Medical term:

carbinoxamine

[kahr″bĭ-nok´sah-mēn]

an antihistamine with sedative and anticholinergic effects; used as the maleate salt in the treatment of nasal, eye, and skin manifestations of allergic reactions, including allergic rhinitis, conjunctivitis, and itching, and also as an ingredient in some cough and cold preparations, administered orally.

carbinoxamine

(car-bi-nox-a-meen) ,

Karbinal ER

(trade name)

Classification

Therapeutic: allergy cold cough remedies
Pharmacologic: antihistamines

Pregnancy Category: C

Indications

Relief of allergic symptoms caused by histamine release including seasonal/perennial allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis (due to inhalant allergens or foods), mild/uncomplicated allergic skin conditions (urticaria or angioedema), dermatographism, as adjunctive management (with epinephrine and other standard acute treatments) of anaphylaxis, and to decrease severity of allergic reactions to blood/plasma

Action

Antagonizes the effects of histamine at H₁–receptor sites; does not bind to or inactivate histamine. Significant CNS depressant and anticholinergic properties.

Therapeutic effects

Decreased symptoms of histamine excess (sneezing, rhinorrhea, nasal/ocular pruritus, ocular tearing/redness and skin itching/urticaria).

Pharmacokinetics

Absorption: Well absorbed following oral administration

Distribution: Unk

Metabolism and Excretion: Extensively metabolized by the liver, inactive metabolites excreted in urine. Negligable renal elimination of unchanged drug.

Half-life: 17 hr

Time/action profile (antihistaminic effects)

ROUTE	ONSET	PEAK	DURATION
PO	unk	6.7 hr	12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity, including sulfite allergy; Lactation: Avoid if breast-feeding (risk of death in infant); Concurrent use of MAOIs; Pediatric: Children < 2 yr (deaths have been reported).

Use Cautiously in: Increased intraocular pressure or narrow angle glaucoma; Hyperthyroidism; Cardiovascular disease including hypertension; Stenosing peptic ulcer or pyloroduodenal obstruction; Symptomatic prostatic hypertrophy or bladder neck obstruction; Geriatric: Elderly may be more susceptible to adverse reactions; Obstetric: Use in pregnancy only if clearly needed; Pediatric: Younger children may be more sensitive to sedation or excitation.

Adverse Reactions/Side Effects

Central nervous system

dizziness (most frequent)
drowsiness (most frequent)
sedation (most frequent)

Respiratory

thickened bronchial secretions (most frequent)

Gastrointestinal

epigastric distress (most frequent)

Neurologic

disturbed coordination (most frequent)

Interactions

Drug-Drug interaction

Concurrent use with MAOIs may ↑ anticholinergic effects.↑ risk of CNS depression with other CNS depressants including alcohol, other antihistamines , opioid analgesics and sedative/hypnotics.

Route/Dosage

Use appropriate measuring device

Oral (Adults and Children ≥ 12 yr) 6–16 mg (7.5–20 mL) every 12 hr

Oral (Children 2–11 yr) 0.2–0.4 mg/kg/day in divided doses every 12 hr; Children 6–11 yr—6–12 mg (7.5–15 mL) every 12 hr; Children 4–5 yr—3–8 mg (3.75–10 mL) every 12 hr ; Children 2–3 yr—3–4 mg (3.75–5 mL) every 12 hr.

Availability

Extended-release oral suspension (contains metabisulfite)strawberry banana: 4 mg/5 mL

Nursing implications

Nursing assessment

Assess allergy symptoms (rhinitis, conjunctivitis, hives) before and periodically during therapy
Assess lung sounds and character of bronchial secretions. Maintain fluid intake of 1500–2000 mL/day to decrease viscosity of secretions
Lab Test Considerations: May case ↑ uric acid levels.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Risk for injury (Adverse Reactions)

Implementation

Begin with lowest dose and increase as needed and tolerated. Dose is based on condition severity and patient response.
Oral: Administer twice daily.
- Use a calibrated measuring device for accurate dose; household tablespoon is not accurate and could lead to overdose.

Patient/Family Teaching

Instruct patient to take medication as directed
May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known
Advise patient to avoid taking alcohol or other CNS depressants concurrently with this drug
Advise patient that good oral hygiene, frequent rinsing of mouth with water, and sugarless gum or candy may minimize dry mouth. Patient should notify dentist if dry mouth persists >2 wk
Instruct female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Decrease in allergic symptoms

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