Usage
Bromhexine + Chlorpheniramine Maleate is prescribed for the relief of coughs associated with mucus (productive cough) in conditions like common cold, allergies, and certain respiratory infections such as bronchitis. It may also be used to manage symptoms like runny nose, sneezing, itchy and watery eyes, and itchy nose or throat.
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Pharmacological Classification:
- Bromhexine: Mucolytic, Expectorant
- Chlorpheniramine Maleate: Antihistamine (first generation, sedating)
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Mechanism of Action: Bromhexine breaks down mucus, making it less viscous and easier to expel. Chlorpheniramine maleate blocks the action of histamine, reducing allergy symptoms.
Alternate Names
While “Bromhexine + Chlorpheniramine Maleate” is the standard generic name, variations may exist internationally. This combination is often found as part of multi-ingredient cold and cough medications.
- Brand Names: This combination is marketed under various brand names, some of which include Askafex-BR and Inacin Cold depending on the region and specific formulation.
How It Works
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Pharmacodynamics: Bromhexine reduces mucus viscosity by breaking down mucopolysaccharide fibers. Chlorpheniramine maleate antagonizes the H1 histamine receptor, reducing capillary permeability and smooth muscle contraction, thereby mitigating allergic manifestations.
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Pharmacokinetics:
- Bromhexine: Readily absorbed orally. Metabolized in the liver, primarily via hepatic CYP enzymes, and excreted renally.
- Chlorpheniramine Maleate: Well-absorbed orally. Metabolized in the liver and eliminated through renal excretion.
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Mode of Action: Bromhexine alters the structure and reduces the viscosity of mucus. Chlorpheniramine maleate competitively inhibits the binding of histamine to its H1 receptors.
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Elimination Pathways: Both drugs are primarily metabolized in the liver and excreted through the kidneys.
Dosage
The dosage information provided below pertains to the Bromhexine and Chlorpheniramine combination and may differ depending on the specific formulation. Please refer to the individual product information and consult patient history for accurate prescription.
Standard Dosage
Adults:
Bromhexine: 8 mg three times a day. This may be increased up to 16 mg three times a day, especially during the initial days of treatment.
Chlorpheniramine: 4 mg every 4-6 hours, not exceeding 24 mg/day. Extended-release preparations allow for less frequent dosing.
Children:
Dosing in children is dependent on age and weight and should be carefully determined by a doctor. Children younger than 6 years old should not be given over-the-counter cough and cold medications containing multiple ingredients including Chlorpheniramine. A general guideline is provided below, however always refer to specific product information:
Chlorpheniramine:
- 2-6 years: 1 mg every 4-6 hours, not exceeding 6 mg/day
- 6-12 years: 2 mg every 4-6 hours, not exceeding 12 mg/day
- 12+ years: adult dose
Bromhexine:
- 2-5 years: 2 mg three times a day or 4 mg twice daily (max 8mg daily)
- 6-11 years: 4-8 mg three times daily (max 24mg daily)
- 12+ years: adult dose
Special Cases:
- Elderly Patients: Reduced doses are often necessary due to age-related decline in organ function. Start with lower doses and monitor closely.
- Patients with Renal Impairment: Dose adjustments are essential due to reduced clearance; consult a nephrologist for appropriate dose adjustments.
- Patients with Hepatic Dysfunction: Reduced doses are recommended. Close monitoring is crucial.
- Patients with Comorbid Conditions: Caution is advised for patients with hypertension, hyperthyroidism, diabetes, glaucoma, prostatic enlargement, gastric ulcer, cardiovascular disease, asthma, and COPD. Individualized assessment and dose modifications may be necessary.
Clinical Use Cases
The Bromhexine + Chlorpheniramine Maleate combination is generally not indicated for use in specific clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. It’s primarily used for outpatient management of cough and cold symptoms. Other medications are typically preferred in these specialized medical contexts.
Dosage Adjustments
Adjustments should be based on individual patient factors, including renal or hepatic function, comorbid conditions, concomitant medications, and age. Therapeutic drug monitoring might be helpful in some cases. Genetic polymorphisms affecting drug metabolism could influence dosing.
Side Effects
Common Side Effects:
- Drowsiness
- Dizziness
- Dry mouth, nose, and throat
- Nausea and vomiting
- Blurred vision
- Constipation
- Headache
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, angioedema, anaphylaxis)
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
Long-Term Effects:
Chronic complications are generally not associated with this combination when used as directed. However, prolonged use of antihistamines can sometimes lead to tolerance.
Adverse Drug Reactions (ADR):
Severe drowsiness, confusion, hallucinations, and other anticholinergic effects, particularly in elderly and pediatric patients.
Contraindications
- Hypersensitivity to bromhexine or chlorpheniramine maleate
- Severe liver or kidney impairment
- Severe coronary artery disease or hypertension
- Acute asthma attack
- MAO inhibitor use within the past 14 days
- Narrow-angle glaucoma
- Symptomatic prostatic hypertrophy
- Bladder neck or pyloroduodenal obstruction
- Children under 2 years of age (Chlorpheniramine)
- Patients under 4 years of age (for combinations with Dextromethorphan)
Drug Interactions
- Alcohol (increased drowsiness)
- Other antihistamines (additive sedative effects)
- Antidepressants (e.g., MAOIs, tricyclic antidepressants)
- Sedatives and tranquilizers
- Opioid pain relievers
- Anticholinergic drugs
Pregnancy and Breastfeeding
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Pregnancy: The safety of this combination during pregnancy has not been fully established. Consult a doctor before use if pregnant.
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Breastfeeding: Small, occasional doses of chlorpheniramine may be acceptable, but larger or prolonged use may affect the infant or milk supply. Bromhexine safety during breastfeeding is not fully established. Alternatives may be preferable.
Drug Profile Summary
- Mechanism of Action: Bromhexine: Mucolytic; Chlorpheniramine: Antihistamine
- Side Effects: Drowsiness, dry mouth, dizziness, nausea, blurred vision
- Contraindications: Hypersensitivity, severe liver/kidney disease, MAOI use, other specific conditions as mentioned earlier
- Drug Interactions: Alcohol, other antihistamines, antidepressants, sedatives, opioids
- Pregnancy & Breastfeeding: Consult a doctor before use
- Dosage: Varies with age, condition, and formulation; consult prescribing information
- Monitoring Parameters: Respiratory status, allergic symptoms, side effects
Popular Combinations
This combination is often included in formulations with other ingredients such as:
- Guaifenesin: Expectorant
- Dextromethorphan: Cough suppressant
- Phenylephrine: Decongestant
- Paracetamol/Acetaminophen: Analgesic and antipyretic
The rationale for these combinations is to provide broader symptomatic relief for cough, cold, and allergy symptoms.
Precautions
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General Precautions: Evaluate patient history for allergies, metabolic disorders, or organ dysfunction.
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Specific Populations: As described previously, exercise caution in pregnant women, breastfeeding mothers, children, and the elderly.
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Lifestyle Considerations: Avoid alcohol and activities requiring alertness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Chlorpheniramine Maleate?
A: Dosage varies depending on age, condition, and formulation. Please refer to the detailed dosage section and specific product information.
Q2: Can this combination be used in children?
A: Yes, but dosing requires careful consideration based on age and weight. Do not administer Chlorpheniramine to children under 2. Consult with pediatrician for appropriate dosage information.
Q3: Is it safe to take this combination during pregnancy or while breastfeeding?
A: Consult a physician before use during pregnancy or breastfeeding as safety is not fully established.
Q4: What are the common side effects?
A: Drowsiness, dry mouth, dizziness, nausea, and blurred vision are common side effects.
Q5: What are the serious side effects that require medical attention?
A: Severe allergic reactions, skin reactions like Stevens-Johnson syndrome, and severe anticholinergic effects necessitate immediate medical attention.
Q6: Can I consume alcohol while taking this medication?
A: Alcohol should be avoided as it can exacerbate the sedative effects of the medication.
Q7: What are the contraindications for this medication?
A: Hypersensitivity, severe liver or kidney disease, MAOI use, certain other medical conditions as mentioned earlier are contraindications.
Q8: Does Bromhexine + Chlorpheniramine interact with any other drugs?
A: Yes, it can interact with other antihistamines, antidepressants, sedatives, opioids and certain antibiotics.
Q9: How does Bromhexine + Chlorpheniramine work to alleviate cough and cold symptoms?
A: Bromhexine thins and loosens mucus, making it easier to cough up, while chlorpheniramine reduces allergic symptoms like runny nose and sneezing.
Q10: Can this medication be used for a dry cough?
A: It is primarily indicated for productive coughs associated with mucus. It might not be the best choice for a dry cough.
