Ammonium Chloride

Ammonium Chloride belongs to the pharmacological class of expectorants, which helps in relieving from the conditions of hypochloremia, metabolic acidosis and as an expectorant

Ammonium Chloride is absorbed in 1-2 hours. Ammonium Chloride is excreted in the form of urine.

The common side effects of Ammonium Chloride are hypokalemia, hypoventilation, drowsiness,seizures, nausea, vomiting, abdominal pain, drowsiness, mental confusion, etc.

Ammonium Chloride is found to be available in the form of intravenous solutions, and syrups.

Ammonium Chloride is available in the U.S., Canada, E.U., India, Australia, and Japan.

Ammonium Chloride belongs to the pharmacological class of expectorants which helps in relieving from the conditions of hypochloremia, metabolic acidosis and as an expectorant

Ammonium chloride is said to increase acidity by increasing the amount of hydrogen ion concentrations.

Ammonium chloride is said to be used as an expectorant as it irritates the bronchial mucosa. This effect causes the production of the respiratory tract fluid which in helps order facilitates the effective cough.

Ammonium Chloride had been approved for relieving symptoms as well as also for the treatment and maintenance of episodes of expectorant, hypochloremia and metabolic acidosis.

The onset of action of Ammonium Chloride is said to be within 30 minutes . The duration of action of Ammonium Chloride is 3-6 hours.

Ammonium Chloride is available in intravenous solutions and syrups.

Ammonium Chloride can be used in the treatment of the following conditions:

• As an Expectorant
• Hypochloremia,
• Metabolic alkalosis

Ammonium Chloride can help to relieve symptoms and also for the treatment and maintenance of hypochloremia, metabolic acidosis and as an expectorant.

Ammonium Chloride is approved for the treatment in the following clinical indications/conditions:

• As an Expectorant
• Hypochloremia,
• Metabolic alkalosis

Intravenous

To be administered Intravenously under the supervision or by the registered medical practitioner

Syrup

To be taken orally by mouth

Injectable solution

100 mEq/ 20mL(5mEq/mL) to 1,200 mg every 12 hours as needed; Dose should not exceed 2 doses nor 2,400 mg in 24 hours

Each mL contains 267.5 mg of ammonium chloride 5 mEq of ammonium and 5mEq of chloride and edetate disodium (anhydrous) 2 mg added as a stabilizer, pH 4.4 (4.0 to 6.0). May contain hydrochloric acid for pH adjustment. 10 mOsmol/mL(calc.). 

Syrup

100ml, 50ml

Intravenous solution and syrup.

Smoking cessation and maintaining health are a must.

Caffeine should be avoided or limited to use as it might lead to the risk of nausea, palpitations, nervousness, rapid heartbeat, etc.

Alcohol intake should be avoided in patients, especially those with an underlying liver disorder or liver dysfunction.

The dietary restrictions should be individualized as per the patient's requirements.

Ammonium Chloride may be contraindicated under the following conditions:

• Hypersensitive to the ingredients of the medication

The physician should closely monitor the patients and keep pharmacovigilance as follows:

• Pulmonary insufficiency, cardiac edema, severe renal impairment (do not give NH4Cl alone if concomitant Na loss)
• Risk of ammonia toxicity (monitor)
• Monitor patients CO2 combining power prior to IV administration to avoid serious acidosis

Avoid alcohol usage while on Ammonium Chloride medication, as alcohol can worsen the effects of any underlying disease condition, including conditions such as dizziness, blurred vision, etc.

No sufficient scientific evidence is traceable regarding the use and safety of Ammonium Chloride in concurrent use with any particular food.

The adverse reactions related to Ammonium Chloride can be categorized as follows:

• Ammonia toxicity symptoms (sweating, altered breathing, slow heart rate, irregular heartbeats, and coma)
• Calcium-deficiency leading to tetany
• Metabolic acidosis
• Rash
• EEG abnormalities
• Seizures
• Nausea/vomiting
• Mental confusion
• Hypokalemia
• Hyperventilation
• Irritability
• Hyperchloremia
• Abdominal pain
• Drowsiness
• Injection site reactions
• Encephalopathy

The clinically relevant drug interactions of Ammonium Chloride are briefly summarized here:

• Dextroamphetamine

Ammonium chloride decreases levels of dextroamphetamine by increasing renal clearance. Use with Caution/Monitor.

• Dichlorphenamide

Dichlorphenamide and ammonium chloride both decrease serum potassium. Use with Caution/Monitor.

• Dichlorphenamide, ammonium chloride. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

• Lisdexamfetamine

Ammonium chloride decreases levels of lisdexamfetamine by increasing renal clearance. Use with Caution/Monitor.

• Methamphetamine

Ammonium chloride decreases levels of methamphetamine by increasing renal clearance. Use with Caution/Monitor.

• Methylenedioxymethamphetamine

Ammonium chloride decreases levels of methylenedioxymethamphetamine by increasing renal clearance. Use with Caution/Monitor.

• Pseudoephedrine

Ammonium chloride decreases effects of pseudoephedrine by an unknown mechanism. Use with Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

The common side effects of Ammonium Chloride include the following:

• Ammonia toxicity symptoms (sweating, altered breathing, slow heart rate, irregular heartbeats, and coma)
• Calcium-deficiency leading to tetany
• Metabolic acidosis
• Rash
• EEG abnormalities
• Seizures
• Nausea/vomiting
• Mental confusion
• Hypokalemia
• Hyperventilation
• Irritability
• Hyperchloremia
• Abdominal pain
• Drowsiness
• Injection site reactions
• Encephalopathy

Physicians should be knowledgeable and vigilant about the treatment pertaining to the treatment and identification of overdosage of Ammonium Chloride.

Patients administered with ammonium chloride should be carefully monitored in order to avoid metabolic acidosis and ammonia toxicity.

Ammonium chloride overdosage can cause excessive acidity in the body fluids (metabolic acidosis) thereby resulting in disorientation, confusion as well as coma.

Ammonium chloride overdose might also result in ammonia toxicity which can cause irregular breathing, irregular heart rhythm, convulsions and coma.

Metabolic acidosis can be reversed by administration of an alkalinizing solution ex: sodium bicarbonate or sodium lactate. Ammonia toxicity may be treated with appropriate supportive and symptomatic care.

Pharmacodynamics

Systemic acidifier. In the liver ammonium chloride is converted into urea with the liberation of hydrogen ions ( which lowers the pH) and chloride.

Pharmacokinetics

• Absorption

Ammonium chloride is completely absorbed within 3–6 hours. In healthy persons, the absorption of ammonium chloride given by mouth was found to be practically complete.

• Metabolism

Ammonium ion is found to be converted to urea in the liver and chloride ion replaces bicarbonate.

• Route of elimination

The major route of elimination is Urine. Only 1 to 3% of the dose of Ammonium chloride was recovered in the feces.

1. https://go.drugbank.com/drugs/DB06767
2. https://www.1mg.com/generics/ammonium-chloride-209362
3. https://www.drugs.com/pro/ammonium-chloride.html
4. https://www.mims.com/malaysia/drug/info/ammonium chloride?mtype=generic
5. https://reference.medscape.com/drug/ammonium-chloride-342855#0
6. https://www.drugs.com/sfx/ammonium-chloride-side-effects.html
7. https://pubchem.ncbi.nlm.nih.gov/compound/Ammonium-Chloride#section=Canonical-SMILES
8. https://www.rxlist.com/consumer_ammonium_chloride/drugs-condition.htm#what_are_side_effects_associated_with_using__ammonium_chloride_zovirax