Vanacof DMX 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
Cough and Cold Preparation
Pharmacologic Class
Expectorant, Antitussive (NMDA receptor antagonist), Alpha-1 Adrenergic Agonist (Decongestant)
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medicine is a combination of three ingredients: Guaifenesin helps thin and loosen mucus in your lungs, making it easier to cough up. Dextromethorphan helps calm your cough. Phenylephrine helps relieve stuffy nose by shrinking blood vessels in the nasal passages. It's used to relieve chest congestion, cough, and nasal stuffiness caused by the common cold, flu, or other breathing illnesses.
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. Drink plenty of non-caffeinated fluids, unless your doctor advises you to limit your fluid intake.
When taking the liquid form of this medication, measure your dose accurately using the measuring device that comes with the medication. If a measuring device is not provided, ask your pharmacist for one to ensure you take the correct dose.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the 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 have questions about disposing 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. Drink plenty of non-caffeinated fluids, unless your doctor advises you to limit your fluid intake.
When taking the liquid form of this medication, measure your dose accurately using the measuring device that comes with the medication. If a measuring device is not provided, ask your pharmacist for one to ensure you take the correct dose.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the 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 have questions about disposing 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, juice) to help loosen mucus.
- Get adequate rest.
- Avoid irritants like smoke, dust, and allergens.
- Do not exceed the recommended dose.
- Do not use for more than 7 days unless directed by a doctor.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
10 mL (Guaifenesin 200 mg, Dextromethorphan 20 mg, Phenylephrine 10 mg) orally every 4 hours as needed
Dose Range:
10 - 10 mg
Condition-Specific Dosing:
maxDailyDose:
Do not exceed 6 doses (60 mL) in 24 hours
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Children 6 to under 12 years: 5 mL orally every 4 hours as needed (max 6 doses/24 hours); Children under 6 years: Not recommended unless directed by a physician
Adolescent:
Adolescents 12 years and older: 10 mL orally every 4 hours as needed (max 6 doses/24 hours)
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment recommended, use with caution
Moderate:
No specific adjustment recommended, use with caution
Severe:
Use with caution; consult physician
Dialysis:
Not well studied; use with caution
Hepatic Impairment:
Mild:
No specific adjustment recommended, use with caution
Moderate:
Use with caution; consult physician
Severe:
Use with caution; consult physician
Confidence:
Medium
Pharmacology
Mechanism of Action
Guaifenesin acts as an expectorant by increasing the volume and decreasing the viscosity of respiratory tract secretions, 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 primarily acts as an alpha-1 adrenergic agonist, causing vasoconstriction in the nasal mucosa, leading to decongestion.
Pharmacokinetics
Absorption:
Bioavailability:
Not available (Guaifenesin: ~60%, Dextromethorphan: ~11%, Phenylephrine: ~38% oral)
Tmax:
Guaifenesin: ~1 hour; Dextromethorphan: ~2 hours; Phenylephrine: ~0.75-2 hours
FoodEffect:
May delay absorption but not significantly alter extent
Distribution:
Vd:
Guaifenesin: Not well characterized; Dextromethorphan: Large (2.5 L/kg); Phenylephrine: Not well characterized
ProteinBinding:
Guaifenesin: Not significant; Dextromethorphan: 60-70%; Phenylephrine: Not significant
CnssPenetration:
Limited (Guaifenesin, Phenylephrine); Yes (Dextromethorphan)
Elimination:
HalfLife:
Guaifenesin: ~1 hour; Dextromethorphan: ~2-4 hours (parent), ~10-20 hours (dextrorphan); Phenylephrine: ~2-3 hours
Clearance:
Not available
ExcretionRoute:
Renal (primarily metabolites)
Unchanged:
Guaifenesin: <1%; Dextromethorphan: <1%; Phenylephrine: <1%
Pharmacodynamics
OnsetOfAction:
Guaifenesin: ~30 minutes; Dextromethorphan: ~15-30 minutes; Phenylephrine: ~15-30 minutes
PeakEffect:
Guaifenesin: ~1 hour; Dextromethorphan: ~2 hours; Phenylephrine: ~1 hour
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
If you experience any of the following symptoms, call your doctor or seek medical attention immediately, as they may be signs of a severe and potentially life-threatening reaction:
- 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, or 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 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.
If you experience any of the following symptoms, call your doctor or seek medical attention immediately, as they may be signs of a severe and potentially life-threatening reaction:
- 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, or 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 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:
- Dizziness, nervousness, or sleeplessness
- Nausea or vomiting that is severe or persistent
- Fast or pounding heartbeat
- Difficulty urinating
- Rash or itching
- Worsening symptoms or new symptoms develop
- Cough that lasts more than 7 days or comes back, or is accompanied by fever, rash, or persistent headache
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 lot 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, such as 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 may interact with this drug.
To ensure your safety, it is crucial to provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter medications you are taking
Any natural products or vitamins you are using
* Your medical history, including any health problems you have
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 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.
Respiratory issues, including a cough that produces a lot 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, such as 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 may interact with this drug.
To ensure your safety, it is crucial to provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter medications you are taking
Any natural products or vitamins you are using
* Your medical history, including any health problems you have
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 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. 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, discuss this with your doctor. You and your doctor will need to weigh the benefits and risks of this medication to both you and your baby.
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, discuss this with your doctor. You and your doctor will need to weigh the benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Guaifenesin: Nausea, vomiting, stomach upset, dizziness
- Dextromethorphan: Nausea, vomiting, dizziness, drowsiness, blurred vision, nystagmus, ataxia, respiratory depression, hallucinations, agitation, confusion, serotonin syndrome (in severe cases)
- Phenylephrine: Hypertension, headache, palpitations, tachycardia, bradycardia (reflex), anxiety, restlessness, tremor, seizures, cerebral hemorrhage
What to Do:
Seek immediate medical attention or call Poison Control at 1-800-222-1222. Treatment is supportive and symptomatic.
Drug Interactions
Contraindicated Interactions
- Monoamine Oxidase Inhibitors (MAOIs) (concurrent use or within 14 days of stopping MAOIs due to risk of hypertensive crisis and serotonin syndrome)
Major Interactions
- Serotonergic drugs (SSRIs, SNRIs, TCAs, triptans, opioids like tramadol, fentanyl) with Dextromethorphan (risk of serotonin syndrome)
- Beta-blockers (may increase pressor effects of phenylephrine)
- Tricyclic antidepressants (TCAs) (may potentiate pressor effects of phenylephrine)
- Other sympathomimetics (e.g., other decongestants, appetite suppressants, amphetamines) (additive cardiovascular effects)
Moderate Interactions
- Antihypertensives (phenylephrine may reduce their effect)
- Digoxin (phenylephrine may increase risk of arrhythmias)
- Alcohol and other CNS depressants (additive CNS depression with dextromethorphan)
Minor Interactions
- Not available
Monitoring
Symptom Monitoring
- Effectiveness of cough suppression and decongestion
- Presence of adverse effects (e.g., dizziness, nervousness, insomnia, nausea, vomiting, increased blood pressure, heart rate)
- Signs of allergic reaction (rash, itching, swelling)
- Signs of serotonin syndrome (agitation, confusion, rapid heart rate, sweating, muscle rigidity, tremors)
Special Patient Groups
Pregnancy
Generally considered Category C. Use only if the potential benefit outweighs the potential risk to the fetus. Consult a healthcare provider.
Trimester-Specific Risks:
First Trimester:
Limited data, generally avoided if possible.
Second Trimester:
Use with caution, generally considered safer than first trimester.
Third Trimester:
Use with caution, phenylephrine may cause uterine vasoconstriction.
Lactation
L3 (Moderately Safe). Guaifenesin and Dextromethorphan are generally considered compatible with breastfeeding, but phenylephrine may reduce milk supply and cause infant irritability. Use with caution and monitor infant for adverse effects.
Infant Risk:
Low to moderate risk of irritability, drowsiness, or decreased milk supply (phenylephrine).
Pediatric Use
Not recommended for children under 6 years of age due to potential for serious side effects and lack of proven efficacy. For children 6-12 years, use only with careful dosing and under medical supervision. Always use pediatric-specific formulations and dosing devices.
Geriatric Use
Use with caution due to increased susceptibility to adverse effects, particularly from phenylephrine (e.g., increased blood pressure, CNS stimulation, urinary retention, exacerbation of pre-existing cardiovascular conditions). Start with lower doses and monitor closely.
Clinical Information
Clinical Pearls
- Advise patients to stay well-hydrated to maximize the expectorant effect of guaifenesin.
- Caution patients about potential for drowsiness or dizziness, especially when driving or operating machinery.
- Emphasize the importance of checking other medications for similar ingredients to avoid accidental overdose.
- Warn patients about the risk of serotonin syndrome when combining dextromethorphan with other serotonergic drugs, especially MAOIs.
- Advise patients with hypertension, heart disease, diabetes, thyroid disease, or prostate enlargement to consult a doctor before using due to phenylephrine content.
- This product is for symptomatic relief and does not treat the underlying cause of the cough or congestion.
Alternative Therapies
- Single-ingredient expectorants (e.g., guaifenesin)
- Single-ingredient antitussives (e.g., dextromethorphan)
- Single-ingredient decongestants (e.g., pseudoephedrine, phenylephrine nasal spray)
- Non-pharmacological treatments (e.g., saline nasal spray, humidifiers, honey for cough)
Cost & Coverage
Average Cost:
$10 - $30 per 120-240 mL bottle
Generic Available:
Yes
Insurance Coverage:
OTC (Over-the-Counter), generally not covered by insurance unless prescribed
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.