatric: Younger children may be more sensitive to sedation or excitation.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness (most frequent)
  • drowsiness (most frequent)
  • sedation (most frequent)

Respiratory

  • thickened bronchial secretions (most frequent)

Gastrointestinal

  • epigastric distress (most frequent)

Neurologic

  • disturbed coordination (most frequent)

Interactions

Drug-Drug interaction

Concurrent use with MAOIs may ↑ anticholinergic effects.↑ risk of CNS depression with other CNS depressants including alcohol, other antihistamines , opioid analgesics and sedative/hypnotics.

Route/Dosage

Use appropriate measuring device
Oral (Adults and Children ≥ 12 yr) 6–16 mg (7.5–20 mL) every 12 hr
Oral (Children 2–11 yr) 0.2–0.4 mg/kg/day in divided doses every 12 hr; Children 6–11 yr—6–12 mg (7.5–15 mL) every 12 hr; Children 4–5 yr—3–8 mg (3.75–10 mL) every 12 hr ; Children 2–3 yr—3–4 mg (3.75–5 mL) every 12 hr.

Availability

Extended-release oral suspension (contains metabisulfite)strawberry banana: 4 mg/5 mL

Nursing implications

Nursing assessment

  • Assess allergy symptoms (rhinitis, conjunctivitis, hives) before and periodically during therapy
  • Assess lung sounds and character of bronchial secretions. Maintain fluid intake of 1500–2000 mL/day to decrease viscosity of secretions
  • Lab Test Considerations: May case ↑ uric acid levels.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Risk for injury (Adverse Reactions)

Implementation

  • Begin with lowest dose and increase as needed and tolerated. Dose is based on condition severity and patient response.
  • Oral: Administer twice daily.
    • Use a calibrated measuring device for accurate dose; household tablespoon is not accurate and could lead to overdose.

Patient/Family Teaching

  • Instruct patient to take medication as directed
  • May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known
  • Advise patient to avoid taking alcohol or other CNS depressants concurrently with this drug
  • Advise patient that good oral hygiene, frequent rinsing of mouth with water, and sugarless gum or candy may minimize dry mouth. Patient should notify dentist if dry mouth persists >2 wk
  • Instruct female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • Decrease in allergic symptoms

carbinoxamine

/car·bi·nox·amine/ (kahr″bin-ok´sah-mēn) an antihistamine with anticholinergic and sedative effects, used as the maleate salt.
References in periodicals archive ?
In 2013 Breckenridge launched several Abbreviated New Drug Applications (ANDAs), including: carbinoxamine maleate tablets and liquid, cilostazol tablets (Pletal), lansoprazole capsules (Prevacid), pioglitazone capsules (Actos), propranolol LA capsules (Inderal LA) and rizatriptan IR and ODT tablets (Maxalt & Maxalt MLT).
The first products targeted then were unapproved prescription products containing the antihistamine carbinoxamine, which had been linked to 21 deaths in children under age 2.
The first products targeted were unapproved prescription products containing the antihistamine carbinoxamine, which had been linked to 21 deaths in children under age 2.
Two of the infants (patients 1 and 2) had been administered prescription medications containing carbinoxamine (an antihistamine), although neither had detectable postmortem blood levels of carbinoxamine.
The FDA said it was targeting carbinoxamine because of safety concerns, including 21 deaths since 1983 in children under age 2 that may be related to the ingredient.
Pamlab, LLC, has launched Palgic[R], a new prescription antihistamine featuring carbinoxamine maleate.
Featured products on the Boca Pharmacal web site include antipyrine and benzocaine otic solution; levetiracetam 250-mg, 500-mg and 750-mg tablets; methscopolamine bromide 2-mg tablets USP; methscopolamine bromide 5-mg tablets USP; and carbinoxamine maleate 4-mg liquid and tablets.
In June 2006, the FDA said it was strengthening its efforts to address unapproved drug products and that it was acting to stop the marketing of unapproved products containing carbinoxamine because of safety concerns in children under age 2.
In June 2006, the FDA announced that it was strengthening its efforts to address unapproved drug products and that it was acting to stop the marketing of unapproved products containing carbinoxamine because of safety concerns in children under age 2.
Carbinoxamine is used in cough and cold treatments, mostly for children, that have been associated with 21 reported deaths since 1983.