Diphex

Ammonium Chloride (Diphex) Injection, USP, after dilution in isotonic sodium chloride injection, may be indicated in the treatment of patients with (1) hypochloremic states and (2) metabolic alkalosis.

Chlorobutanol (Diphex) has antibacterial and antifungal properties and it is used at a concentration of 0.5% as a preservative in injections and in eye drops as well as cosmetics.

Chlorobutanol (Diphex) has been used as a mild sedative and local analgesic but other compounds are preferred. It has been used in preparations for inflammatory and painful conditions of the ear and oropharynx.

Diphenhydramine (Diphex) in the injectable form is effective in adults and pediatric patients, other than premature infants and neonates, for the following conditions when Diphenhydramine (Diphex) in the oral form is impractical.

Antihistaminic

For amelioration of allergic reactions to blood or plasma, in anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symptoms have been controlled, and for other uncomplicated allergic conditions of the immediate type when oral therapy is impossible or contraindicated.

Motion sickness

For active treatment of motion sickness.

Antiparkinsonism

For use in parkinsonism, when oral therapy is impossible or contraindicated, as follows: parkinsonism in the elderly who are unable to tolerate more potent agents; mild cases of parkinsonism in other age groups, and in other cases of parkinsonism in combination with centrally acting anticholinergic agents.

Prophylaxis & treatment of cystine & uric acid renal calculi. Urinary alkalizer in gout therapy. Treatment of acidosis in renal tubular disorders; chronic metabolic acidosis resulting from chronic renal insufficiency or the syndrome of renal tubular acidosis especially when administration of K salts is contraindicated. Prophylactic agent for acid-aspiration pneumonitis. Used in pre-anaesth medication as a non-particulate acid-neutralizing buffer of gastric acid to lessen the danger from acid-aspiration pneumonitis.

Diphenhydramine (Diphex) is an antihistamine. Diphenhydramine (Diphex) blocks the effects of the naturally occurring chemical histamine in the body.

Diphenhydramine (Diphex) is used to treat sneezing; runny nose; itching, watery eyes; hives; rashes; itching; and other symptoms of allergies and the common cold.

Diphenhydramine (Diphex) is also used to suppress coughs, to treat motion sickness, to induce sleep, and to treat mild forms of Parkinson's disease.

Diphenhydramine (Diphex) may also be used for purposes other than those listed in this medication guide.

Citric acid and Sodium Citrate (Diphex) are both alkalinizing agents that make the urine less acidic.

The combination of citric acid and Sodium Citrate (Diphex) is used to prevent gout or kidney stones, or metabolic acidosis in people with kidney problems.

Citric acid and Sodium Citrate (Diphex) may also be used for other purposes not listed in this medication guide.

Ammonium Chloride (Diphex) Injection, USP is administered intravenously and must be diluted before use. Solutions for intravenous infusion should not exceed a concentration of 1% to 2% of Ammonium Chloride (Diphex).

Dosage is dependent upon the condition and tolerance of the patient. It is recommended that the contents of one to two vials (100 to 200 mEq) be added to 500 or 1000 mL of isotonic (0.9%) sodium chloride injection. The rate of intravenous infusion should not exceed 5 mL per minute in adults (approximately 3 hours for infusion of 1000 mL). Dosage should be monitored by repeated serum bicarbonate determinations.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.

Usual Adult Dose for Insomnia

Note: Acetaminophen-Diphenhydramine (Diphex) is generally dosed based on the Diphenhydramine (Diphex) component to equal 50 mg of Diphenhydramine (Diphex) (76 mg Diphenhydramine (Diphex) citrate) at bedtime.

Acetaminophen-Diphenhydramine (Diphex) comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Usual Adult Dose for Pain

Note: Acetaminophen-Diphenhydramine (Diphex) is generally dosed based on the Diphenhydramine (Diphex) component to equal 50 mg of Diphenhydramine (Diphex) (76 mg Diphenhydramine (Diphex) citrate) at bedtime.

Acetaminophen-Diphenhydramine (Diphex) comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Usual Adult Dose for Headache

Note: Acetaminophen-Diphenhydramine (Diphex) is generally dosed based on the Diphenhydramine (Diphex) component to equal 50 mg of Diphenhydramine (Diphex) (76 mg Diphenhydramine (Diphex) citrate) at bedtime.

Acetaminophen-Diphenhydramine (Diphex) comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Usual Pediatric Dose for Insomnia

Greater than or equal to 12 years:

Note: Acetaminophen-Diphenhydramine (Diphex) is generally dosed based on the Diphenhydramine (Diphex) component to equal 50 mg of Diphenhydramine (Diphex) (76 mg Diphenhydramine (Diphex) citrate) at bedtime.

Acetaminophen-Diphenhydramine (Diphex) comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Usual Pediatric Dose for Pain

Greater than or equal to 12 years:

Note: Acetaminophen-Diphenhydramine (Diphex) is generally dosed based on the Diphenhydramine (Diphex) component to equal 50 mg of Diphenhydramine (Diphex) (76 mg Diphenhydramine (Diphex) citrate) at bedtime.

Acetaminophen-Diphenhydramine (Diphex) comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Usual Pediatric Dose for Headache

Greater than or equal to 12 years:

Note: Acetaminophen-Diphenhydramine (Diphex) is generally dosed based on the Diphenhydramine (Diphex) component to equal 50 mg of Diphenhydramine (Diphex) (76 mg Diphenhydramine (Diphex) citrate) at bedtime.

Acetaminophen-Diphenhydramine (Diphex) comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Use with caution in patients with liver disease. Chronic use of acetaminophen is not recommended in patients with liver disease.

Precautions

Patients who consume three or more alcohol containing drinks per day should be informed to consult with their physician for advice on when and how to take acetaminophen. Chronic, heavy alcohol users may be at increased risk of liver damage when taking more than recommended dosages.

Patients and adults taking care of children should be advised to consult with their doctor before continuing to use acetaminophen if symptoms of illness worsen. Although rare, there is the possibility of acetaminophen intoxication on chronic use of the drug, and the symptoms seen during the first phase of intoxication (nausea, vomiting, anorexia, malaise, and diaphoresis) may trigger the use of more doses.

Patients should be warned of the sedative effects of Diphenhydramine (Diphex), and advised not to take this drug with alcohol.

Due to the anticholinergic effect of Diphenhydramine (Diphex), it should be used with caution in patients with narrow-angle glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction, prostatic hypertrophy or bladder neck obstructions. It should also be used with caution in patients with increased intraocular pressure, hyperthyroidism, cardiovascular disease, or hypertension.

Dialysis

Data not available

Adult: Add the contents of 1-2 sachets to a glass of cool water and mix. Sodium Citrate (Diphex) may be taken up to 4 times daily. Do not take for >5 days unless advised to do so by the physician.

Ammonium Chloride (Diphex) is contraindicated in patients with severe impairment of renal or hepatic function.

Ammonium Chloride (Diphex) should not be administered when metabolic alkalosis due to vomiting of hydrochloric acid is accompanied by loss of sodium (excretion of sodium bicarbonate in the urine).

Not recommended for children under 3 months of age

See also:
What is the most important information I should know about Diphenhydramine (Diphex)?

Hypersensitivity to Diphenhydramine (Diphex), other structurally related antihistamines, or any component of the formulation; neonates or premature infants; breast-feeding

Additional contraindications:

Parenteral: Use as a local anesthetic

OTC labeling: When used for self-medication, do not use in children <6 years, to make a child sleep, or with any other Diphenhydramine (Diphex)-containing products (including topical products)

See also:
What is the most important information I should know about Sodium Citrate (Diphex)?

Renal failure or hypernatremia; in conjunction with hexamine mandelate or hexamine hippurate therapy because an acidic urine is needed.

Caution is advised in overt and occult cardiac failure. Concomitant use of urinary alkalinizers and quinolone antibiotics should be avoided. Crystalluria may be more likely to occur in alkaline urine.

Use Diphenhydramine (Diphex) orally disintegrating strips as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Diphenhydramine (Diphex) orally disintegrating strips by mouth with or without food.
• Do not remove the strip from the pouch until you are ready to take Diphenhydramine (Diphex) orally disintegrating strips. Make sure that your hands are dry when you open Diphenhydramine (Diphex) orally disintegrating strips. Remove and place the strip on the tongue. The strip dissolves quickly (and it can be swallowed with saliva). Diphenhydramine (Diphex) orally disintegrating strips may be taken with or without water. Take the strip immediately after opening the pouch. Do not store the strip for future use.
• Use Diphenhydramine (Diphex) orally disintegrating strips exactly as directed on the package, unless instructed differently by your doctor. If you are taking Diphenhydramine (Diphex) orally disintegrating strips without a prescription, follow any warnings and precautions on the label.
• If you miss a dose of Diphenhydramine (Diphex) orally disintegrating strips and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Diphenhydramine (Diphex) orally disintegrating strips.

Use Sodium Citrate (Diphex) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Sodium Citrate (Diphex) after meals and at bedtime, unless directed otherwise by your health care provider.
• Shake well before using.
• Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.
• Mix Sodium Citrate (Diphex) with water before swallowing. Follow with additional water, if desired.
• If you miss a dose of Sodium Citrate (Diphex), take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Sodium Citrate (Diphex).

Ammonium Chloride (Diphex) is used for the relief of cough in the form of cough expectorant. It is also used as an injection to treat patients with hypochloremia and metabolic alkalosis.

Diphenhydramine (Diphex) is an antihistamine used to relieve symptoms of allergy, hay fever, and the common cold. These symptoms include rash, itching, watery eyes, itchy eyes/nose/throat, cough, runny nose, and sneezing. It is also used to prevent and treat nausea, vomiting and dizziness caused by motion sickness. Diphenhydramine (Diphex) can also be used to help you relax and fall asleep.

This medication works by blocking a certain natural substance (histamine) that your body makes during an allergic reaction. Its drying effects on such symptoms as watery eyes and runny nose are caused by blocking another natural substance made by your body (acetylcholine).

Cough-and-cold products have not been shown to be safe or effective in children younger than 6 years. Therefore, do not use this product to treat cold symptoms in children younger than 6 years unless specifically directed by the doctor. Some products (such as long-acting tablets/capsules) are not recommended for use in children younger than 12 years. Ask your doctor or pharmacist for more details about using your product safely.

These products do not cure or shorten the length of the common cold and may cause serious side effects. To decrease the risk for serious side effects, carefully follow all dosage directions. Do not use this product to make a child sleepy. Do not give other cough-and-cold medication that might contain the same or similar ingredients. Ask the doctor or pharmacist about other ways to relieve cough and cold symptoms (such as drinking enough fluids, using a humidifier or saline nose drops/spray).

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

Diphenhydramine (Diphex) is also used alone or with other medications to treat shaking (tremor) and muscle stiffness caused by Parkinson's disease. It may also be used to treat side effects of certain psychiatric drugs such as involuntary movements and muscle stiffness (such as EPS). It works by blocking acetylcholine.

How to use Diphenhydramine (Diphex)

Follow all directions on the product package. If your doctor has prescribed this medication, take it as directed. If you are uncertain about any of the information, consult your doctor or pharmacist.

Take the tablet, capsule, or liquid form by mouth with or without food. Measure liquid forms of this medication using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. If you have a single-dose form of this medication (such as a single-use whistle), you do not need to measure the dose.

The rapidly-dissolving tablet or strip should be allowed to dissolve on the tongue and then swallowed, with or without water. The chewable tablets should be chewed thoroughly before being swallowed.

The dosage is based on your age, medical condition, and response to treatment. There are many brands and forms of Diphenhydramine (Diphex) available. Read the dosing instructions carefully for each product because the amount of Diphenhydramine (Diphex) may be different between products. Do not increase your dose or take this medication more often than directed.

To prevent motion sickness, take your dose 30 minutes before starting activity such as travel. To help you sleep, take your dose about 30 minutes before bedtime. If you continue to have difficulty sleeping for longer than 2 weeks, contact your doctor.

Tell your doctor if your condition does not improve or if it worsens.

Use: Labeled Indications

Anticoagulant:

Concentrate (triCitrasol): Anticoagulant used in granulocytapheresis procedures

Solution: Anticoagulant for use with cytapheresis device only

Off Label Uses

Regional anticoagulation for continuous renal replacement therapy circuit

Data from several small randomized, controlled trials support the use of regional Sodium Citrate (Diphex) to reduce the risk of clot formation in continuous renal replacement therapy (CRRT) circuits, thus prolonging circuit life and avoiding interruptions in therapy. It should be noted that patients with high bleeding risk, severe coagulopathy, metabolic abnormalities, or liver dysfunction were excluded from these trials.

In a treatment, patients should be monitored closely for signs of ammonia poisoning: pallor, sweating, irregular breathing, vomiting, bradycardia, arrhythmias, tremors, convulsions and coma.

Ammonium Chloride (Diphex) should be used with caution in patients with heart and lung failure.

A longer-term correction of a hypochloraemia in patients with secondary metabolic alkalosis due to an intracellular potassium depletion can not be achieved by the sole administration of Ammonium Chloride (Diphex). Concomitant administration of potassium is also necessary.

See also:
What other drugs will affect Diphenhydramine (Diphex)?

Most reports of clinically significant drug interactions occurring with the barbiturates have involved phenobarbital

1. Anticoagulants: Diphenhydramine (Diphex) lowers the plasma levels of dicumarol (name previously used: bishydorxycoumarin) and causes a decrease in anticoagulant activity as measured by the prothrombin time. Diphenhydramine (Diphex) can induce hepatic microsomal enzymes resulting in increased metabolism and decreased anticoagulant response of oral anticoagulants (e.g., warfarin, acenocournarol, dicumarol, and phenprocoumon). Patients stabilized on anticoagulant therapy may require dosage adjustments if phenobarbital is added to or withdrawn from their dosage regimen

2. Corticosteroids: Diphenhydramine (Diphex) appears to enhance the metabolism of exogenous corticosteroids probably through the induction of hepatic microsomal enzymes. Patients stabilized on corticosteroid therapy may require dosage adjustments if phenobarbital is added to or withdrawn from their dosage regimen.

3. Griseofulvin: Diphenhydramine (Diphex) appears to interfere with the absorption of orally administered griseofulvin, thus decreasing its blood level. The effect of the resultant decreased blood levels of griseofulvin on therapeutic response has not been established. However, it would be preferable to avoid concomitant administration of these drugs.

4. Doxycycline: Diphenhydramine (Diphex) has been shown to shorten the half- life of doxycycline for as long as 2 weeks after barbiturate therapy is discontinued. This mechanism is probably through the induction of hepatic microsomal enzymes that metabolize the antibiotic. If phenobarbital and doxycycline are administered concurrently, the clinical response to doxycycline should be monitored closely

5. Phenytoin, sodium valproate, valproic acid: The effect of phenobarbital on the metabolism of phenytoin appears to be variable. Some investigators report an accelerating effect, while others report no effect. Because the effect of phenobarbital on the metabolism of phenytoin is not predictable, phenytoin and phenobarbital blood levels should be monitored more frequently if these drugs are given concurrently. Sodium valproate and valproic acid appear to decrease phenobarbital metabolism; therefore, phenobarbital blood levels should be monitored and appropriate dosage adjustments made as indicated.

6. Central nervous system depressants: The concomitant use of other central nervous system depressants including other sedatives or hypnotics, antihistamines, tranquilizers, or alcohol, may produce additive depressant effects

7. Monoamine oxidase inhibitors (MAOIs): MAOIs prolong the effects of phenobarbital probably because metabolism of the phenobarbital is inhibited.

8. Estradiol, estrone, progesterone and other steroidal hormones: Pretreatment with or concurrent administration of phenobarbital may decrease the effect of estradiol by increasing its metabolism. There have been reports of patients treated with antiepileptic drugs (e.g., phenobarbital) who became pregnant while taking oral contraceptives. An alternate contraceptive method might be suggested to women taking phenobarbital.

See also:
What other drugs will affect Sodium Citrate (Diphex)?

General: Alkalinization of the urine due to the use of Sodium Citrate (Diphex), theoretically, may result in a decreased therapeutic effect of the following medications: Chlorpropamide, lithium, salicylates and tetracyclines. Alternatively, alkalinization of the urine due to the use of Sodium Citrate (Diphex), theoretically, may result in an increased therapeutic effect of the following medications: Amphetamines, ephedrine/pseudoephedrine.

Antacids: Concurrent use of antacids with citrates may result in systemic alkalosis. Concomitant administration of antacids with Sodium Citrate (Diphex) and sodium bicarbonate may promote the development of calcium stones in patients with uric acid stones and may also cause hypernatremia. Concurrent use of aluminum-containing antacids with citrate salts can increase aluminum absorption, possibly resulting in acute aluminum toxicity, especially in patients with renal insufficiency.

Quinolones: Citrates may reduce the solubility of ciprofloxacin, norfloxacin or ofloxacin in the urine. Patients should be observed for signs of crystalluria and nephrotoxicity.

Laxatives: Concurrent administration of citrates with laxatives may have an additive effect.

See also:
What are the possible side effects of Ammonium Chloride (Diphex)?

Rapid intravenous administration of Ammonium Chloride (Diphex) may be accompanied by pain or irritation at the site of injection or along the venous route.

Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation and hypervolemia (from large volume diluent).

If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and save the remainder of the fluid for examination if deemed necessary.

Hypersensitivity reactions to the individual ingredients could occur.

See also:
What are the possible side effects of Diphenhydramine (Diphex)?

Applies to acetaminophen / Diphenhydramine (Diphex): tablets

Other dosage forms:

• capsules, tablets

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; diarrhea; dizziness; drowsiness; dry mouth, nose, or throat; excitability; headache; loss of appetite; nausea; nervousness or anxiety; upset stomach; vomiting; weakness.

Seek medical attention right away if any of these SEVERE side effects occur while taking acetaminophen / Diphenhydramine (Diphex):

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); dark urine or pale stools; difficulty urinating or inability to urinate; fast or irregular heartbeat; hallucinations; seizures; severe dizziness, drowsiness, lightheadedness, or headache; severe or persistent loss of appetite; stomach pain; tremor; trouble sleeping; unusual fatigue; vision changes; yellowing of the skin or eyes.

See also:
What are the possible side effects of Sodium Citrate (Diphex)?

The tartrate component of Sodium Citrate (Diphex) may be incompletely absorbed. Because of this Sodium Citrate (Diphex) may be exert a mild laxative effect. Prolonged and excessive use may cause a systemic alkolosis and / or hypernatremia.

Diphenhydramine (Diphex) is used to treat hypertension and edema. Like other thiazides, benzthiazide promotes water loss from the body (diuretics). They inhibit Na+/Cl- reabsorption from the distal convoluted tubules in the kidneys. Thiazides also cause loss of potassium and an increase in serum uric acid. Thiazides are often used to treat hypertension, but their hypotensive effects are not necessarily due to their diuretic activity. Thiazides have been shown to prevent hypertension-related morbidity and mortality although the mechanism is not fully understood. Thiazides cause vasodilation by activating calcium-activated potassium channels (large conductance) in vascular smooth muscles and inhibiting various carbonic anhydrases in vascular tissue.

Each 4 g of Sodium Citrate (Diphex) contains sodium bicarbonate 1760 mg, anhydrous Sodium Citrate (Diphex) 630 mg, anhydrous citric acid 720 mg and tartaric acid 890 mg.

It also contains the following excipients: Nature identical lemon flavor oil, terpeneless and sodium saccharin.

Sodium Citrate (Diphex) consists of formulation and pleasantly flavored granules. When added to water, Sodium Citrate (Diphex) effervesces and dissolves, forming a clear or orange-colored alkaline solution.