Lohist-DM 5-2-10mg Syrup
It is used to treat nose stuffiness.It is used to ease allergy signs.It is used to relieve coughing.
Drug Class
Cold, Cough, and Allergy Relief
Pharmacologic Class
Antihistamine (first-generation), Antitussive, Alpha-1 Adrenergic Agonist
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medication is a combination syrup used to relieve symptoms of the common cold, allergies, and flu. It contains an antihistamine (brompheniramine) to reduce sneezing and runny nose, a cough suppressant (dextromethorphan) to calm coughs, and a decongestant (phenylephrine) to clear stuffy noses.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. You can take this medication with or without food. If it causes stomach upset, take it with food to help minimize this side effect. When taking the liquid form, measure the dose carefully using the measuring device that comes with the medication. If no device is provided, ask your pharmacist for a suitable measuring tool.
Storing and Disposing of Your Medication
Store this medication at room temperature in a dry location, avoiding the bathroom. Keep all medications in a safe place, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs available in your area.
Missing a Dose
If you take this medication regularly and miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at the same time or take extra doses. If you take this medication as needed, do not take it more frequently than directed by your doctor.
To use this medication correctly, follow your doctor's instructions and read all the information provided. You can take this medication with or without food. If it causes stomach upset, take it with food to help minimize this side effect. When taking the liquid form, measure the dose carefully using the measuring device that comes with the medication. If no device is provided, ask your pharmacist for a suitable measuring tool.
Storing and Disposing of Your Medication
Store this medication at room temperature in a dry location, avoiding the bathroom. Keep all medications in a safe place, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs available in your area.
Missing a Dose
If you take this medication regularly and miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at the same time or take extra doses. If you take this medication as needed, do not take it more frequently than directed by your doctor.
Lifestyle & Tips
- Avoid driving or operating heavy machinery until you know how this medication affects you, as it may cause drowsiness.
- Avoid alcohol and other CNS depressants while taking this medication, as they can increase drowsiness.
- Stay hydrated by drinking plenty of fluids to help thin mucus.
- Do not exceed the recommended dose, as this can lead to serious side effects.
- Consult a healthcare professional before use if you have high blood pressure, heart disease, diabetes, thyroid disease, glaucoma, or prostate enlargement.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
10 mL orally every 4-6 hours as needed
Dose Range:
10 - 20 mg
Condition-Specific Dosing:
maxDailyDose:
Do not exceed 6 doses (60 mL) in 24 hours
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established (contraindicated for children under 2 years)
Child:
Children 6 to under 12 years: 5 mL orally every 4-6 hours as needed (max 30 mL/24 hours). Not recommended for children under 6 years.
Adolescent:
Children 12 years and older: 10 mL orally every 4-6 hours as needed (max 60 mL/24 hours)
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment recommended, use with caution
Moderate:
Use with caution, consider reduced frequency or dose due to potential accumulation of brompheniramine and its metabolites
Severe:
Use with caution, consider reduced frequency or dose due to potential accumulation of brompheniramine and its metabolites
Dialysis:
Not well studied; use with caution, monitor for adverse effects
Hepatic Impairment:
Mild:
No specific adjustment recommended, use with caution
Moderate:
Use with caution, consider reduced frequency or dose due to metabolism of all components in the liver
Severe:
Use with caution, consider reduced frequency or dose due to metabolism of all components in the liver
Confidence:
Medium
Pharmacology
Mechanism of Action
Brompheniramine is a first-generation antihistamine that competitively blocks H1 histamine receptors, reducing allergic symptoms like sneezing, rhinorrhea, and watery eyes. Dextromethorphan is an antitussive that acts centrally on the cough center in the medulla to elevate the cough threshold. Phenylephrine is an alpha-1 adrenergic agonist that causes vasoconstriction in the nasal mucosa, leading to reduced swelling and congestion.
Pharmacokinetics
Absorption:
Bioavailability:
Brompheniramine: ~40-60%; Dextromethorphan: Variable (extensive first-pass); Phenylephrine: Low oral bioavailability (~38%)
Tmax:
Brompheniramine: 2-5 hours; Dextromethorphan: 2-2.5 hours; Phenylephrine: 1-2 hours
FoodEffect:
Food may delay absorption but generally does not significantly affect extent of absorption.
Distribution:
Vd:
Brompheniramine: 11.7 L/kg; Dextromethorphan: High (lipophilic); Phenylephrine: Not well characterized orally
ProteinBinding:
Brompheniramine: ~90%; Dextromethorphan: ~60-70%; Phenylephrine: Not extensively protein bound
CnssPenetration:
Brompheniramine: Yes (causes sedation); Dextromethorphan: Yes; Phenylephrine: Limited (does not readily cross BBB)
Elimination:
HalfLife:
Brompheniramine: 12-34 hours; Dextromethorphan: 1.4-3.9 hours (parent), 15-20 hours (dextrorphan); Phenylephrine: 2-3 hours
Clearance:
Brompheniramine: Renal and hepatic; Dextromethorphan: Hepatic; Phenylephrine: Hepatic and intestinal
ExcretionRoute:
Renal (primarily)
Unchanged:
Brompheniramine: ~2%; Dextromethorphan: <1%; Phenylephrine: <1%
Pharmacodynamics
OnsetOfAction:
Brompheniramine: 15-60 minutes; Dextromethorphan: 15-30 minutes; Phenylephrine: 15-30 minutes
PeakEffect:
Brompheniramine: 3-6 hours; Dextromethorphan: 1-2 hours; Phenylephrine: 1-2 hours
DurationOfAction:
Brompheniramine: 4-6 hours; Dextromethorphan: 5-6 hours; Phenylephrine: 4 hours
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Attention Immediately
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical help right away:
- Signs of an allergic reaction, such as:
- Rash
- Hives
- Itching
- Red, swollen, blistered, or peeling skin with or without fever
- Wheezing
- Tightness in the chest or throat
- Trouble breathing, swallowing, or talking
- Unusual hoarseness
- Swelling of the mouth, face, lips, tongue, or throat
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. Contact your doctor or seek medical help if you experience any of the following side effects or if they bother you or do not go away:
- Feeling dizzy or sleepy
- Feeling nervous and excitable
- Trouble sleeping
Additional Information
This list does not include all possible side effects. If you have questions or concerns about side effects, consult your doctor. For medical advice about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical help right away:
- Signs of an allergic reaction, such as:
- Rash
- Hives
- Itching
- Red, swollen, blistered, or peeling skin with or without fever
- Wheezing
- Tightness in the chest or throat
- Trouble breathing, swallowing, or talking
- Unusual hoarseness
- Swelling of the mouth, face, lips, tongue, or throat
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. Contact your doctor or seek medical help if you experience any of the following side effects or if they bother you or do not go away:
- Feeling dizzy or sleepy
- Feeling nervous and excitable
- Trouble sleeping
Additional Information
This list does not include all possible side effects. If you have questions or concerns about side effects, consult your doctor. For medical advice about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or drowsiness
- Nervousness, restlessness, or tremors
- Difficulty sleeping
- Fast or pounding heartbeat
- Significant increase in blood pressure
- Difficulty urinating
- Hallucinations or confusion (rare, but possible with overdose or interactions)
- Rash or allergic reaction
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
If you have taken certain medications for depression or Parkinson's disease within the last 14 days, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to very high blood pressure.
If you are currently taking linezolid or methylene blue, as these medications may interact with this drug.
If you have a cough that produces a lot of mucus, a persistent cough caused by smoking or exposure to smoke, or lung conditions such as asthma or emphysema.
This list is not exhaustive, and it is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. Your doctor and pharmacist need this information to ensure it is safe for you to take this medication with your other medications and health conditions. Never start, stop, or adjust the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
If you have taken certain medications for depression or Parkinson's disease within the last 14 days, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to very high blood pressure.
If you are currently taking linezolid or methylene blue, as these medications may interact with this drug.
If you have a cough that produces a lot of mucus, a persistent cough caused by smoking or exposure to smoke, or lung conditions such as asthma or emphysema.
This list is not exhaustive, and it is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. Your doctor and pharmacist need this information to ensure it is safe for you to take this medication with your other medications and health conditions. Never start, stop, or adjust the dose of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
To minimize the risk of severe side effects, do not exceed the dosage prescribed by your doctor. Taking more than the recommended amount can increase your chances of experiencing adverse effects. Additionally, do not take this medication for a longer period than specified by your doctor.
Until you are aware of how this medication affects you, it is recommended that you avoid operating a vehicle or engaging in activities that require alertness. It is also advisable to refrain from consuming alcohol while taking this drug.
Before using marijuana, other forms of cannabis, or prescription and over-the-counter (OTC) medications that may cause drowsiness, consult with your doctor.
When administering this medication to a child, exercise caution, as children may have a higher risk of experiencing excitability. This medication should not be used to induce sleep in children; instead, consult with your doctor for guidance.
It is crucial to note that different brands of this medication may be suitable for children of varying ages. Therefore, before giving this medication to a child, consult with your doctor to ensure you are using the appropriate brand and dosage.
If you are pregnant, planning to become pregnant, or are breast-feeding, inform your doctor. It is necessary to discuss the potential benefits and risks of this medication to both you and your baby.
To minimize the risk of severe side effects, do not exceed the dosage prescribed by your doctor. Taking more than the recommended amount can increase your chances of experiencing adverse effects. Additionally, do not take this medication for a longer period than specified by your doctor.
Until you are aware of how this medication affects you, it is recommended that you avoid operating a vehicle or engaging in activities that require alertness. It is also advisable to refrain from consuming alcohol while taking this drug.
Before using marijuana, other forms of cannabis, or prescription and over-the-counter (OTC) medications that may cause drowsiness, consult with your doctor.
When administering this medication to a child, exercise caution, as children may have a higher risk of experiencing excitability. This medication should not be used to induce sleep in children; instead, consult with your doctor for guidance.
It is crucial to note that different brands of this medication may be suitable for children of varying ages. Therefore, before giving this medication to a child, consult with your doctor to ensure you are using the appropriate brand and dosage.
If you are pregnant, planning to become pregnant, or are breast-feeding, inform your doctor. It is necessary to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe drowsiness or coma
- Excitement, agitation, or hallucinations
- Seizures
- Severe dry mouth, blurred vision, dilated pupils
- Flushing, fever
- Rapid or irregular heartbeat
- High blood pressure, followed by low blood pressure
- Urinary retention
- Respiratory depression
What to Do:
Seek immediate medical attention. Call 911 or your local poison control center (1-800-222-1222 in the US).
Drug Interactions
Contraindicated Interactions
- Monoamine Oxidase Inhibitors (MAOIs) (concurrent use or within 14 days of stopping MAOIs due to risk of hypertensive crisis with phenylephrine and serotonin syndrome with dextromethorphan)
- Severe hypertension
- Severe coronary artery disease
Major Interactions
- Other sympathomimetics (e.g., pseudoephedrine, ephedrine, stimulants) - increased risk of cardiovascular effects
- Tricyclic antidepressants (TCAs) - enhanced pressor effects of phenylephrine
- Beta-blockers (non-selective) - increased risk of hypertension and bradycardia with phenylephrine
- CNS depressants (e.g., alcohol, sedatives, hypnotics, anxiolytics, opioids) - additive CNS depression with brompheniramine and dextromethorphan
- Anticholinergic drugs (e.g., atropine, some antipsychotics, TCAs) - additive anticholinergic effects with brompheniramine
- Serotonergic drugs (e.g., SSRIs, SNRIs, triptans) - increased risk of serotonin syndrome with dextromethorphan
Moderate Interactions
- Digoxin - increased risk of arrhythmias with phenylephrine
- Alpha-adrenergic blocking agents - reduced efficacy of phenylephrine
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) - increased dextromethorphan exposure and risk of adverse effects
- Antihypertensives - phenylephrine may reduce the effect of antihypertensive medications
Minor Interactions
- Food (see pharmacokinetics)
Monitoring
Baseline Monitoring
Blood Pressure (BP) and Heart Rate (HR)
Rationale: Phenylephrine can increase BP and HR, especially in susceptible individuals.
Timing: Prior to initiation, especially in patients with pre-existing cardiovascular conditions.
Medical History (including cardiovascular, thyroid, diabetes, glaucoma, prostate enlargement)
Rationale: Identify contraindications or conditions requiring caution.
Timing: Prior to initiation.
Routine Monitoring
Symptom relief (cough, congestion, sneezing)
Frequency: Daily, as needed
Target: Adequate symptom control
Action Threshold: Lack of efficacy or worsening symptoms may indicate need for alternative therapy or medical evaluation.
Adverse effects (e.g., drowsiness, dizziness, nervousness, insomnia, dry mouth, urinary retention, increased BP/HR)
Frequency: Daily, as needed
Target: Absence or mild, tolerable effects
Action Threshold: Severe or persistent adverse effects warrant dose reduction or discontinuation.
Blood Pressure (BP) and Heart Rate (HR)
Frequency: As clinically indicated, especially in patients with hypertension or cardiovascular disease
Target: Within patient's normal range
Action Threshold: Significant increase in BP or HR warrants discontinuation and medical evaluation.
Symptom Monitoring
- Drowsiness
- Dizziness
- Nervousness
- Insomnia
- Dry mouth
- Blurred vision
- Urinary retention
- Palpitations
- Headache
- Nausea
- Vomiting
Special Patient Groups
Pregnancy
Generally considered Category C. Use only if the potential benefit justifies the potential risk to the fetus. Consult a healthcare provider.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally avoided unless clearly needed.
Second Trimester:
May be used with caution if benefits outweigh risks.
Third Trimester:
Phenylephrine may cause uterine vasoconstriction; brompheniramine may cause neonatal irritability or withdrawal symptoms if used close to term. Generally avoided.
Lactation
Not recommended. All components are excreted into breast milk and may cause adverse effects in the infant (e.g., drowsiness, irritability, tachycardia) or reduce milk supply (antihistamine).
Infant Risk:
Moderate risk (L3). Potential for infant drowsiness, irritability, tachycardia, and theoretical risk of reduced milk supply.
Pediatric Use
Contraindicated in children under 2 years of age due to serious and potentially life-threatening risks. Use with extreme caution and only as directed by a healthcare professional for children 2-12 years. Dosing must be precise and based on age/weight. Overdose is a significant risk.
Geriatric Use
Use with caution. Elderly patients are more susceptible to the anticholinergic effects of brompheniramine (e.g., sedation, confusion, urinary retention, constipation) and the cardiovascular effects of phenylephrine (e.g., hypertension, tachycardia). Start with lower doses and monitor closely.
Clinical Information
Clinical Pearls
- This combination product is effective for multi-symptom cold/allergy relief but carries risks, especially in vulnerable populations.
- Educate patients on the potential for drowsiness and to avoid activities requiring mental alertness.
- Emphasize the importance of not exceeding recommended doses, particularly in children, due to the risk of overdose from multiple active ingredients.
- Advise patients to check other medications (prescription and OTC) for similar ingredients to avoid accidental overdose.
- Caution patients with underlying cardiovascular conditions, hypertension, or diabetes due to the phenylephrine component.
- Brompheniramine is a first-generation antihistamine, so it is more sedating and has more anticholinergic effects than newer antihistamines.
Alternative Therapies
- Single-ingredient antihistamines (e.g., loratadine, cetirizine for allergies)
- Single-ingredient cough suppressants (e.g., dextromethorphan, guaifenesin)
- Single-ingredient decongestants (e.g., pseudoephedrine, oxymetazoline nasal spray)
- Saline nasal sprays for congestion
- Non-pharmacological measures (e.g., rest, fluids, humidifiers)
Cost & Coverage
Average Cost:
Varies widely, typically $10-$30 per 120 mL or 240 mL bottle
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (often covered by most insurance plans as a generic or preferred brand)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the overdose, including the medication taken, the amount, and the time it occurred.