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 ?
Steelman added, "We're excited to be partnered with Tris Pharma to make this pleasant-tasting, extended-release liquid formulation of carbinoxamine, an antihistamine with years of proven safety and efficacy, available for patients as young as two years old.
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 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.
We're excited to be partnered with Tris to make this pleasant-tasting extended-release liquid formulation of carbinoxamine, a mildly-sedating antihistamine with years of proven safety and efficacy, available for patients as young as two years old.
Carbinoxamine is used in cough and cold treatments, mostly for children, that have been associated with 21 reported deaths since 1983.
Carbinoxamine is a mildly-sedating antihistamine with years of proven safety and efficacy.
March 9, 2011 /PRNewswire/ -- Tris Pharma, a specialty pharmaceutical company that develops innovative drug delivery technologies, announced today that the US Food and Drug Administration (FDA) has accepted its Extended Release Carbinoxamine Oral Suspension NDA for the treatment of allergies in kids two years and older.
Carbinoxamine Maleate 4mg Tablet is indicated to treat seasonal and perennial allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis due to inhalant allergens and food, mild, uncomplicated allergic skin manifestations of urticaria and angioedema, dermatographism, as therapy for anaphylactic reactions adjunctive to epinephrine and other standard measures after acute manifestations have been controlled and amelioration of the severity of allergic reactions to blood or plasma.
Carbinoxamine Maleate Oral Solution 4mg/5mL is indicated to treat seasonal and perennial allergic rhinitis.
The lawsuit alleges that Jewel Food Stores, through its Jewel-Osco pharmacy, filled the prescription for Rondec with a non-generic brand called Carbaxefed DM RF, which contained three (3) active ingredients, pseudoephedrine, dextromethorphan and carbinoxamine that were never tested in infants and have been known to cause death and injury to infants in the past.