Nohist-DM Liquid

Chlorpheniramine is a first-generation antihistamine that competitively blocks H1 receptors, reducing histamine-mediated symptoms like sneezing, rhinorrhea, and watery eyes. It also has anticholinergic properties. Phenylephrine is a direct-acting sympathomimetic amine that primarily acts as an alpha-1 adrenergic agonist, causing vasoconstriction in the nasal mucosa, leading to decongestion. Dextromethorphan is an antitussive that acts centrally on the cough center in the medulla to elevate the cough threshold. Its mechanism is thought to involve sigma-1 receptor agonism and non-competitive antagonism of NMDA receptors.

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
Signs of high blood pressure, including:
+ Severe headache
+ Dizziness
+ Fainting
+ Changes in eyesight
Chest pain or pressure
Fast heartbeat
Shakiness

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. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:

Dizziness
Drowsiness
Feeling nervous and excitable
* Trouble sleeping

Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns, contact your doctor for medical advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

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 you experienced, including any symptoms that occurred.
Respiratory issues, such as a cough that produces a significant amount of mucus, a persistent cough caused by smoking or exposure to smoke, or lung conditions like asthma or emphysema.
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 severely high blood pressure.
If you are currently taking linezolid or methylene blue, as these medications can interact with this drug.

To ensure your safety, it is crucial to provide your doctor and pharmacist with a comprehensive list of all your medications, including:

Prescription and over-the-counter (OTC) medications
Natural products
* Vitamins

Additionally, inform them about any existing health problems. This information will help your doctor determine whether it is safe for you to take this medication with your other medications and health conditions. Never start, stop, or change the dosage of any medication without first consulting your doctor.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

Until you are aware of how this drug affects you, avoid operating a vehicle or engaging in any activities that require your full attention.

Adhere strictly to the dosage prescribed by your doctor. Taking more than the recommended dose may increase your risk of experiencing severe side effects. Additionally, do not take this medication for a longer duration than prescribed by your doctor.

While taking this drug, refrain from consuming alcohol. Before using marijuana, other forms of cannabis, or any prescription or over-the-counter medications that may cause drowsiness, consult with your doctor.

If the patient is a child, exercise caution when administering this drug, as children may have a higher risk of experiencing excitability. Note that different brands of this medication may be suitable for different age groups of children, so it is crucial to consult with the doctor before giving this drug to a child. Furthermore, do not use this medication as a means to induce sleep in a child; instead, discuss this with the doctor.

If you are pregnant, planning to become pregnant, or are breastfeeding, inform your doctor. It is necessary to discuss the potential benefits and risks of this medication to both you and your baby.

• 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)
• Linezolid (due to MAOI activity)
• Methylene Blue (due to MAOI activity)
• Severe uncontrolled hypertension (due to phenylephrine)
• Narrow-angle glaucoma (due to chlorpheniramine's anticholinergic effects)
• Urinary retention (due to chlorpheniramine's anticholinergic effects)

• CNS depressants (e.g., alcohol, sedatives, hypnotics, anxiolytics, opioids) - increased sedation and respiratory depression (chlorpheniramine, dextromethorphan)
• Tricyclic Antidepressants (TCAs) - enhanced pressor effect of phenylephrine, increased anticholinergic effects of chlorpheniramine
• Beta-blockers (non-selective) - increased risk of hypertension and bradycardia with phenylephrine
• Other sympathomimetics (e.g., other decongestants, amphetamines) - additive cardiovascular effects (phenylephrine)
• Serotonergic drugs (e.g., SSRIs, SNRIs, triptans) - increased risk of serotonin syndrome with dextromethorphan
• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) - increased dextromethorphan levels and risk of toxicity

• Anticholinergic drugs (e.g., atropine, benztropine, some antipsychotics) - additive anticholinergic effects (chlorpheniramine)
• Digoxin - phenylephrine may increase risk of arrhythmias
• Alpha-adrenergic blockers (e.g., prazosin) - reduced decongestant effect of phenylephrine
• Antihypertensives - phenylephrine may reduce their effect

• Food (may delay absorption of chlorpheniramine)

• Effectiveness of symptom relief (cough, congestion, sneezing)
• Drowsiness or sedation
• Dizziness or lightheadedness
• Dry mouth, nose, or throat
• Blurred vision
• Urinary retention or difficulty urinating
• Increased heart rate or palpitations
• Increased blood pressure (especially in patients with hypertension)
• Nervousness, restlessness, or insomnia
• Signs of serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, sweating, muscle rigidity, twitching, loss of coordination, nausea, vomiting, diarrhea)

Generally not recommended during pregnancy unless clearly necessary and benefits outweigh risks. Chlorpheniramine is Category B, but phenylephrine and dextromethorphan are Category C. Phenylephrine can cause vasoconstriction, potentially affecting uterine blood flow. Chlorpheniramine's anticholinergic effects may be a concern near term.

Use with caution. Chlorpheniramine (L3) can cause drowsiness in the infant and may decrease milk supply. Phenylephrine (L3) is poorly absorbed orally but can cause irritability in infants and theoretically reduce milk supply. Dextromethorphan (L2) is generally considered safer but can cause drowsiness. Monitor infant for sedation, irritability, or poor feeding. Consider alternative agents if possible.

Contraindicated in children under 2 years of age due to serious and potentially life-threatening side effects. Use with extreme caution and only under medical supervision for children 2-6 years. Always follow specific product labeling for age-appropriate dosing. Risk of overdose is higher in young children.

Increased susceptibility to anticholinergic effects (e.g., sedation, confusion, urinary retention, constipation) and sympathomimetic effects (e.g., increased blood pressure, heart rate, insomnia) due to age-related changes in metabolism and elimination. Start with lower doses and monitor closely. Avoid in elderly with glaucoma, prostate enlargement, or cardiovascular disease unless benefits clearly outweigh risks.

• This is an OTC product; always advise patients to read and follow the specific product label instructions carefully.
• Educate patients on the potential for drowsiness and to avoid activities requiring mental alertness.
• Warn about the risk of serotonin syndrome, especially if patients are taking other serotonergic drugs or MAOIs.
• Advise patients with underlying conditions like hypertension, heart disease, diabetes, or thyroid disorders to consult their physician before use due to the phenylephrine component.
• Emphasize that this medication treats symptoms and does not cure the underlying cause of cold or flu.

• Single-ingredient antihistamines (e.g., loratadine, cetirizine for non-drowsy options)
• Single-ingredient decongestants (e.g., pseudoephedrine, oxymetazoline nasal spray)
• Single-ingredient antitussives (e.g., guaifenesin, benzonatate)
• Saline nasal sprays for congestion
• Honey for cough relief
• Warm fluids, humidifiers

If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it is a good idea to consult with your pharmacist. If you have any questions or concerns about this medication, do not hesitate to discuss them with 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 detailed information about the overdose, including the medication taken, the amount, and the time it occurred.