Vanacof DM Liquid
It is used to treat nose stuffiness.It is used to thin mucus so it can be taken from the body by coughing.It is used to relieve coughing.
Drug Class
Expectorant, Antitussive, Decongestant
Pharmacologic Class
Expectorant (Guaifenesin), NMDA receptor antagonist (Dextromethorphan), Alpha-1 adrenergic agonist (Phenylephrine)
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medicine helps relieve cough, chest congestion, and stuffy nose. Guaifenesin helps thin and loosen mucus in your lungs, making it easier to cough up. Dextromethorphan helps calm your cough. Phenylephrine helps clear up your stuffy nose by reducing swelling in your nasal passages.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. You can take this medication with or without food, but if it causes stomach upset, take it with food to help minimize discomfort.
It's essential to stay hydrated while taking this medication, so drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake. When measuring liquid doses, use the measuring device that comes with the medication. If one is not provided, ask your pharmacist for a suitable measuring device to ensure accurate dosing.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding storage in a bathroom. Keep all medications in a safe location, 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 by your doctor or pharmacist. If you're unsure about the best way to dispose of your medication, consult with your pharmacist, who may be aware of drug take-back programs in your area.
What to Do If You Miss a Dose
If you take this medication on a regular schedule, take the missed dose as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume 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 get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. You can take this medication with or without food, but if it causes stomach upset, take it with food to help minimize discomfort.
It's essential to stay hydrated while taking this medication, so drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake. When measuring liquid doses, use the measuring device that comes with the medication. If one is not provided, ask your pharmacist for a suitable measuring device to ensure accurate dosing.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding storage in a bathroom. Keep all medications in a safe location, 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 by your doctor or pharmacist. If you're unsure about the best way to dispose of your medication, consult with your pharmacist, who may be aware of drug take-back programs in your area.
What to Do If You Miss a Dose
If you take this medication on a regular schedule, take the missed dose as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume 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
- Drink plenty of fluids (water, clear broths) to help thin mucus and stay hydrated.
- Get adequate rest.
- Avoid irritants like smoke, dust, and allergens.
- Use a humidifier to help moisten the air and soothe irritated airways.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
Dosage varies by product concentration. Typically, 10-20 mL orally every 4 hours as needed, not to exceed 6 doses in 24 hours.
Condition-Specific Dosing:
general:
Follow specific product label instructions. Common concentrations: Guaifenesin 100-200 mg/5mL, Dextromethorphan 10-20 mg/5mL, Phenylephrine 5 mg/5mL.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established (generally not recommended for children under 2 years old)
Child:
Dosage varies by product concentration and age/weight. Typically, for 6-12 years: 5-10 mL orally every 4 hours as needed, not to exceed 6 doses in 24 hours. For 2-6 years: Consult a healthcare professional; generally not recommended or lower doses.
Adolescent:
Same as adult dosing for ages 12 years and older.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment typically recommended for the combination.
Moderate:
Use with caution. Phenylephrine may require dose reduction in severe renal impairment.
Severe:
Use with caution. Phenylephrine may require dose reduction due to potential for accumulation and increased cardiovascular effects.
Dialysis:
Considerations: Not well-studied for combination. Avoid phenylephrine in patients with end-stage renal disease unless benefits outweigh risks.
Hepatic Impairment:
Mild:
No specific adjustment typically recommended.
Moderate:
Use with caution. Dextromethorphan is metabolized by CYP2D6; hepatic impairment may increase exposure. Phenylephrine metabolism may also be affected.
Severe:
Use with caution. Consider reduced doses due to altered metabolism and clearance of Dextromethorphan and Phenylephrine.
Confidence:
Medium
Pharmacology
Mechanism of Action
Guaifenesin acts as an expectorant by increasing the volume and decreasing the viscosity of respiratory tract secretions, thereby facilitating their removal by ciliary action and coughing. Dextromethorphan is an antitussive that acts centrally on the cough center in the medulla to elevate the cough threshold. Phenylephrine is a direct-acting sympathomimetic amine that acts as an alpha-1 adrenergic receptor agonist, causing vasoconstriction in the nasal mucosa, leading to reduced swelling and congestion.
Pharmacokinetics
Absorption:
Bioavailability:
Guaifenesin: Rapidly absorbed. Dextromethorphan: Rapidly absorbed, extensive first-pass metabolism. Phenylephrine: Variable oral bioavailability (approx. 38%) due to extensive first-pass metabolism.
Tmax:
Guaifenesin: ~1 hour. Dextromethorphan: ~2 hours. Phenylephrine: ~1-2 hours.
FoodEffect:
Generally, no significant food effect reported for absorption of these components.
Distribution:
Vd:
Guaifenesin: Not well-defined. Dextromethorphan: Large volume of distribution. Phenylephrine: Not well-defined.
ProteinBinding:
Guaifenesin: Not extensively protein bound. Dextromethorphan: Not extensively protein bound. Phenylephrine: Not extensively protein bound.
CnssPenetration:
Guaifenesin: Limited. Dextromethorphan: Yes (acts centrally). Phenylephrine: Limited (poor penetration across BBB).
Elimination:
HalfLife:
Guaifenesin: ~1 hour. Dextromethorphan: ~2-4 hours (parent drug), Dextrorphan ~10-20 hours. Phenylephrine: ~2-3 hours.
Clearance:
Guaifenesin: Rapid. Dextromethorphan: Varies based on CYP2D6 phenotype. Phenylephrine: Rapid.
ExcretionRoute:
Guaifenesin: Renal (metabolites). Dextromethorphan: Renal (unchanged drug and metabolites). Phenylephrine: Renal (metabolites and unchanged drug).
Unchanged:
Guaifenesin: <1%. Dextromethorphan: Small percentage. Phenylephrine: Small percentage.
Pharmacodynamics
OnsetOfAction:
Guaifenesin: ~30 minutes. Dextromethorphan: ~15-30 minutes. Phenylephrine: ~15-30 minutes.
PeakEffect:
Guaifenesin: ~1 hour. Dextromethorphan: ~1-2 hours. Phenylephrine: ~1-2 hours.
DurationOfAction:
Guaifenesin: ~4-6 hours. Dextromethorphan: ~4-6 hours. Phenylephrine: ~4 hours.
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. Immediately contact your doctor or seek medical attention if you notice any of the following symptoms, which may indicate a serious allergic reaction:
- Rash
- Hives
- Itching
- Red, swollen, blistered, or peeling skin (with or without fever)
- Wheezing
- Tightness in the chest or throat
- Difficulty 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 persist or bother you:
- Dizziness
- 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 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, some people may experience severe and potentially life-threatening side effects while taking this medication. Immediately contact your doctor or seek medical attention if you notice any of the following symptoms, which may indicate a serious allergic reaction:
- Rash
- Hives
- Itching
- Red, swollen, blistered, or peeling skin (with or without fever)
- Wheezing
- Tightness in the chest or throat
- Difficulty 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 persist or bother you:
- Dizziness
- 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 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:
- Cough that lasts more than 7 days, comes back, or occurs with fever, rash, or persistent headache.
- Nasal congestion that lasts more than 7 days or worsens.
- Symptoms of an allergic reaction (e.g., rash, itching, swelling, severe dizziness, trouble breathing).
- Signs of high blood pressure (e.g., severe headache, blurred vision, pounding in ears).
- Nervousness, dizziness, or sleeplessness that is severe or persistent.
- Difficulty urinating (especially in men with prostate problems).
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.
Respiratory issues, including 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.
Recent use of certain medications for depression or Parkinson's disease within the last 14 days, such as isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure.
Current use of linezolid or methylene blue, as these medications can interact with this drug.
To ensure safe treatment, it is crucial to disclose all of your:
Prescription and over-the-counter (OTC) medications
Natural products
Vitamins
Health problems
Your doctor and pharmacist need this information to assess potential interactions and determine the safety of taking this medication with your other drugs and health conditions. Never start, stop, or adjust the dosage of any medication without 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.
Respiratory issues, including 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.
Recent use of certain medications for depression or Parkinson's disease within the last 14 days, such as isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure.
Current use of linezolid or methylene blue, as these medications can interact with this drug.
To ensure safe treatment, it is crucial to disclose all of your:
Prescription and over-the-counter (OTC) medications
Natural products
Vitamins
Health problems
Your doctor and pharmacist need this information to assess potential interactions and determine the safety of taking this medication with your other drugs and health conditions. Never start, stop, or adjust the dosage of any medication without 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. Adhering to the recommended treatment duration is also crucial; do not take this drug for longer than the period specified by your doctor.
If you are considering giving this medication to a child, consult with your doctor first, as different brands may be suitable for different age groups.
If you are pregnant, planning to become pregnant, or are breastfeeding, it is vital to discuss your situation with your doctor. This conversation will help you understand the benefits and risks associated with taking this medication during these periods, allowing you to make an informed decision regarding you and your baby's health.
If you are considering giving this medication to a child, consult with your doctor first, as different brands may be suitable for different age groups.
If you are pregnant, planning to become pregnant, or are breastfeeding, it is vital to discuss your situation with your doctor. This conversation will help you understand the benefits and risks associated with taking this medication during these periods, allowing you to make an informed decision regarding you and your baby's health.
Overdose Information
Overdose Symptoms:
- Dextromethorphan: Nausea, vomiting, dizziness, drowsiness, blurred vision, nystagmus, ataxia, hallucinations, agitation, confusion, serotonin syndrome (agitation, hyperthermia, rapid heart rate, muscle rigidity, sweating, tremors).
- Phenylephrine: Hypertension, headache, palpitations, bradycardia (reflex), anxiety, restlessness, tremor, seizures, cerebral hemorrhage.
- Guaifenesin: Nausea, vomiting, stomach upset, dizziness.
What to Do:
Seek immediate medical attention or call a poison control center (1-800-222-1222). Treatment is supportive and symptomatic. Activated charcoal may be considered if ingestion is recent. Monitor vital signs, CNS status, and cardiovascular function.
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)
Major Interactions
- Serotonergic drugs (SSRIs, SNRIs, TCAs, triptans, fentanyl, tramadol, bupropion, St. John's Wort) with Dextromethorphan (risk of serotonin syndrome)
- Other sympathomimetics (e.g., pseudoephedrine, ephedrine, amphetamines) with Phenylephrine (additive pressor effects, increased cardiovascular risk)
- Beta-blockers (non-selective) with Phenylephrine (risk of unopposed alpha-adrenergic stimulation leading to severe hypertension)
- Tricyclic Antidepressants (TCAs) with Phenylephrine (potentiated pressor effects)
- Ergot alkaloids (e.g., ergotamine, dihydroergotamine) with Phenylephrine (increased vasoconstriction)
Moderate Interactions
- Antihypertensive agents (Phenylephrine may reduce their effect)
- Digoxin (Phenylephrine may increase risk of arrhythmias)
- General anesthetics (e.g., halogenated anesthetics) with Phenylephrine (increased risk of arrhythmias)
- Alcohol and other CNS depressants (additive CNS depression with Dextromethorphan)
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) with Dextromethorphan (may increase dextromethorphan levels and adverse effects)
Minor Interactions
- None specifically for this combination that are not covered by higher severity.
Monitoring
Routine Monitoring
Symptom improvement (cough, congestion, mucus)
Frequency: Daily, as needed
Target: Reduction in severity and frequency of symptoms
Action Threshold: Lack of improvement after 7 days, worsening symptoms, or development of new symptoms (e.g., fever, rash, persistent headache) warrants medical evaluation.
Adverse effects (e.g., dizziness, nervousness, insomnia, nausea, vomiting, increased blood pressure, palpitations)
Frequency: Daily, as needed
Target: Absence or mild, tolerable side effects
Action Threshold: Severe or persistent adverse effects, or signs of allergic reaction, require immediate medical attention.
Symptom Monitoring
- Cough frequency and severity
- Nasal congestion
- Mucus thickness and ease of expectoration
- Dizziness
- Nervousness
- Insomnia
- Headache
- Nausea
- Vomiting
- Palpitations
- Increased blood pressure
- Urinary retention (especially in men with BPH)
Special Patient Groups
Pregnancy
Category C. Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus. Consult a healthcare provider.
Trimester-Specific Risks:
First Trimester:
Limited data. Avoid if possible, especially during organogenesis.
Second Trimester:
Generally considered safer than first trimester, but still use with caution.
Third Trimester:
Phenylephrine use near term may cause uterine vasoconstriction and fetal hypoxia. Dextromethorphan and Guaifenesin generally considered low risk but still Category C.
Lactation
L3 (Moderately Safe). All components are excreted into breast milk in small amounts. Use with caution. Monitor infant for irritability, drowsiness, or feeding difficulties. Consult a healthcare provider.
Infant Risk:
Low to moderate. Potential for irritability or drowsiness in the infant from dextromethorphan. Phenylephrine may reduce milk supply, especially with prolonged use.
Pediatric Use
Not recommended for children under 2 years of age due to potential for serious adverse effects. For children 2-12 years, use only under the guidance of a healthcare professional and follow age-specific dosing on the product label. Accidental overdose is a significant risk in this population.
Geriatric Use
Use with caution. Elderly patients may be more sensitive to the effects of phenylephrine (e.g., increased blood pressure, CNS stimulation) and dextromethorphan (e.g., sedation, dizziness). Pre-existing conditions like hypertension, cardiovascular disease, benign prostatic hyperplasia (BPH), and glaucoma should be considered. Start with the lowest effective dose.
Clinical Information
Clinical Pearls
- Advise patients to read the product label carefully for specific dosing instructions and warnings, as concentrations vary between products.
- Emphasize the importance of not exceeding the recommended dose or frequency, especially due to the phenylephrine component which can cause cardiovascular side effects.
- Counsel patients to avoid concurrent use with other cough/cold/flu medications to prevent accidental overdose of similar ingredients.
- Warn about potential for drowsiness (dextromethorphan) and advise caution when driving or operating machinery.
- Remind patients that this medication treats symptoms, not the underlying cause of the cough or congestion. If symptoms persist or worsen, medical evaluation is necessary.
Alternative Therapies
- Single-ingredient expectorants (e.g., Guaifenesin)
- Single-ingredient antitussives (e.g., Dextromethorphan, Benzonatate)
- Single-ingredient decongestants (e.g., Pseudoephedrine, Phenylephrine nasal spray)
- Antihistamines (for allergic rhinitis symptoms)
- Saline nasal sprays/washes
- Humidifiers
- Honey (for cough relief)
- Non-pharmacological measures (rest, hydration)
Cost & Coverage
Average Cost:
Varies widely, typically $5-$20 per 4 oz (120 mL) bottle
Generic Available:
Yes
Insurance Coverage:
Over-the-counter (OTC), generally not covered by insurance unless prescribed or through FSA/HSA.
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 your 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 medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.