Usage
This combination medication is primarily prescribed for filarial infections (like lymphatic filariasis) and tropical pulmonary eosinophilia. It targets the parasitic infection and manages associated allergic symptoms.
Pharmacological Classification: Antiparasitic, antihistamine, mucolytic.
Mechanism of Action: This combination works through the synergistic action of its three components:
- Diethylcarbamazine (DEC): Immobilizes and kills microfilariae (larval stage of filarial worms) by affecting their neuromuscular function, increasing their vulnerability to the host’s immune system.
- Cetirizine: An antihistamine that blocks histamine H1 receptors, reducing allergic reactions (itching, swelling, inflammation) linked to filarial infections.
- Bromhexine: A mucolytic that thins and loosens mucus in the airways, easing its expulsion and managing respiratory symptoms related to the infection or allergic response.
Alternate Names
No specific alternate names exist for this combination. It is typically referred to by its constituent generic names. Brand names may vary regionally. A popular brand name in India is Bcd.
How It Works
Pharmacodynamics:
- DEC: Affects the neuromuscular function of microfilariae, leading to paralysis and death.
- Cetirizine: Antagonizes the effects of histamine at H1 receptors, reducing allergic symptoms.
- Bromhexine: Alters the structure of mucus, reducing its viscosity and making it easier to clear.
Pharmacokinetics:
- Absorption: DEC and cetirizine are well-absorbed orally. Bromhexine is also absorbed orally and metabolized to its active metabolite, ambroxol.
- Metabolism: DEC is extensively metabolized in the liver. Cetirizine undergoes less extensive metabolism. Bromhexine is metabolized in the liver to ambroxol.
- Elimination: DEC and its metabolites are primarily excreted in the urine. Cetirizine is also mainly excreted unchanged in the urine. Bromhexine and ambroxol are eliminated through renal excretion.
Mode of Action:
- DEC: Disrupts neuromuscular transmission in microfilariae.
- Cetirizine: Competitively inhibits histamine binding to H1 receptors.
- Bromhexine: Depolymerizes mucopolysaccharides, reducing mucus viscosity.
Dosage
Standard Dosage
Adults:
One tablet containing 8 mg bromhexine, 10 mg cetirizine, and 50 mg diethylcarbamazine. Dosage frequency and treatment duration are determined by the physician based on the specific infection.
Children:
Pediatric dosing is determined by a physician, considering the child’s age and weight. Cetirizine is generally considered safe for children older than 6 months, but DEC is typically not recommended for young children.
Special Cases:
- Elderly Patients: Dose adjustment may be necessary. Start with a lower dose and monitor for adverse effects.
- Patients with Renal Impairment: Dose reduction is required.
- Patients with Hepatic Dysfunction: Dose adjustment may be required.
- Patients with Comorbid Conditions: Careful consideration of potential drug interactions is essential; adjust treatment as needed.
Clinical Use Cases
Dosage adjustments for specific clinical settings (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations) should be determined on a case-by-case basis by the treating physician, considering patient-specific factors and the underlying condition.
Dosage Adjustments
Dose modifications are based on individual patient characteristics, including renal/hepatic dysfunction, metabolic disorders, or genetic polymorphisms affecting drug metabolism.
Side Effects
Common Side Effects:
Nausea, fatigue, loss of appetite, dry mouth, dizziness, sleepiness, headache, allergic reactions.
Rare but Serious Side Effects:
Severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, liver dysfunction, seizures.
Long-Term Effects:
Chronic complications from prolonged use are rare, but monitoring for liver and kidney function is advisable.
Adverse Drug Reactions (ADR):
Severe skin reactions, angioedema, anaphylaxis, hepatotoxicity.
Contraindications
Hypersensitivity to any component; severe renal or hepatic impairment; pregnancy (DEC); breastfeeding (DEC and cetirizine).
Drug Interactions
Alcohol (increased drowsiness with cetirizine); other antihistamines (additive sedative effects); CNS depressants (enhanced sedation); MAO inhibitors (potential for serotonin syndrome with cetirizine). Diphenhydramine, duloxetine, and pregabalin.
Pregnancy and Breastfeeding
Pregnancy: DEC and cetirizine are contraindicated during pregnancy.
Breastfeeding: DEC and cetirizine are contraindicated during breastfeeding.
Drug Profile Summary
- Mechanism of Action: See above.
- Side Effects: Nausea, fatigue, dry mouth, dizziness, headache, allergic reactions; rarely, severe skin reactions or liver dysfunction.
- Contraindications: Hypersensitivity, severe renal/hepatic impairment, pregnancy, breastfeeding.
- Drug Interactions: Alcohol, other antihistamines, CNS depressants, MAO inhibitors, Diphenhydramine, duloxetine, and pregabalin.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: See above.
- Monitoring Parameters: Liver and renal function tests, complete blood count, observation for allergic reactions.
Popular Combinations
This specific combination is itself a standard regimen for filarial infections.
Precautions
- General Precautions: Pre-screening for allergies, metabolic disorders, organ dysfunction.
- Pregnant Women: Contraindicated.
- Breastfeeding Mothers: Contraindicated.
- Children & Elderly: Dose adjustments may be necessary.
- Lifestyle Considerations: Avoid alcohol; caution with driving or operating machinery due to potential drowsiness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Cetirizine + Diethylcarbamazine?
A: The standard dose is one tablet (8 mg bromhexine, 10 mg cetirizine, 50 mg DEC), but the regimen should be individualized.
Q2: Can this combination be used in children?
A: Cetirizine can be used in children over 6 months, but DEC is generally avoided in young children. A physician should determine pediatric dosing.
Q3: What are the common side effects?
A: Common side effects include nausea, fatigue, dry mouth, dizziness, sleepiness, and headache.
Q4: Are there any serious side effects?
A: Rare but serious side effects include severe allergic reactions, liver dysfunction, and seizures.
Q5: Can this combination be taken during pregnancy or breastfeeding?
A: No, it’s contraindicated in both pregnancy and breastfeeding due to the risks associated with DEC and cetirizine.
Q6: What are the contraindications for this drug?
A: Contraindications include hypersensitivity to any component, severe renal or hepatic impairment, pregnancy, and breastfeeding.
Q7: What other medications should be avoided while taking this combination?
A: Avoid alcohol, other antihistamines, CNS depressants, and MAO inhibitors, Diphenhydramine, duloxetine, and pregabalin. Consult a doctor before starting any new medication.
Q8: What precautions should be taken while using this medication?
A: Monitor liver and kidney function, and observe for allergic reactions. Avoid alcohol and use caution while driving or operating machinery. Elderly patients may require dose adjustments.
Q9: What is the mechanism of action of each component?
A: DEC disrupts the neuromuscular function of microfilariae. Cetirizine blocks histamine H1 receptors. Bromhexine thins and loosens mucus.
