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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.


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

Karbinal ER

(trade name)


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


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


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).


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)

POunk6.7 hr12 hr


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)


  • thickened bronchial secretions (most frequent)


  • epigastric distress (most frequent)


  • disturbed coordination (most frequent)


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.


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.


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)


  • 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


/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 ?
Now, with the approval of Karbinal ER, I look forward to having an effective and great-tasting extended-release liquid formulation to offer patients as young as two years old.
The approval of Karbinal ER marks our fourth liquid extended-release NDA approval based upon our proprietary OralXR+ technology.
Karbinal ER is an H1 receptor antagonist (antihistamine) indicated for two years of age and older.
The addition of Karbinal ER to our portfolio of products further demonstrates our commitment to meeting unmet needs of pediatric patients.
The launch of Karbinal ER demonstrates the continued success of our OralXR+ technology and is representative of Tris' history of developing and manufacturing first-to-market liquid sustained-release products that fill significant unmet patient needs," added Ketan Mehta, President and CEO of Tris Pharma.
Do not give Karbinal ER to children younger than 2 years of age.
Karbinal ER contains sodium metabisulfite, a sulfite which may cause anaphylaxis and life-threatening or less severe asthmatic episodes in susceptible individuals.
Avoid use of Karbinal ER with monoamine oxidase inhibitors (MAOIs) which prolong and intensify the anticholinergic (drying) effects of antihistamines.
Avoid use of Karbinal ER with alcohol and CNS depressants (hypnotics, sedatives, tranquilizers, etc.
Karbinal ER is expected to be available in pharmacies across the U.
Under the terms of the exclusive agreement, Tris will manufacture Karbinal ER using its proprietary OralXR+(TM) technology and FSC will market the drug.