carbinoxamine
General
Pronunciation:
car-bi-nox-a-meen
Trade Name(s)
- Karbinal ER
- Ryvent
Ther. Class.
allergy, cold and cough remedies
Pharm. Class.
Indications
- Seasonal and perennial allergic rhinitis.
- Vasomotor rhinitis.
- Allergic conjunctivitis due to inhalant allergens and foods.
- Mild, uncomplicated allergic skin manifestations of urticaria and angioedema.
- Dermatographism.
- Anaphylaxis (as adjunct to epinephrine after acute manifestations controlled).
- Allergic reactions to blood or 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 Effect(s):
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: Unknown
Metabolism and Excretion: Extensively metabolized by the liver, inactive metabolites excreted in urine. Negligible renal elimination of unchanged drug.
Half-life: 17 hr
TIME/ACTION PROFILE (plasma concentrations)
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
PO-IR | unknown | unknown | 4 hr |
PO-ER | unknown | 6.7 hr | 12 hr |
Contraindication/Precautions
Contraindicated in:
- Hypersensitivity, including sulfite allergy
- Lactation: Lactation;
- Concurrent use of MAO inhibitors
- Pedi: Children <2 yr (↑ risk of death).
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
- OB: Safety not established in pregnancy;
- Pedi: Younger children may be more sensitive to sedation or excitation
- Geri: Older adults may be more susceptible to adverse reactions.
Adverse Reactions/Side Effects
GI: epigastric distress
Neuro: disturbed coordination, dizziness, drowsiness, sedation
Resp: thickened bronchial secretions
* CAPITALS indicate life-threatening.
Underline indicate most frequent.
Interactions
Drug-Drug
- Concurrent use with MAO inhibitors may ↑ anticholinergic effects.
- ↑ risk of CNS depression with other CNS depressants including alcohol, other antihistamines , opioid analgesics and sedative/hypnotics.
Route/Dosage
PO (Adults and Children ≥ 12 yr): Immediate-release tablets or solution: 4–8 mg 3–4 times daily; Extended-release suspension: 6–16 mg every 12 hr.
PO (Children 6–11 yr): Immediate-release tablets or solution: 2–4 mg 3–4 times daily; Extended-release suspension: 6–12 mg every 12 hr.
PO (Children 4–5 yr): Immediate-release solution: 1–2 mg 3–4 times daily; Extended-release suspension: 3–8 mg every 12 hr.
PO (Children 2–3 yr): Immediate-release solution: 1–2 mg 3–4 times daily; Extended-release suspension: 3–4 mg every 12 hr.
Availability (generic available)
Immediate-release tablets: 4 mg, 6 mg
Immediate-release oral solution (banana bubble gum flavor): 4 mg/5 mL
Extended-release oral suspension (contains metabisulfite) (strawberry banana flavor): 4 mg/5 mL
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.
Implementation
- Begin with lowest dose and increase as needed and tolerated. Dose is based on condition severity and patient response.
- PO Administer twice daily.
- Use a calibrated measuring device for accurate dose; household tablespoon is not accurate and could lead to overdose. May be fatal if administered to children under 2 yr.Shake well before using.
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, may cause overdose.
- 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
- Rep: Instruct females of reproductive potential to notify health care professional if pregnancy is planned or suspected and avoid breastfeeding during therapy.
Evaluation/Desired Outcomes
Decrease in allergic symptoms