chlorpheniramine Nursing Considerations & Management
Chlorpheniramine maleate is an antihistamine indicated for symptomatic relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis.
Generic Names & Brand Names
(klor fen ir‘ a meen)
Aller-Chlor; Allergy; Chlo-Amine; Chlor-Trimeton Allergy 4 hr, 8 hr, and
12 hr; Chlor-Tripolon (CAN); Efidac 24
Pregnancy Category B
Drug class
Antihistamine (alkylamine type)
Therapeutic actions
Competitively blocks the effects of histamine at H1-receptor sites; has atropine-like, antipruritic, and sedative effects.
Indications
- Symptomatic relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis.
Contraindications and cautions
- Contraindicated with allergy to any antihistamines, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction, third trimester of pregnancy, lactation.
- Use cautiously in pregnancy.
Available forms
Chewable tablets—2 mg; tablets—4 mg; ER tablets—8, 12, 16 mg; syrup—2 mg/5 mL; SR capsules—8, 12 mg
Dosages
ADULTS AND CHILDREN > 12 YR
Tablets or syrup
- 4 mg PO q 4–6 hr; do not exceed 24 mg in 24 hr.
Sustained-release
- 8–12 mg PO hs or q 8–12 hr during the day; do not exceed 24 mg in 24 hr.
Extended-release (Efidac 24)
- 16 mg with liquid PO q 24 hr.
PEDIATRIC PATIENTS
Tablets or syrup
- 2–< 6 yr: 1 mg q 4–6 hr PO; do not exceed 4 mg in 24 hr.
- 6–12 yr: 2 mg q 4–6 hr PO; do not exceed 12 mg in 24 hr.
Sustained-release
- < 6 yr: Not recommended.
- 6–12 yr: 8 mg PO hs or during the day.
GERIATRIC PATIENTS
- More likely to cause dizziness, sedation, syncope, toxic confusional states, and hypotension in elderly patients; use with caution.
Pharmacokinetics
Route | Onset | Peak |
Oral | 0.5–6 hr | 2–6 hr |
Metabolism: Hepatic; T1/2: 12–15 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Urine
Adverse effects
- CNS: Drowsiness, sedation, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, headache, blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis, hysteria, tingling, heaviness and weakness of the hands
- CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles
- GI: Epigastric distress, anorexia, increased appetite and weight gain, nausea, vomiting, diarrhea or constipation
- GU: Urinary frequency, dysuria, urinary retention, early menses, decreased libido, impotence
- Hematologic: Hemolytic anemia, hypoplastic anemia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia
- Respiratory: Thickening of bronchial secretions, chest tightness, wheezing, nasal stuffiness, dry mouth, dry nose, dry throat, sore throat
- Other: Urticaria, rash, anaphylactic shock, photosensitivity, excessive perspiration, chills
Interactions
Drug-drug
- Increased depressant effects with alcohol, other CNS depressants
Nursing considerations
Assessment
- History: Allergy to any antihistamines; narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction, pregnancy, lactation
- Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examination; P, BP; R, adventitious sounds; bowel sounds; prostate palpation; CBC with differential
Interventions
- Administer with food if GI upset occurs.
- Caution patient not to crush or chew SR preparations.
- Arrange for periodic blood tests during prolonged therapy.
Teaching points
- Take as prescribed; avoid excessive dosage. Take with food if GI upset occurs; do not cut, crush, or chew the SR preparations.
- Avoid OTC drugs; many contain ingredients that could cause serious reactions if taken with this antihistamine.
- Avoid alcohol; serious sedation may occur.
- You may experience these side effects: Dizziness, sedation, drowsiness (use caution driving or performing tasks that require alertness); epigastric distress, diarrhea, or constipation (take with meals; consult care provider if severe); dry mouth (frequent mouth care; sucking on sugarless lozenges may help); thickening of bronchial secretions, dryness of nasal mucosa (use a humidifier).
- Report difficulty breathing; hallucinations, tremors, loss of coordination; unusual bleeding or bruising; visual disturbances; irregular heartbeat.