Triaminic Expectorant DH

Guaifenesin:

• Triaminic Expectorant DH (Guaifenesin) reviews

Indication: Used to assist the expectoration of phlegm from the airways in acute respiratory tract infections.

Triaminic Expectorant DH (Guaifenesin) is an expectorant which increases the output of phlegm (sputum) and bronchial secretions by reducing adhesiveness and surface tension. The increased flow of less viscous secretions promotes ciliary action and changes a dry, unproductive cough to one that is more productive and less frequent. By reducing the viscosity and adhesiveness of secretions, Triaminic Expectorant DH (Guaifenesin) increases the efficacy of the mucociliary mechanism in removing accumulated secretions from the upper and lower airway.

Hydrocodone Bitartrate:

• Indications and usage
• Dosage and administration
• Dosage forms and strengths
• Contraindications
• Warnings and precautions
• Adverse reactions
• Drug interactions
• Use in specific populations
• Drug abuse and dependence
• Overdosage
• Description
• Clinical pharmacology
• Nonclinical toxicology
• Clinical studies
• How supplied/storage and handling
• Patient counseling information
• Medication guide obredon oral solution (oh-brĕ-don oral solution) (hydrocodone bitartrate and guaifenesin) each 5 ml contains hydrocodone bitartrate, usp, 2.5 mg; and guaifenesin, usp, 200 mg. c-ii
• Triaminic Expectorant DH (Hydrocodone Bitartrate) reviews

1 INDICATIONS AND USAGE

Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is indicated for symptomatic relief of cough and to loosen mucus associated with the common cold.

Important Limitations of Use:

Not indicated for pediatric patients under 18 years of age .

Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is a combination product containing an opioid antitussive and expectorant indicated for:

• Symptomatic relief of cough and to loosen mucus associated with the common cold.

Important Limitations of Use:

Not indicated for pediatric patients under 18 years of age. ( 8.4)

2 DOSAGE AND ADMINISTRATION

Adults and adolescents 18 years of age and older: 10 mL every 4 to 6 hours, not to exceed 6 doses in 24 hours. ( 2.1)

Measure Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution with an accurate milliliter measuring device. ( 5.10)

2.1 Recommended dosage

Adults and adolescents 18 years of age and older: 10 mL every 4 to 6 hours, not to exceed 6 doses (60 mL) in 24 hours.

Administer Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution by the oral route only. Measure Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution with an accurate milliliter measuring device. Do not use a household teaspoon to measure the dose .

3 DOSAGE FORMS AND STRENGTHS

Oral Solution:

Each 5 mL contains Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate, USP, 2.5 mg; and guaifenesin, USP, 200 mg .

Oral Solution: Each 5 mL contains Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate, USP, 2.5 mg; and guaifenesin, USP, 200 mg.( 3)

4 CONTRAINDICATIONS

Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is contraindicated in:

• Patients with known hypersensitivity to Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate, guaifenesin, or any of the inactive ingredients of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution.
• Patients receiving MAOI therapy or within 14 days of stopping such therapy .

• Patients with known hypersensitivity to Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate, guaifenesin, or any of the inactive ingredients of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution. ( 4)
• Patients receiving monoamine oxidase inhibitor (MAOI) therapy or within 14 days of stopping such therapy. ( 4)

5 WARNINGS AND PRECAUTIONS

• Dose-related respiratory depression: Use with caution.
• Drug Dependence: Prescribe with caution that is appropriate to the use of other opioids. ( 5.3)
• Head injury and increased intracranial pressure: Avoid in patients with head injury, intracranial lesions or increased intracranial pressure. ( 5.4)
• Activities requiring mental alertness: Avoid engaging in hazardous tasks requiring complete mental alertness such as driving or operating machinery. ( 5.5)
• Acute abdominal conditions: Use with caution in patients with acute abdominal conditions. ( 5.6)
• Coexisting conditions: Use with caution in patients with diabetes, thyroid disease, Addison’s disease, prostatic hypertrophy, or urethral stricture, or asthma. ( 5.11)

5.1 Risks from Concomitant Use with Benzodiazepines or other CNS Depressants

Concomitant use of opioids, including Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution, with benzodiazepines, or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Because of these risks, avoid use of opioid cough medications in patients taking benzodiazepines, other CNS depressants, or alcohol .

Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. Because of similar pharmacologic properties, it is reasonable to expect similar risk with concomitant use of opioid cough medications and benzodiazepines, other CNS depressants, or alcohol.

Advise both patients and caregivers about the risks of respiratory depression and sedation if Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is used with benzodiazepines, alcohol, or other CNS depressants .

5.2 Respiratory Depression

Triaminic Expectorant DH bitartrate, one of the active ingredients in Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution, produces dose-related respiratory depression by directly acting on brain stem respiratory centers. Overdose of Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate in adults has been associated with fatal respiratory depression, and the use of Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate in children less than 6 years of age has been associated with fatal respiratory depression. Exercise caution when administering Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution because of the potential for respiratory depression. If respiratory depression occurs, it may be antagonized by the use of naloxone hydrochloride and other supportive measures when indicated .

5.3 Drug Dependence

Triaminic Expectorant DH (Hydrocodone Bitartrate) can produce drug dependence of the morphine type and therefore, has the potential for being abused. Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution. Prescribe and administer Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution with the same degree of caution appropriate to the use of other opioid drugs .

5.4 Head Injury and Increased Intracranial Pressure

The respiratory depression effects of opioids and their capacity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions, or a pre-existing increase in intracranial pressure. Furthermore, opioids produce adverse reactions which may obscure the clinical course of patients with head injuries. The use of Triaminic Expectorant DH Oral Solution should be avoided in these patients.

5.5 Activities Requiring Mental Alertness

Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate, one of the active ingredients in Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution, may produce marked drowsiness and impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. Advise patients to avoid engaging in hazardous tasks requiring mental alertness and motor coordination after ingestion of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution. Concurrent use of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution with alcohol or other central nervous system depressants should be avoided because additional impairment of central nervous system performance may occur.

5.6 Acute Abdominal Conditions

Triaminic Expectorant DH Oral Solution should be used with caution in patients with acute abdominal conditions since the administration of Triaminic Expectorant DH (Hydrocodone Bitartrate) may obscure the diagnosis or clinical course of patients with acute abdominal conditions. The concurrent use of other anticholinergics with Triaminic Expectorant DH (Hydrocodone Bitartrate) may produce paralytic ileus .

5.7 Co-administration with Anticholinergics

The concurrent use of anticholinergics with Triaminic Expectorant DH (Hydrocodone Bitartrate) may produce paralytic ileus. Exercise caution when using Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution in patients taking anticholinergic medications .

5.8 Co-administration with MAOIs or Tricyclic Antidepressants

Triaminic Expectorant DH Oral Solution should not be used in patients receiving MAOI therapy or within 14 days of stopping such therapy. The use of MAOIs or tricyclic antidepressants with Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate may increase the effect of either the antidepressant or Triaminic Expectorant DH (Hydrocodone Bitartrate) .

5.9 Persistent Cough

Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution should not be used in patients with a persistent or chronic cough such as occurs with smoking, asthma, chronic bronchitis, or emphysema, or where cough is accompanied by excessive phlegm (mucus).

5.10 Dosing

Patients should be advised to measure Triaminic Expectorant DH Oral Solution with an accurate milliliter measuring device. Patients should be informed that a household teaspoon is not an accurate measuring device and could lead to overdosage, which can result in serious adverse reactions . Patients should be advised to ask their pharmacist to recommend an appropriate measuring device and for instructions for measuring the correct dose.

5.11 Coexisting Conditions

Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution should be used with caution in patients with diabetes, thyroid disease, Addison's disease, prostatic hypertrophy or urethral stricture, and asthma.

5.12 Renal Impairment

Triaminic Expectorant DH Oral Solution should be used with caution in patients with severe renal impairment.

5.13 Hepatic Impairment

Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution should be used with caution in patients with severe hepatic impairment .

6 ADVERSE REACTIONS

Use of Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate is associated with the following:

• Respiratory depression
• Drug dependence
• Increased intracranial pressure
• Decreased mental alertness with impaired mental and/or physical abilities
• Paralytic ileus

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

The most common adverse reactions experienced by subjects taking a single dose of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution in the clinical setting include the following: Central Nervous System: headache, dizziness, sedation (somnolence); Gastrointestinal System: nausea, diarrhea; Cardiovascular System: decreased blood pressure; Vascular System: hot flush.

The most common adverse reactions of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution include:

Dizziness, headache, sedation, nausea, and decreased blood pressure. ( 6)

To report SUSPECTED ADVERSE REACTIONS, contact ABER Pharmaceuticals, LLC. at tel: 1-855-461-5102; www.obredon.com or FDA at 1-800-FDA-1088; www.fda.gov/medwatch.

7 DRUG INTERACTIONS

No specific interaction studies have been conducted with Triaminic Expectorant DH Oral Solution.

• Opioids, antihistamines, antipsychotics, anti-anxiety agents, or other CNS depressants (including alcohol): Avoid using with Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution; may exhibit additive CNS depression. ( 7.1)
• MAO inhibitors (MAOIs) or tricyclic antidepressants: Do not use. May increase the effect of either the antidepressant or Triaminic Expectorant DH (Hydrocodone Bitartrate). ( 7.2)
• Anticholinergic drugs: Use with caution in order to avoid paralytic ileus and excessive anticholinergic effects. ( 7.3)

7.1 Benzodiazepines, Opioids, Antihistamines, Antipsychotics, Anti-anxiety Agents, or Other CNS Depressants (Including Alcohol)

The use of benzodiazepines, opioids, antihistamines, antipsychotics, anti-anxiety agents, or other CNS depressants concomitantly with Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution may cause an additive CNS depressant effect, profound sedation, respiratory depression, coma, and death and should be avoided .

7.2 MAO Inhibitors or Tricyclic Antidepressants

Do not prescribe Triaminic Expectorant DH Oral Solution if the patient is taking a prescription MAOI (i.e., certain drugs used for depression, psychiatric or emotional conditions, or Parkinson’s disease), or for 2 weeks after stopping a MAOI drug. The use of MAOIs or tricyclic antidepressants with Triaminic Expectorant DH (Hydrocodone Bitartrate) preparations may increase the effect of either the antidepressant or Triaminic Expectorant DH (Hydrocodone Bitartrate) .

7.3 Anticholinergic Drugs

Triaminic Expectorant DH (Hydrocodone Bitartrate) should be administered cautiously to persons receiving anticholinergic drugs in order to avoid paralytic ileus and excessive anticholinergic effects .

8 USE IN SPECIFIC POPULATIONS

• Renal Impairment: Use with caution in patients with severe renal impairment.
• Hepatic Impairment: Use with caution in patients with severe hepatic impairment. ( 8.7)

8.1 Pregnancy

Teratogenic Effects: Pregnancy Category C

There are no adequate and well controlled studies of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution in pregnant women. Reproductive toxicity studies have not been conducted with Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution; however, studies are available with an individual active ingredient or related active ingredient. Triaminic Expectorant DH (Hydrocodone Bitartrate) was teratogenic in hamsters. Codeine, an opiate related to Triaminic Expectorant DH (Hydrocodone Bitartrate), increased resorptions and decreased fetal weight in rats. Because animal reproduction studies are not always predictive of human response, Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution should be used during pregnancy only if the benefit justifies the potential risk to the fetus.

Triaminic Expectorant DH (Hydrocodone Bitartrate):

Triaminic Expectorant DH (Hydrocodone Bitartrate) has been shown to be teratogenic in hamsters when given in a dose approximately 27 times the maximum recommended human daily dose (MRHDD) (on a mg/m ² basis at a single subcutaneous dose of 102 mg/kg on gestation day 8). Reproductive toxicology studies were also conducted with codeine, an opiate related to Triaminic Expectorant DH (Hydrocodone Bitartrate). In a study in which pregnant rats were dosed throughout organogenesis, a dose of codeine approximately 40 times the MRHDD of Triaminic Expectorant DH (Hydrocodone Bitartrate) (on a mg/m ² basis at an oral dose of 120 mg/kg/day of codeine) increased resorptions and decreased fetal weight; however, these effects occurred in the presence of maternal toxicity. In studies in which rabbits and mice were dosed throughout organogenesis, doses of codeine up to approximately 20 and 100 times, respectively, the MRHDD of Triaminic Expectorant DH (Hydrocodone Bitartrate) (on a mg/m ² basis at oral doses of 30 and 600 mg/kg/day, respectively), produced no adverse developmental effects.

Nonteratogenic Effects: Babies born to mothers who have been taking opioids regularly prior to delivery will be physically dependent. The withdrawal signs include irritability and excessive crying, tremors, hyperactive reflexes, increased respiratory rate, increased stools, sneezing, yawning, vomiting, and fever. The intensity of the syndrome does not always correlate with the duration of maternal opioid use or dose.

8.2 Labor and Delivery

As with all opioids, administration of Triaminic Expectorant DH Oral Solution to the mother shortly before delivery may result in some degree of respiratory depression in the newborn, especially if higher doses are used.

8.3 Nursing Mothers

Caution should be exercised when Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is administered to nursing mothers. Triaminic Expectorant DH (Hydrocodone Bitartrate) is known to be excreted in human milk. No studies have been performed to determine if guaifenesin is excreted into breastmilk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

8.4 Pediatric Use

Safety and effectiveness of Triaminic Expectorant DH Oral Solution in pediatric patients under 18 years of age has not been established. The use of Triaminic Expectorant DH (Hydrocodone Bitartrate) in children less than 6 years of age is associated with fatal respiratory depression .

8.5 Geriatric Use

Clinical studies have not been conducted with Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution in geriatric populations. Other reported clinical experience with the individual active ingredients of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution has not identified differences in responses between the elderly and patients younger than 65 years of age. In general, dose selection for an elderly patient should be made with caution, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

8.6 Renal Impairment

Triaminic Expectorant DH Oral Solution should be given with caution in patients with severe impairment of renal function.

8.7 Hepatic Impairment

Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution should be given with caution in patients with severe impairment of hepatic function.

9 DRUG ABUSE AND DEPENDENCE

9.1 Controlled Substance

Triaminic Expectorant DH Oral Solution is a Schedule II controlled prescription containing Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate and should be prescribed and administered with caution.

9.2 Abuse

Triaminic Expectorant DH (Hydrocodone Bitartrate) can produce drug dependence of the morphine type and therefore, has the potential for being abused. Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution, and it should be prescribed and administered with the same degree of caution appropriate to the use of other opioid drugs.

Abuse of guaifenesin has been linked to the formation of kidney stones composed of the major metabolite β-(2-methoxyphenoxy) lactic acid.

9.3 Dependence

Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of opioids; therefore, Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution should be prescribed and administered with caution.

Physical dependence, the condition in which continued administration of the drug is required to prevent the appearance of a withdrawal syndrome, assumes clinically significant proportions only after several weeks of continued oral opioid use, although some mild degree of physical dependence may develop after a few days of opioid therapy.

10 OVERDOSAGE

No human overdosage data are available for Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution.

Triaminic Expectorant DH (Hydrocodone Bitartrate):

Overdosage with Triaminic Expectorant DH (Hydrocodone Bitartrate) is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, dizziness, ringing in the ears, confusion, blurred vision, eye problems, cold and clammy skin, and sometimes bradycardia and hypotension. In severe overdose, apnea, circulatory collapse, cardiac arrest and death may occur.

Guaifenesin:

Overdosage with guaifenesin can cause depression of the central nervous system. While present in polypharmacy overdoses, one case of overdose with only significant levels of guaifenesin has been reported. Symptoms included slurred speech, shallow respirations, reduced heart rate with rhythm sinus bradycardia, followed by asystole.

Treatment of overdosage consists of discontinuation of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution together with institution of appropriate therapy. Primary attention should be given to the reestablishment of adequate respiratory exchange through provision of a patent airway and the institution of assisted or controlled ventilation. The opioid antagonist naloxone hydrochloride is a specific antidote for respiratory depression which may result from overdosage or unusual sensitivity to opioids including Triaminic Expectorant DH (Hydrocodone Bitartrate). Therefore, an appropriate dose of naloxone hydrochloride should be administered, preferably by the intravenous route, simultaneously with efforts at respiratory resuscitation. For further information, see full prescribing information for naloxone hydrochloride. An antagonist should not be administered in the absence of clinically significant respiratory depression. Oxygen, intravenous fluids, vasopressors, and other supportive measures should be employed as indicated. Gastric emptying may be useful in removing unabsorbed drug.

11 DESCRIPTION

Triaminic Expectorant DH Oral Solution contains Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate (a centrally-acting opioid antitussive) and guaifenesin (an expectorant).

Each 5 mL dose of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution contains: Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate, USP, 2.5 mg; and guaifenesin, USP, 200 mg.

Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution also contains: artificial raspberry flavor, citric acid, glycerin, methylparaben, potassium citrate, potassium sorbate, propylene glycol, propylparaben, purified water, and saccharin sodium.

11.1 Triaminic Expectorant DH (Hydrocodone Bitartrate) Bitartrate

Triaminic Expectorant DH (Hydrocodone Bitartrate) Bitartrate is a centrally-acting opioid antitussive and analgesic. It is affected by light and occurs as fine white crystals or crystalline powder which is derived from the opium alkaloid, thebaine. Its chemical name is morphinan-6-one, 4,5-epoxy-3-methoxy-17-methyl-, (5α)-, [R-(R*,R*)]-2,3-dihydroxybutanedioate (1:1), hydrate (2:5). It is also known as 4,5α-Epoxy-3-methoxy-17-methylmorphinan-6-one tartrate (1:1) hydrate (2:5); and may be represented by the following structural formula:

C ₁₈H ₂₁NO ₃ - C ₄H ₆O ₆ - 2½H ₂O MW= 494.50

HCB Chemical Structure

11.2 Guaifenesin

Guaifenesin is an expectorant and occurs as a white powder. Its chemical name is 3-(2-methoxyphenoxy)-1,2- propanediol, and may be represented by the following structural formula:

C ₁₀H ₁₄O ₄ MW= 198.22

GFN Chemical Structure

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

Triaminic Expectorant DH is a semisynthetic narcotic antitussive and analgesic with multiple actions qualitatively similar to those of codeine. The precise mechanism of action of Triaminic Expectorant DH (Hydrocodone Bitartrate) and other opiates is not known; however, Triaminic Expectorant DH (Hydrocodone Bitartrate) is believed to act directly on the cough center. In excessive doses, Triaminic Expectorant DH (Hydrocodone Bitartrate) will depress respiration. Triaminic Expectorant DH (Hydrocodone Bitartrate) can produce miosis, euphoria, and physical and physiological dependence.

Guaifenesin is an expectorant the action of which promotes or facilitates the removal of secretions from the respiratory tract. The precise mechanism of action of guaifenesin is not known; however, it is thought to act as an expectorant by increasing the volume and reducing the viscosity of secretions in the trachea and bronchi. In turn, this may increase the efficiency of the cough reflex and facilitate removal of the secretions.

12.3 Pharmacokinetics

Systemic exposure (in terms of peak plasma concentrations and area under plasma concentration versus time curve) of Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate and guaifenesin after single dose administration of 10 mL Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution are equivalent to respective reference solutions of 5 mL Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate (5 mg/5 mL), and 10 mL guaifenesin (200 mg/5 mL).

Triaminic Expectorant DH (Hydrocodone Bitartrate): Following a single 10 mL oral dose of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution administered to 36 healthy adults (19-74 years), the geometric mean C _max and AUC _0-inf for Triaminic Expectorant DH (Hydrocodone Bitartrate) were 12.6 ng/ml and 80.9 ng·hr/ml, respectively. The median time to maximum concentration for Triaminic Expectorant DH (Hydrocodone Bitartrate) was about 1.25 hours. Food has no significant effect on the extent of absorption of Triaminic Expectorant DH (Hydrocodone Bitartrate). The mean plasma half-life of Triaminic Expectorant DH (Hydrocodone Bitartrate) is approximately 5 hours.

Guaifenesin: Following a single 10 mL oral dose of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution administered to 57 healthy adults (19-74 years), the geometric mean Cmax and AUC0-inf for guaifenesin were 3.7 mcg/ml and 4.2 mcg·hr/ml, respectively. The median time to maximum concentration was about 20 minutes. The effect of food on guaifenesin systemic exposure is not considered to be clinically meaningful. The mean plasma half-life of guaifenesin is approximately 1 hour.

Drug interactions

When guaifenesin and Triaminic Expectorant DH (Hydrocodone Bitartrate) were administered in combination, the pharmacokinetics for each component were similar to those observed when each component was administered separately.

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Carcinogenicity, mutagenicity, and reproductive studies have not been conducted with Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution; however, published information is available for the individual active ingredients or related active ingredients.

Triaminic Expectorant DH (Hydrocodone Bitartrate):

Carcinogenicity studies were conducted with codeine, an opiate related to Triaminic Expectorant DH (Hydrocodone Bitartrate). In 2 year studies in F344/N rats and B6C3F1 mice, codeine showed no evidence of tumorigenicity at dietary doses up to 70 and 400 mg/kg/day, respectively (approximately 23 and 65 times, respectively, the MRHDD of Triaminic Expectorant DH (Hydrocodone Bitartrate) on a mg/m ² basis).

Guaifenesin:

Carcinogenicity, genotoxicity, or reproductive toxicology studies have not been conducted with guaifenesin

14 CLINICAL STUDIES

Efficacy studies were not conducted with Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution. Efficacy of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is based on demonstration of bioequivalence to the individual comparator products .

16 HOW SUPPLIED/STORAGE AND HANDLING

Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is supplied as a clear, raspberry flavored liquid containing 2.5 mg Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate and 200 mg guaifenesin in each 5 mL. It is available in:

White HDPE bottles of 16 fl oz. (473 mL): NDC 69166-523-16 (raspberry flavored)

White HDPE bottles of 4 fl oz. (118 mL): NDC 69166-523-04 (raspberry flavored)

Store solution at 20° to 25°C (68° to 77°F).

Dispense in a tight, light-resistant container, as defined in the USP, with a child-resistant closure.

17 PATIENT COUNSELING INFORMATION

Overdosage

Advise patients not to increase the dose or dosing frequency of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution because serious adverse events such as respiratory depression may occur with overdosage .

Dosing

Advise patients to measure Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution with an accurate milliliter measuring device. Patients should be informed that a household teaspoon is not an accurate measuring device and could lead to overdosage, especially when half a teaspoon is measured. Patients should be advised to ask their pharmacist to recommend an appropriate measuring device and for instructions for measuring the correct dose .

Interactions with Benzodiazepines and Other Central Nervous System Depressants

Inform patients and caregivers that potentially fatal additive effects may occur if Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is used with benzodiazepines or other CNS depressants, including alcohol.

Because of this risk, patients should avoid concomitant use of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution with benzodiazepines or other CNS depressants, including alcohol .

Activities Requiring Mental Alertness

Advise patients to avoid engaging in hazardous tasks that require mental alertness and motor coordination such as operating machinery or driving a motor vehicle as Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution may produce marked drowsiness .

Drug Dependence

Caution patients that Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution contains Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate and can produce drug dependence .

For Medical Information

Contact Medical Affairs Department

Phone: 1-855-461-5102

Manufactured for:

Accelis Pharma

East Windsor, NJ 08520

ACELLIS logo

MEDICATION GUIDE

Triaminic Expectorant DH Oral Solution (Oh-brĕ-don Oral Solution)

(hydrocodone bitartrate and guaifenesin) Each 5 mL contains Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate, USP, 2.5 mg; and guaifenesin, USP, 200 mg. C-II

What is the most important information I should know about Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution?

• Taking Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution with benzodiazepines, or other central nervous system depressants, including alcohol can cause severe drowsiness, breathing problems (respiratory depression), coma, and death.
• Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution can cause you to be drowsy. Do not drive a car or operate machinery until you know how Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution affects you. Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution can slow your thinking and motor skills, and may affect your vision.
• Women who breastfeed should talk to their healthcare provider before taking Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution.
• Call your healthcare provider or get emergency medical help right away if anyone taking Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution has any of the symptoms below:
  • increased sleepiness
  • confusion
  • difficulty breathing
  • shallow breathing
  • limpness
  • your baby has difficulty breastfeeding
• Keep Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution in a safe place away from children. Accidental use by a child is a medical emergency and can cause death. If a child accidentally takes Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution, get emergency medical help right away.
• Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution can cause serious side effects, including death.
• Take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution exactly as prescribed by your healthcare provider. If you take the wrong dose of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution, you could overdose and die.
• Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is not for children under 18 years of age.

What is Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution?

• Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is a prescription medicine used to treat a cough and to loosen mucus associated with the common cold, in patients 18 years and older. Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution contains two medicines, Triaminic Expectorant DH (Hydrocodone Bitartrate) and guaifenesin. Triaminic Expectorant DH (Hydrocodone Bitartrate) is a narcotic cough suppressant. Guaifenesin is an expectorant.
• Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is a federal controlled substance (C-II) because it contains Triaminic Expectorant DH (Hydrocodone Bitartrate) that can be abused or lead to dependence. Keep Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution in a safe place to prevent misuse and abuse. Selling or giving away Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution may harm others, and is against the law. Tell your healthcare provider if you have abused or been dependent on alcohol, prescription medicines or street drugs.
• Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is not for children under 18 years of age. It is not known if Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution is safe and effective in children.

Who should not take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution?

• Do not take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution if you are allergic to any of the ingredients in Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution. See the end of this Medication Guide for a complete list of ingredients. You may have an increased risk of having an allergic reaction to Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution if you are allergic to certain other opioid medicines.
• Do not take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution if you take a medicine for depression called a Monoamine Oxidase Inhibitor (MAOI)
  • Do not take an MAOI within 14 days after you stop taking Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution.
  • Do not start Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution if you stopped taking an MAOI in the last 14 days.

Before you take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution, tell your healthcare provider about all of your medical conditions, including if you:

• • have a drug dependence
  • have lung or breathing problems
  • have had a head injury
  • have pain in your stomach-area (abdomen)
  • have a history of severe or persistent cough
  • have prostate problems
  • have problems with your urinary tract(urethral stricture)
  • plan to have surgery
  • drink alcohol
  • have kidney or liver problems
  • have diabetes
  • have thyroid problems, such as hypothyroidism
  • are pregnant or plan to become pregnant. It is not known if Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution will harm your unborn baby. You and your healthcare provider should decide if you should take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution while you are pregnant.
  • are breastfeeding or plan to breastfeed. It is not known if Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution passes into your breast milk. You and your healthcare provider should decide if you will take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution or breastfeed. You should not do both.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Taking Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution with certain other medicines can cause side effects or affect how well Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution or the other medicines work. Do not start or stop other medicines without talking to your healthcare provider.

Especially tell your healthcare provider if you:

• take pain medicines such as narcotics
• take cold or allergy medicines that contain antihistamines or cough suppressants
• take medicines for mental illness (anti-psychotics, anti-anxiety)
• drink alcohol
• take medicines for depression, including monoamine oxidase inhibitors (MAOIs) and tricyclics
• The use of MAOIs or tricyclic antidepressants with Triaminic Expectorant DH (Hydrocodone Bitartrate) bitartrate may increase the effect of either the antidepressant or Triaminic Expectorant DH (Hydrocodone Bitartrate).

How should I take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution?

• Take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution exactly as your healthcare provider tells you to take it.
• Your healthcare provider will tell you how much Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution to take and when to take it. Do not change your dose without talking to your healthcare provider.
• Administer Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution by the oral route only.
• Ask your pharmacist to give you a measuring device to help you measure the correct amount of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution. Do not use a household teaspoon to measure your medicine. You may accidently take too much.
• If you take too much Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution, call your healthcare provider or go to the nearest hospital emergency room right away.

What should I avoid while taking Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution?

• Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution can cause you to be drowsy. Do not drive a car or operate machinery while you take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution until you know how it affects you.
• Avoid drinking alcohol while taking Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution. Drinking alcohol can increase your chances of having serious side effects.

What are the possible side effects of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution?

Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution may cause serious side effects, including:

• See “What is the most important information I should know about Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution?”
• breathing problems (respiratory depression) which can lead to death. Call your healthcare provider or get emergency treatment right away if you are sleeping more than usual, have shallow or slow breathing, or confusion.
• Physical dependence or abuse. Take Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution exactly as your healthcare provider tells you to take it. Stopping Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution suddenly could cause withdrawal symptoms.
• Bowel problems including constipation or stomach pain.

The most common side effects of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution include:

• Sleepiness
• Confusion
• nausea and vomiting
• difficulty urinating
• trouble breathing

These are not all the possible side effects of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution?

• Store Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution at room temperature between 68°F to 77°F (20°C to 25°C).
• Safely throw away medicine that is out of date or no longer needed.
• Keep Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution and all medicines out of the reach of children.

General information about the safe and effective use of Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution.

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution for a condition for which it was not prescribed. Do not give Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution to other people, even if they have the same symptoms that you have. It may harm them.

You can ask your pharmacist or healthcare provider for information about Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution that is written for health professionals.

What are the ingredients in Triaminic Expectorant DH (Hydrocodone Bitartrate) Oral Solution?

Active ingredients: Triaminic Expectorant DH (Hydrocodone Bitartrate) Bitartrate and Guaifenesin

Inactive ingredients: artificial raspberry flavor, citric acid, glycerin, methylparaben, potassium citrate, potassium sorbate, propylene glycol, propylparaben, purified water, and saccharin sodium

Manufactured for:

Accelis Pharma, East Windsor, NJ 08520

For more information, go to www.obredon.com or call 1-855-461-5102.

This Medication Guide has been approved by the U.S. Food and Drug Administration Issued: 09/2016

Pheniramine Maleate:

• Triaminic Expectorant DH (Pheniramine Maleate) reviews

Indication: Triaminic Expectorant DH (Pheniramine Maleate) is an antihistamine used to treat allergic conditions such as hay fever or urticaria.

Triaminic Expectorant DH (Pheniramine Maleate) is an antihistamine used to treat allergic conditions such as hay fever or urticaria. It is generally sold in combination with other medications, rather than as a stand-alone drug. Allergies are caused by an excessive type 1 hypersensitivity response of the body to allergens, mediated by inappropriate histamine signalling. By inhibiting the binding of histamine, antihistamines decrease the normal histamine response from cells, consequently decreasing allergic symptoms.

Phenylpropanolamine Hydrochloride:

• Triaminic Expectorant DH (Phenylpropanolamine Hydrochloride) reviews

Indication: For the treatment of nasal congestion, control of urinary incontinence, priapism and obesity.

Triaminic Expectorant DH (Phenylpropanolamine Hydrochloride) (PPA), a sympathomimetic agent structurally similar to pseudoephedrine, is used to treat nasal congestion. Triaminic Expectorant DH (Phenylpropanolamine Hydrochloride) is found in appetite suppressant formulations and with guaifenesinin in cough-cold formulations. In 2000, the FDA requested that all drug companies discontinue marketing products containing Triaminic Expectorant DH (Phenylpropanolamine Hydrochloride), due to an increased risk of hemorrhagic stroke in women who used Triaminic Expectorant DH (Phenylpropanolamine Hydrochloride).

Pyrilamine Maleate:

• Triaminic Expectorant DH (Pyrilamine Maleate) reviews

For use when an oral antihistamine is needed.

Can be provided to horse: 1/2 ounce (1 tablespoon) per 1000lbs body weight. Can be repeated at 12 hour intervals as needed, or as recommended by a veterinarian. The large end of the enclosed scoop measures 1 tablespoon.

This product contains Triaminic Expectorant DH (Pyrilamine Maleate) Maleate which may be prohibited in certain competition. Caution must be taken when used on competition horse subject to drug testing. Check with the event sanction body for the necessary withdrawal time.

EACH OUNCE CONTAINS (minimum): Triaminic Expectorant DH (Pyrilamine Maleate) Maleat USP 600mg, in a palatable base.

FOR ANIMAL USE ONLY.

KEEP THIS AND ALL MEDICATIONS OUT OF THE REACH OF CHILDREN.

Keep lid tightly closed and store in a dry place Do not store above 30 C (86 F).

NDC#: 65090-004-15

Triaminic Expectorant DH (Pyrilamine Maleate)

Antihistamine Granules

Net Contents: 20 ounces (567 Gm)