**BEERS Drug**


Trade Name(s)

  • Karbinal ER

Ther. Class.

allergy, cold and cough remedies

none assigned

Pharm. Class.



  • Seasonal and perennial allergic rhinitis.
  • Vasomotor rhinitis.
  • Allergic conjunctivitis due to inhalant allergens and foods.
  • Mild, uncomplicated allergic skin manifestations of urticaria and angioedema.
  • Dermatographism.
  • Anaphylaxis (as adjunct to epinephrine after acute manifestations controlled).
  • Allergic reactions to blood or 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: Unknown

Metabolism and Excretion: Extensively metabolized by the liver, inactive metabolites excreted in urine. Negligible renal elimination of unchanged drug.

Half-life: 17 hr

TIME/ACTION PROFILE (plasma concentrations)

PO-IRunknownunknown4 hr
PO-ERunknown6.7 hr12 hr


Contraindicated in:

  • Hypersensitivity, including sulfite allergy
  •  Lactation: Lactation (risk of death in children <2 yr);
  • Concurrent use of MAO inhibitors
  • 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
  • OB:  Safety not established in pregnancy;
  • Pedi:  Younger children may be more sensitive to sedation or excitation
  • Geri:  Older adults may be more susceptible to adverse reactions.

Adverse Reactions/Side Effects

Resp: thickened bronchial secretions

GI: epigastric distress

Neuro: disturbed coordination, dizziness, drowsiness, sedation

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



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


PO (Adults and Children ≥ 12 yr): Immediate-release tablets or solution– 4–8 mg 3–4 times daily;  Extended-release suspension– 6–16 mg every 12 hr.

PO (Children 6–11 yr): Immediate-release tablets or solution– 2–4 mg 3–4 times daily;  Extended-release suspension– 6–12 mg every 12 hr.

PO (Children 4–5 yr): Immediate-release solution– 1–2 mg 3–4 times daily;  Extended-release suspension– 3–8 mg every 12 hr.

PO (Children 2–3 yr): Immediate-release solution– 1–2 mg 3–4 times daily;  Extended-release suspension– 3–4 mg every 12 hr.

Availability (generic available)

Immediate-release tablets: 4 mg

Immediate-release oral solution (banana bubble gum flavor): 4 mg/5 mL

Extended-release oral suspension (contains metabisulfite) (strawberry banana flavor): 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. May be fatal if administered to children under 2 yr.

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
  • Rep:  Instruct females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Monitor infants breastfeeding mothers taking carbinoxamine for drowsiness and irritability.

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. .