Guaifenesin Dosing in Inpatient Settings
The recommended dosing for guaifenesin in inpatient settings is 200-400 mg every 4 hours or 600-1200 mg extended-release formulation every 12 hours, with a maximum daily dose of 2400 mg.
Dosing Guidelines
Immediate-Release Formulation
- Standard adult dose: 200-400 mg every 4 hours
- Maximum daily dose: 2400 mg (6 doses of 400 mg)
- Administration: Can be given with or without food
Extended-Release Formulation
- Standard adult dose: 600-1200 mg every 12 hours
- Maximum daily dose: 2400 mg (2 doses of 1200 mg)
- Administration: Can be taken with or without food, though food may delay peak concentration (Tmax) 1
Clinical Considerations
Mechanism of Action
Guaifenesin works as an expectorant by:
- Loosening mucus in the airways
- Making coughs more productive
- Promoting effective mucus clearance
- Potentially inhibiting cough reflex sensitivity in patients with upper respiratory infections 2
Indications in Inpatient Setting
- Productive cough with mucus hypersecretion
- Chest congestion due to upper respiratory tract infections
- Adjunctive therapy in stable chronic bronchitis 3
Pharmacokinetics
- Absorption: Rapid absorption with immediate-release formulation
- Peak concentration (Tmax): Approximately 15 minutes for immediate-release formulation
- Half-life: Approximately 2.6 hours 4
- Extended-release formulation: Provides sustained therapeutic effect over 12 hours 1
Special Populations and Considerations
Renal Impairment
- No specific dosage adjustments are recommended in the available guidelines
- Consider monitoring for adverse effects in patients with severe renal impairment
Hepatic Impairment
- No specific dosage adjustments are recommended in the available guidelines
- Use with caution in patients with severe hepatic impairment
Elderly Patients
- Standard adult dosing is generally appropriate
- Consider starting at the lower end of the dosing range
Safety Considerations
Adverse Effects
- Generally well-tolerated with mild side effects
- Common adverse effects include:
- Nausea
- Vomiting
- Gastrointestinal discomfort
- Drowsiness
Toxicity
- Rare cases of severe central nervous system depression have been reported with massive overdose 5
- Monitor for signs of CNS depression in cases of suspected overdose
Drug Interactions
- No significant drug interactions are documented in the available guidelines
- Can be used concomitantly with most medications commonly prescribed for respiratory conditions
Practical Administration Tips
- For patients with difficulty swallowing, immediate-release tablets can be crushed or liquid formulations can be used
- Extended-release tablets should not be crushed or chewed
- For patients requiring around-the-clock symptom control, the extended-release formulation offers more convenient dosing (every 12 hours versus every 4 hours)
- Encourage adequate hydration to enhance the expectorant effect
Monitoring
- Assess for clinical response (improved productive cough, decreased chest congestion)
- Monitor for adverse effects
- Evaluate the need for continued therapy based on clinical response