Advil Cold and Sinus Plus is a combination of Ibuprofen, Pseudoephedrine, and Chlorpheniramine. It acts to relieve pain, inflammation, congestion, and other allergic symptoms in patients with common cold and hay fever.

Uses:

• Symptoms of the common cold, hay fever, or other respiratory allergies are momentarily relieved by it.

Dose in Adults:

Dose for Common cold, hay fever, respiratory allergies:

• While symptoms last, it can be taken orally as one caplet every four to six hours.
• The maximum that can be given is 6 caplets in 24 hours.
• A treatment regimen of more than 10 days is not advised unless prescribed by a medical professional.

Dose in Children:

Refer to adults dosing.

Pregnancy Risk Category: C/D

• See individual agents (Ibuprofen, pseudoephedrine, and chlorpheniramine)

Use during breastfeeding:

• See individual agents (Ibuprofen, pseudoephedrine, and chlorpheniramine)

Dose in Renal Disease:

Avoid in advanced kidney disease.

Dose in Liver disease:

See individuals agents. NSAIDs should generally be avoided in advanced liver disease because of the risks of gastrointestinal bleeding, hepatorenal syndrome, and fluid retention.

Side effects:

See individual agents.

Contraindications:

• Hypersensitivity to ibuprofen or pseudoephedrine, as well as any component of the formulation is contraindicated.
• It is also not recommended to use it with or within two weeks of MAO inhibitors (MAOI) the last dosage. 
• This drug should not be administered before or after coronary bypass surgery (CABG).

Warnings and precautions

• Anaphylactoid reactions

  • An anaphylactoid reaction can occur even if there was no prior exposure. 
  • Patients who have "Samter's Trilogy" (rhinitis, aspirin intolerance, and bronchial asthma) may be at greater risk.
  • Use with caution in patients who have previously had aspirin or NSAID therapy for bronchospasm, asthma, rhinitis, or urticaria.

• Cardiovascular events

  • There is proof that using NSAIDs can make you more likely to experience harmful cardiovascular events including a stroke, MI, or newly developed hypertension.
  • A compounded risk exists if there are already existing heart disease.
  • Before prescribing the medication, a clinical assessment should be performed on patients who are at higher risk of developing heart disease.
  • Aspirin's cardioprotective effect is interrupted if concomitantly used along with ibuprofen, and potentially other nonselective NSAIDs.
  • To reduce the risk of heart attacks, it should be compatible with patient goals. Patients at high risk should consider alternative therapies.

• CNS effects

  • It can cause blurred vision, drowsiness and dizziness as well as other neurologic effects that could impair mental or physical abilities. 
  • It is important to warn patients about tasks that require mental alertness, such as driving or operating machinery.
  • If you have blurred or reduced vision, stop using it and conduct an ophthalmologic examination.
  • Patients receiving long-term therapy should be evaluated periodically for visual acuity.

• Events involving the GI

  • NSAIDs can increase the risk of GI irritations, inflammation, ulceration and bleeding.
  • These events can happen at any moment.
  • Individuals who have a history of GI disease, such as bleeding or ulcers, concurrent therapy with aspirin, anticoagulants, and/or corticosteroids, smoking, alcohol usage, being elderly, or patients who are debilitated should exercise caution.
  • The lowest effective dose should only be applied for a brief period of time to minimise the possibility of GI adverse events.
  • Patients at high risk should consider alternative therapies.
  • Aspirin can be used in conjunction with aspirin to increase the likelihood of GI problems like ulcers. 
  • It is recommended to use concurrent gastroprotective therapy, such as proton pump inhibitors.
  • Avoid non-aspirin NSAIDs in patients who have had a history or recent occurrences of lower GI bleeding.

• Hematologic effects

  • Reduced platelet adhesion or aggregation is a possibility. This might make bleeding last longer.
  • Patients with pre-existing anticoagulant use or patients with coagulation disorders should be closely monitored.
  • Anemia should be checked in patients on long-term NSAID treatment. Rarely, NSAID therapy has been linked to severe blood disorders like thrombocytopenia, agranulocytosis and aplastic anemia.

• Hyperkalemia:

  • NSAIDs can increase the likelihood of potassium elevations in elderly people, diabetics, and those with renal disease.
  • Monitor potassium closely.

• Reactions to skin:

  • NSAIDs can lead to skin side effects such toxic epidermal necrolysis, Stevens-Johnson syndrome, and exfoliative dermatitis (EJS). If you get skin rash or hypersensitivity, stop taking NSAIDs.

• Aseptic meningitis

  • Patients with combined connective tissue disorders and systemic lupus erythematosus may experience an increased risk of aseptic meningitis as a result of this (SLE).

  Asthma

  • NSAIDs shouldn't be administered to asthma patients who are aspirin sensitive.
  • There could be severe bronchospasm.
  • Patients with additional types of asthma should exercise caution.

• Bariatric surgery

  • Avoid taking nonselective NSAIDs for an extended period of time following bariatric surgery if you have stomach cancer.
  • Perforations can happen and anastomotic ulceration is particularly common.
  • Celecoxib and IV ketorolac are suggested for short-term use as part of a multimodal pain treatment plan.

• Coronary bypass surgery for coronary artery bypass graft:

  • It is not recommended to be used right before or after coronary bypass graft surgery (CABG).
  • The risk of stroke and MI may rise with the use of CABG surgery.
  • When you have diabetes, be cautious.

• Hepatic impairment

  • Patients with impaired hepatic function should be treated with caution.
  • Be aware of abnormal LFTs. NSAIDs have been linked to severe hepatic reactions such as fulminant hepatitis or liver failure.
  • If liver disease symptoms or systemic diseases develop, discontinue use.

• Hypertension:

  • It may cause newly developing hypertension or exacerbate an ailment that already exists.

• Glaucoma/increased intraocular pressure

  • Glaucoma is a condition that can be caused by increased intraocular pressure, angle-closure, or other eye conditions.

• Prostatic hyperplasia/Urinary Obstruction:

  • Patients suffering from BPH or obstruction of the bladder should be treated with caution.

• Renal impairment

  • NSAIDs can cause impairment of existing renal function. The drug causes a dose-dependent decrease in prostaglandin production. NSAIDs decrease renal blood flow, further deteriorating renal function.
  • Renal damage is more likely to occur in elderly people and those with chronic kidney disease, heart failure, liver dysfunction, diuretics, and ACE inhibitors.
  • Keep an eye on RFTs and ensure that one is hydrated.
  • It is not recommended in ESRD.
  • If it is used long-term, it can cause renal papillary necrosis.

• Thyroid disease:

  • Patients with thyroid disease should be cautious.

Monitoring Parameters:

None mentioned.

How to administer?

It may be administered with food or milk if stomach upset occurs.

Mechanism of action:

See individual agents (Ibuprofen, pseudoephedrine, and chlorpheniramine)

International Brand Names of Ibuprofen, pseudoephedrine, and chlorpheniramine:

• Advil Allergy Sinus
• Advil Multi-Symptom Cold
• Advil Cold and Sinus Nighttime
• Advil Cold and Sinus Plus
• Children's Advil Cold and Flu MultiSymptom
• Finagrip
• Ibupirac Grip

Ibuprofen, pseudoephedrine, and chlorpheniramine Brand Names in Pakistan:

No Brands Available in Pakistan.