**BEERS Drug**


Trade Name(s)

  • Karbinal ER

Ther. Class.
allergy, cold and cough remedies
none assigned

Pharm. Class.


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


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

Therapeutic Effect(s):

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


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)

POunk6.7 hr12 hr


Contraindicated in:

  • Hypersensitivity, including sulfite allergy
  • Lactation: Avoid if breast-feeding (risk of death in infant);
  • Concurrent use of MAOIs
  • Pedi:   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
  • Geri:  Elderly may be more susceptible to adverse reactions;
  • OB:  Use in pregnancy only if clearly needed
  • Pedi:  Younger children may be more sensitive to sedation or excitation.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, sedation

Resp: thickened bronchial secretions

GI: epigastric distress

Neuro: disturbed coordination

* CAPITALS indicate life-threatening.
Underline indicate most frequent.



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


Use appropriate measuring device

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

PO (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.


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


  • 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 Diagnoses


  • Begin with lowest dose and increase as needed and tolerated. Dose is based on condition severity and patient response.
  • PO 

    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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Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drugs, procedures, and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and PRIME Journals. .