CLEAR COUGH SYRUP : Uses,Dose,Side Effects,Precautions

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What it is and what it is used for

Active ingredients and class

• Diphenhydramine hydrochloride: An antihistamine that can cause sedation.
• Ammonium chloride; sodium citrate: Listed actives in this cough mixture.

Indication (exactly as per source)

• Alleviation of cough.

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How it works (simple explanation)

• Speak to your doctor or pharmacist if you need more detail about how these ingredients may help with cough.

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Who should NOT use this medicine

Do not use CLEAR COUGH® SYRUP if:

• You are allergic (hypersensitive) to diphenhydramine hydrochloride, ammonium chloride, sodium citrate, or any other ingredient in the product (see “What the medicine contains”). Signs of allergy include rash, trouble breathing or swallowing, and swelling of the lips, face, throat, or tongue.
• You are pregnant or breastfeeding.
• You have impaired liver or kidney function (past or present).
• You are having an asthma attack.
• You are under 6 years of age.
• You have porphyria.
• You are taking or have taken an MAOI (monoamine oxidase inhibitor) in the past two weeks. Do not use concurrently with MAOIs, within two weeks after stopping an irreversible MAOI, or take an MAOI for at least one week after stopping CLEAR COUGH® SYRUP.

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Warnings and precautions (Read before use)

Use with extra caution and speak to a healthcare professional before taking this medicine if any of the following apply:

• You use alcohol or take other nervous system depressants (e.g., barbiturates, hypnotics for sleep, narcotic pain medicines, sedatives, tranquillisers). The combination can increase drowsiness and impaired concentration.
• Your cough lasts more than 1 week, returns frequently, or occurs with high fever, rash, or persistent headache—seek medical advice.
• You have heart failure, other cardiovascular disease, or an irregular heartbeat.
• You have peripheral oedema (swelling of hands/feet) or pulmonary oedema (excess fluid in the lungs).
• You have toxaemia of pregnancy (pregnancy-related high blood pressure with other abnormalities).
• You have glaucoma (raised pressure in the eye).
• You have an enlarged prostate (prostatic hypertrophy) or urinary retention.
• You have any allergies.
• You are elderly, as you may be more prone to dizziness, sedation, confusion, low blood pressure, and anticholinergic effects (e.g., dry mouth, blurred vision, dry eyes, constipation, urine problems).
• You have been told you cannot tolerate certain sugars—the syrup contains sucrose.
• You plan to take any other medicines, including non-prescription and traditional remedies.

Driving and using machines

• CLEAR COUGH® SYRUP can cause drowsiness and impaired concentration. This effect is worse with alcohol. It is unsafe to drive or operate machinery while using this medicine.

Alcohol

• Do not drink alcohol during treatment. Alcohol increases sedation and poor concentration.

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Pregnancy, planning pregnancy, and breastfeeding

• Do not use during pregnancy or while breastfeeding.
• If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, speak to your doctor or pharmacist before using any medicine.

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Interactions

Tell your doctor or pharmacist about all medicines you are taking, including non-prescription and traditional products.

Use with caution and only on medical advice if also taking:

• Central nervous system depressants (e.g., alcohol, barbiturates, hypnotics, narcotic analgesics, sedatives, tranquillisers) — increased drowsiness and impaired concentration may occur.
• Anticholinergic medicines — anticholinergic effects may be increased.
• Tricyclic antidepressants (and maprotiline) — effects may be enhanced by diphenhydramine; anticholinergic effects may be potentiated.
• MAOIs — do not use with CLEAR COUGH® SYRUP, or within 14 days of stopping an MAOI (see “Who should NOT use”).
• Ototoxic medicines — ear-related side effects may be masked by diphenhydramine.

Food and drink

• Avoid alcohol (see above).
• With or without food: Not specified in the source.

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How to take (Step-by-step)

Always use exactly as described in the leaflet or as advised by your doctor or pharmacist. Do not share your medicine with others.

1. Measure the dose accurately using a medicine measure (spoon or cup).
2. Adults: Take 5–10 ml every 3 to 4 hours.
3. Children 6–12 years: Take 2,5–5 ml every 4 hours.
4. Children under 6 years: Do not use.
5. Maximum daily dosing: Do not exceed four doses in 24 hours.

Note: Although adult directions mention “every 3 to 4 hours,” the leaflet also states a maximum of four doses per day. Follow both instructions by spacing doses so that you do not exceed four doses in 24 hours.

Missed dose

• If you forget a dose, take it as soon as you remember.
• If it is almost time for the next dose, skip the missed dose.
• Do not take a double dose to make up for a missed dose.

Overdose

• Overdose may increase side effects.
• Seek medical help immediately: contact your doctor or pharmacist, or go to the nearest hospital or poison control centre.
• Take the carton and bottle with you so the healthcare team can see exactly what you took.
• Treatment is symptomatic and supportive (as per source).

Practical tips from the source

• Use a proper medicine measure.
• Keep track of doses and timing to avoid exceeding four doses per day.
• Avoid alcohol and other sedating or anticholinergic medicines unless advised by a healthcare professional.

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Dosing table

Age group	Dose per administration	Frequency (as per leaflet)	Maximum doses in 24 h
Adults	5–10 ml	Every 3–4 hours	Do not exceed 4 doses/day
Children 6–12 years	2,5–5 ml	Every 4 hours	Do not exceed 4 doses/day
Children under 6 years	Do not use	—	—

Note: The leaflet specifies both “every 3–4 hours” (adults) and a maximum of four doses per day. Space doses accordingly to stay within the daily maximum.

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Possible side effects

Stop using the medicine and get urgent medical help if any of the following occur (serious):

• Allergic reaction: swelling of the hands, feet, ankles, face, lips, or throat (which can cause trouble swallowing or breathing), or an itchy nettle-type rash (urticaria).
• Fainting.

These may be signs of a serious reaction and require immediate medical attention or hospital care.

Common (listed as “frequent” in the source):

• Drowsiness/sedation, difficulty concentrating, tiredness/lack of energy (lassitude).
• Dizziness, low blood pressure (hypotension).
• Muscular weakness, incoordination.

Less common (listed as “less frequent” in the source):

• Headache, palpitations, pale skin, confusion, back or abdominal pain — may relate to abnormal red blood cells (haemolytic anaemia).
• Sore mouth/skin, sore throat, cough, breathing difficulty, light-headedness, fever, chills, body aches — may suggest low white blood cells (leukopenia).
• Bleeding gums, nosebleeds, skin rashes, blood in urine, excessive/easy bleeding, bruising, fatigue, general weakness — may indicate low platelets (thrombocytopenia).
• Loss of appetite (anorexia), blurred vision, ringing in the ears (tinnitus).
• Mood/behaviour changes: elation (high spirits), depression, irritability, nightmares, euphoria, restlessness, insomnia, nervousness.
• Dry mouth, chest tightness, tingling, heaviness/weakness of the hands.
• Constipation, diarrhoea, upper/middle stomach pain, nausea.
• Fits (seizures).
• Sunlight sensitivity (photosensitisation).
• Increased heartbeat, shaking, muscle twitching, thirst.
• Abnormally deep and rapid breathing, progressive drowsiness, mental confusion.
• Difficulty passing urine.

What to do about side effects

• Mild effects: speak to your pharmacist or doctor if symptoms are troublesome or persistent.
• Severe or allergic effects: stop the medicine and seek urgent medical help.

Reporting side effects

• You can report adverse effects to SAHPRA using the “6.04 Adverse Drug Reaction Reporting Form” available under SAHPRA Publications (as referenced in the leaflet). Reporting helps improve safety information.

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Storage and disposal

• Keep out of the reach of children.
• Store at or below 25 °C.
• Do not freeze.
• Keep in the original packaging to protect from light.
• Do not use after the expiry date on the packaging.
• Return unused medicine to your pharmacist.
• Do not dispose of unused medicine in drains or sewerage systems (e.g., toilets).

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What the medicine contains

Actives

• Diphenhydramine hydrochloride
• Ammonium chloride
• Sodium citrate

Other ingredients (excipients) listed in the leaflet

• Sucrose (sugar) — 1,5 g per 5 ml
• Alcohol — 0,1% v/v
• Nipastat — 0,02% m/v (preservative)
• Chloroform spirits
• Clarks caramel
• Menthol
• Purified water
• Sodium carboxymethyl cellulose

Important composition notes

• Contains sugar (sucrose) — if you have been told you cannot tolerate certain sugars, contact your doctor before use.
• Contains alcohol.

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Pack information and appearance

• Appearance: Brown syrupy liquid.
• Pack sizes: 100 ml, 200 ml, 2,5 litre, and 25 litre containers.
• Holder of Certificate of Registration: Ranbaxy Pharmaceuticals (Pty) Ltd.

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FAQs

Can I take CLEAR COUGH® SYRUP if I am pregnant or breastfeeding?
No. The leaflet states it should not be taken during pregnancy or breastfeeding. Speak to your doctor or pharmacist for alternatives.

Is it safe for children under 6 years?
No. Do not give CLEAR COUGH® SYRUP to children under 6 years.

Can I drive after taking a dose?
No. The medicine causes drowsiness and impaired concentration, which can lead to accidents. Do not drive or operate machinery.

Can I drink alcohol while using it?
No. Avoid alcohol. Alcohol increases drowsiness and impaired concentration.

I am on antidepressants—can I take this syrup?
Do not use if you are taking or have taken an MAOI in the last two weeks. Tricyclic antidepressants (and maprotiline) may also have enhanced or potentiated effects with diphenhydramine. Speak to your doctor or pharmacist.

I missed a dose—what should I do?
Take it as soon as you remember, but if it is almost time for the next dose, skip the missed one. Do not double up.

What is the maximum number of doses per day?
The leaflet states a maximum of four doses in 24 hours. Space your doses to stay within this limit.

What should I do if I take too much?
Seek medical help immediately—contact your doctor/pharmacist or go to the nearest hospital or poison control centre. Take the carton and bottle with you.

What if my cough doesn’t get better?
If the cough lasts more than one week, keeps coming back, or occurs with high fever, rash, or a persistent headache, consult a doctor.

Does it contain sugar or alcohol?
Yes. Sucrose 1,5 g/5 ml and alcohol 0,1% v/v are listed in the composition.