Vanacof Liquid
It is used to treat nose stuffiness.It is used to ease allergy signs.It is used to relieve coughing.
Drug Class
Antitussive, Antihistamine, Decongestant
Pharmacologic Class
Non-opioid antitussive; H1-receptor antagonist, alkylamine; Alpha-adrenergic agonist, sympathomimetic
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled (Pseudoephedrine is regulated under the Combat Methamphetamine Epidemic Act, but not DEA scheduled as a controlled substance)
Overview
What is this medicine?
Vanacof Liquid is a medication used to relieve symptoms of the common cold, allergies, or other respiratory illnesses. It contains a cough suppressant (chlophedianol) to help stop coughing, an antihistamine (dexchlorpheniramine) to reduce sneezing, runny nose, and watery eyes, and a decongestant (pseudoephedrine) to clear stuffy nose and sinuses.
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 any 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 dose, skip the missed dose and resume your regular 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 any 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 dose, skip the missed dose and resume your regular 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
- Do not drive or operate heavy machinery until you know how this medication affects you, as it may cause drowsiness or dizziness.
- Avoid alcohol and other CNS depressants while taking this medication, as they can increase drowsiness and other side effects.
- Drink plenty of fluids to help thin mucus and soothe your throat.
- Do not exceed the recommended dose or frequency. Overdosing can lead to serious side effects.
- Inform your doctor or pharmacist about all other medications you are taking, including over-the-counter drugs, vitamins, and herbal supplements, especially MAOIs, blood pressure medications, or other cold/allergy medicines.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
Typically 5 mL (one teaspoonful) every 4 to 6 hours as needed, not to exceed 30 mL in 24 hours. (Based on common concentrations: Chlophedianol 12.5 mg, Dexchlorpheniramine 2 mg, Pseudoephedrine 30 mg per 5 mL)
Dose Range:
5 - 30 mg
Condition-Specific Dosing:
max_daily_dose:
30 mL (6 doses) in 24 hours
Pediatric Dosing
Neonatal:
Not established (Contraindicated in infants under 2 years)
Infant:
Not established (Contraindicated in infants under 2 years)
Child:
6 to under 12 years: 2.5 mL every 4 to 6 hours as needed, not to exceed 15 mL in 24 hours. (Use with caution and under medical supervision, especially for children under 6 years due to risk of serious side effects).
Adolescent:
12 years and older: 5 mL every 4 to 6 hours as needed, not to exceed 30 mL in 24 hours.
Dose Adjustments
Renal Impairment:
Mild:
Adjustment may be considered; monitor for increased side effects.
Moderate:
Reduce dose by 50% or extend dosing interval; monitor for increased side effects.
Severe:
Contraindicated or significant dose reduction (e.g., 75%) and extended interval; consult nephrologist. Pseudoephedrine and antihistamines are primarily renally eliminated.
Dialysis:
Not well studied; generally avoid or use with extreme caution and significant dose reduction. Pseudoephedrine is dialyzable to some extent.
Hepatic Impairment:
Mild:
Adjustment may be considered; monitor for increased side effects.
Moderate:
Use with caution; consider dose reduction (e.g., 25-50%) due to metabolism of components.
Severe:
Use with extreme caution or avoid; significant dose reduction required due to impaired metabolism and clearance of all components.
Confidence:
Medium
Pharmacology
Mechanism of Action
Chlophedianol is a centrally acting non-opioid antitussive that suppresses the cough reflex by acting on the cough center in the medulla oblongata. Dexchlorpheniramine is an alkylamine antihistamine that competitively antagonizes H1-receptors, thereby reducing histamine-mediated effects such as sneezing, rhinorrhea, and watery eyes. It also possesses anticholinergic properties, contributing to its drying effects. Pseudoephedrine is a sympathomimetic amine that acts directly and indirectly on alpha-adrenergic receptors in the respiratory mucosa, causing vasoconstriction, which reduces swelling and congestion.
Pharmacokinetics
Absorption:
Bioavailability:
High (well absorbed orally for all components)
Tmax:
Chlophedianol: ~2-4 hours; Dexchlorpheniramine: ~2-6 hours; Pseudoephedrine: ~0.5-2 hours
FoodEffect:
Minimal or no significant effect on absorption rate or extent for most components.
Distribution:
Vd:
Chlophedianol: Not well established; Dexchlorpheniramine: ~1-10 L/kg; Pseudoephedrine: ~2.6-3.5 L/kg
ProteinBinding:
Chlophedianol: Not well established; Dexchlorpheniramine: ~72%; Pseudoephedrine: Minimal (~10%)
CnssPenetration:
Dexchlorpheniramine: Yes (causes sedation); Chlophedianol: Yes (central action); Pseudoephedrine: Limited (less than ephedrine, but can cause CNS stimulation)
Elimination:
HalfLife:
Chlophedianol: ~20-30 hours; Dexchlorpheniramine: ~12-15 hours; Pseudoephedrine: ~4-9 hours (pH dependent)
Clearance:
Not well established for combination; varies by component
ExcretionRoute:
Renal (primarily for pseudoephedrine and metabolites; significant renal excretion for dexchlorpheniramine and chlophedianol metabolites)
Unchanged:
Pseudoephedrine: ~50-90% (pH dependent); Dexchlorpheniramine: <1%; Chlophedianol: Minimal
Pharmacodynamics
OnsetOfAction:
Within 30-60 minutes for symptomatic relief
PeakEffect:
1-4 hours
DurationOfAction:
4-6 hours (due to pseudoephedrine and dexchlorpheniramine half-lives, though chlophedianol has a longer half-life, its clinical effect duration in combination is often limited by other components)
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Attention Immediately
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice 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 or dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Fast heartbeat
Shakiness
Other Possible Side Effects
Like all medications, this drug can cause side effects. However, many people do not experience any side effects or only have mild ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor or seek medical help:
Feeling dizzy or sleepy
Feeling nervous and excitable
Trouble sleeping
Note: This is not an exhaustive list of all possible side effects. If you have questions or concerns 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. If you notice 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 or dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Fast heartbeat
Shakiness
Other Possible Side Effects
Like all medications, this drug can cause side effects. However, many people do not experience any side effects or only have mild ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor or seek medical help:
Feeling dizzy or sleepy
Feeling nervous and excitable
Trouble sleeping
Note: This is not an exhaustive list of all possible side effects. If you have questions or concerns 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.
- Extreme nervousness, restlessness, or insomnia.
- Fast, pounding, or irregular heartbeat (palpitations).
- Chest pain.
- Severe headache.
- Difficulty urinating.
- Blurred vision.
- Hallucinations or unusual thoughts/behavior.
- Skin rash or itching.
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 you experienced, including any symptoms that occurred.
If you have a cough that produces a significant amount of mucus, a chronic 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) drugs
Natural products
* Vitamins
Additionally, inform them about 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 you experienced, including any symptoms that occurred.
If you have a cough that produces a significant amount of mucus, a chronic 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) drugs
Natural products
* Vitamins
Additionally, inform them about 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. Taking more than the recommended amount can increase your chances of experiencing adverse effects. Additionally, do not take this medication for a longer duration than specified by your doctor.
Until you understand how this medication affects you, it is crucial to avoid operating a vehicle, performing tasks, or engaging in activities that require alertness. It is also recommended to refrain from consuming alcohol while taking this drug.
Before using marijuana, other forms of cannabis, or any prescription or over-the-counter (OTC) medications that may cause drowsiness or slow your reactions, consult with your doctor to discuss potential interactions.
When administering this medication to a child, exercise caution, as children may have a higher risk of experiencing excitability.
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 make an informed decision.
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 duration than specified by your doctor.
Until you understand how this medication affects you, it is crucial to avoid operating a vehicle, performing tasks, or engaging in activities that require alertness. It is also recommended to refrain from consuming alcohol while taking this drug.
Before using marijuana, other forms of cannabis, or any prescription or over-the-counter (OTC) medications that may cause drowsiness or slow your reactions, consult with your doctor to discuss potential interactions.
When administering this medication to a child, exercise caution, as children may have a higher risk of experiencing excitability.
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 make an informed decision.
Overdose Information
Overdose Symptoms:
- Severe drowsiness or coma (antihistamine/antitussive)
- Severe nervousness, restlessness, tremors, seizures (pseudoephedrine)
- Rapid heart rate, irregular heartbeat, high blood pressure (pseudoephedrine)
- Dilated pupils, dry mouth, flushed skin, fever (anticholinergic effects)
- Nausea, vomiting
- Respiratory depression
What to Do:
Seek immediate medical attention or call Poison Control at 1-800-222-1222. Treatment is supportive and symptomatic, potentially including activated charcoal, gastric lavage, benzodiazepines for seizures, and cardiovascular support.
Drug Interactions
Contraindicated Interactions
- Monoamine Oxidase Inhibitors (MAOIs) (concurrent use or within 14 days of stopping MAOIs due to risk of hypertensive crisis with pseudoephedrine and prolonged/intensified anticholinergic effects with dexchlorpheniramine)
- Other sympathomimetics (e.g., other decongestants, appetite suppressants, amphetamines) due to additive cardiovascular effects
Major Interactions
- CNS Depressants (e.g., alcohol, sedatives, hypnotics, anxiolytics, opioids, tricyclic antidepressants, antipsychotics) - increased sedation and CNS depression due to dexchlorpheniramine and chlophedianol.
- Antihypertensives (e.g., beta-blockers, methyldopa, reserpine, guanethidine) - pseudoephedrine may reduce the hypotensive effects.
- Digitalis glycosides - increased risk of ectopic pacemaker activity with pseudoephedrine.
- Ergot alkaloids (e.g., ergotamine, dihydroergotamine) - increased risk of vasoconstriction with pseudoephedrine.
Moderate Interactions
- Anticholinergics (e.g., atropine, benztropine, some antipsychotics) - additive anticholinergic effects (dry mouth, urinary retention, blurred vision) due to dexchlorpheniramine.
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) - may increase dexchlorpheniramine levels.
- Urinary acidifiers (e.g., ammonium chloride) - may increase pseudoephedrine excretion, reducing its effect.
- Urinary alkalinizers (e.g., sodium bicarbonate) - may decrease pseudoephedrine excretion, increasing its effect.
Minor Interactions
- None commonly cited for significant clinical impact beyond moderate interactions.
Monitoring
Baseline Monitoring
Patient medical history (especially cardiovascular disease, hypertension, diabetes, thyroid disorders, glaucoma, prostatic hypertrophy, asthma)
Rationale: To identify contraindications or conditions requiring caution due to sympathomimetic and anticholinergic effects.
Timing: Prior to initiation
Current medication list
Rationale: To identify potential drug interactions, especially with MAOIs, CNS depressants, and antihypertensives.
Timing: Prior to initiation
Routine Monitoring
Symptom relief (cough, congestion, sneezing)
Frequency: Daily, as needed
Target: Improved or resolved symptoms
Action Threshold: Lack of improvement or worsening symptoms after 7 days (or 5 days for children) warrants medical re-evaluation.
Adverse effects (e.g., drowsiness, dizziness, nervousness, insomnia, dry mouth, urinary retention, palpitations)
Frequency: Daily, as needed
Target: Absence or mild, tolerable side effects
Action Threshold: Severe or persistent side effects, or new onset of concerning symptoms (e.g., chest pain, severe headache, hallucinations) require immediate medical attention and discontinuation.
Symptom Monitoring
- Effectiveness in reducing cough, nasal congestion, and allergic symptoms.
- Signs of CNS depression (drowsiness, impaired coordination, dizziness).
- Signs of CNS stimulation (nervousness, restlessness, insomnia, tremors, anxiety, hallucinations).
- Anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation).
- Cardiovascular effects (palpitations, tachycardia, increased blood pressure, chest pain).
- Gastrointestinal upset (nausea, vomiting).
Special Patient Groups
Pregnancy
Category C. Use only if the potential benefit justifies the potential risk to the fetus. Pseudoephedrine and antihistamines have been associated with potential risks in some studies, particularly in the first trimester (e.g., gastroschisis with pseudoephedrine, though data is conflicting). Chlophedianol data is limited.
Trimester-Specific Risks:
First Trimester:
Pseudoephedrine: Possible association with gastroschisis (abdominal wall defect), though overall risk is low and data is conflicting. Antihistamines: Generally considered low risk, but some older antihistamines have limited data.
Second Trimester:
Generally considered safer than first trimester, but use only if clearly needed.
Third Trimester:
Pseudoephedrine: Risk of maternal hypertension and reduced uterine blood flow. Antihistamines: May cause irritability or sedation in the neonate if used close to delivery. Avoid use near term.
Lactation
L3 (Moderate Risk). Not recommended. All components are excreted into breast milk. Pseudoephedrine can reduce milk supply. Dexchlorpheniramine can cause drowsiness, irritability, or anticholinergic effects in the infant and may also reduce milk supply. Chlophedianol data is limited but likely excreted.
Infant Risk:
Irritability, drowsiness, anticholinergic effects (e.g., dry mouth, constipation), potential for CNS stimulation (pseudoephedrine), reduced milk supply.
Pediatric Use
Contraindicated in children under 2 years of age due to risk of serious and life-threatening adverse events (e.g., respiratory depression, seizures). Use with extreme caution and only under medical supervision for children 2 to under 6 years. For children 6 years and older, use appropriate pediatric dosing and monitor closely for side effects. Always use a calibrated measuring device.
Geriatric Use
Use with caution. Elderly patients are more susceptible to the anticholinergic effects (e.g., urinary retention, constipation, confusion, blurred vision) and sympathomimetic effects (e.g., hypertension, tachycardia, CNS stimulation) of the components. Start with lower doses and monitor closely.
Clinical Information
Clinical Pearls
- This is a combination product; ensure patients are not taking other medications containing similar ingredients (e.g., other decongestants, antihistamines, or cough suppressants) to avoid overdose.
- Advise patients about potential for drowsiness and to avoid activities requiring mental alertness until effects are known.
- Counsel patients on the importance of hydration to help with mucus clearance.
- Pseudoephedrine can cause CNS stimulation (insomnia, nervousness); advise patients to avoid taking doses close to bedtime.
- Due to pseudoephedrine content, this product may be subject to purchase restrictions in some regions.
- Patients with underlying conditions such as hypertension, heart disease, diabetes, thyroid disorders, glaucoma, or prostatic hypertrophy should consult a physician before use due to the pseudoephedrine and anticholinergic components.
Alternative Therapies
- Single-ingredient antitussives (e.g., dextromethorphan, guaifenesin)
- Single-ingredient antihistamines (e.g., loratadine, fexofenadine, cetirizine for non-sedating options; diphenhydramine for sedating)
- Single-ingredient decongestants (e.g., pseudoephedrine, phenylephrine)
- Nasal saline sprays for congestion
- Humidifiers for cough and congestion
- Non-pharmacological measures for cold/allergy symptoms
Cost & Coverage
Average Cost:
Not available (varies widely by pharmacy, formulation, and insurance) per 120 mL bottle
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (often covered as a generic prescription or OTC if 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, including the amount taken and the time it happened, to ensure you receive the best possible care.