Bromhexine + Chlorpheniramine Maleate + Dextromethorphan Hydrobromide + Guaifenesin + Pseudoephedrine

Usage

This combination medication is primarily prescribed for the relief of cough, nasal congestion, and other symptoms associated with the common cold, allergies, or other respiratory tract infections. It is not available as a single formulation; instead, similar combinations with phenylephrine are available. The provided combination contains a mucolytic, antihistamine, cough suppressant, expectorant, and decongestant.

Pharmacological Classification:

This combination includes drugs from the following classifications:

• Mucolytic: Bromhexine
• Antihistamine: Chlorpheniramine Maleate
• Cough Suppressant: Dextromethorphan Hydrobromide
• Expectorant: Guaifenesin
• Decongestant: Pseudoephedrine (Note: Sources mention Phenylephrine, a similar decongestant, instead of Pseudoephedrine)

Mechanism of Action: This combination works by thinning and loosening mucus (Bromhexine, Guaifenesin), suppressing the cough reflex (Dextromethorphan), reducing allergic responses (Chlorpheniramine), and relieving nasal congestion by constricting blood vessels in the nasal passages (Pseudoephedrine/Phenylephrine).

Alternate Names

There is no one official international nonproprietary name (INN) for this combination product as it is not commonly available with pseudoephedrine. The individual components have the following INNs: Bromhexine Hydrochloride, Chlorpheniramine Maleate, Dextromethorphan Hydrobromide, Guaifenesin, and Pseudoephedrine Hydrochloride/Sulfate. Brand names vary depending on the manufacturer and region. One brand name mentioned in the sources containing a similar combination (with Phenylephrine) is Bodrexin Flu & Batuk (Indonesia).

How It Works

Pharmacodynamics:

• Bromhexine: Reduces mucus viscosity by breaking disulfide bonds in mucoproteins.
• Chlorpheniramine: Antagonizes histamine H1 receptors, reducing allergic symptoms.
• Dextromethorphan: Suppresses the cough reflex by acting centrally on the medulla oblongata.
• Guaifenesin: Increases respiratory tract fluid secretions, making it easier to cough up phlegm.
• Pseudoephedrine: Alpha-adrenergic agonist causing vasoconstriction in the nasal mucosa, relieving congestion.

Pharmacokinetics: All components are absorbed orally. Metabolism is primarily hepatic via CYP450 enzymes, especially for Dextromethorphan and Chlorpheniramine. Elimination is primarily renal. Pseudoephedrine is partially metabolized and partially excreted unchanged in the urine.

Dosage

As this specific combination is not generally available commercially, dosage information is not provided in standard resources. Dosage information for similar combinations containing phenylephrine is available, as outlined below. Always consult local guidelines and product-specific information.

Standard Dosage for a combination containing Phenylephrine:

Adults: 10 mL orally every 6 hours, not exceeding 4 doses daily (for a syrup containing 2 mg chlorpheniramine, 15 mg dextromethorphan, 100 mg guaifenesin, and 10 mg phenylephrine per 5 mL).

Children:

• 6-12 years: 5 mL every 6 hours, not exceeding 4 doses daily.
• 2-6 years: 2.5 mL every 6 hours, not exceeding 4 doses daily.

Special Cases: Dosage adjustments should be made based on patient factors like renal or hepatic impairment. Insufficient data exists in the sources to provide specific recommendations for these special cases.

Clinical Use Cases: There are no specific dosage recommendations for this combination in clinical settings like intubation, surgical procedures, or ICU use. Individual components may be used separately in such settings.

Side Effects

Common Side Effects: Drowsiness, dizziness, headache, nausea, vomiting, constipation, blurred vision.

Rare but Serious Side Effects: Allergic reactions (rash, itching, swelling), difficulty breathing, hallucinations, confusion.

Long-Term Effects: No specific long-term effects are typically associated with short-term use. Chronic use of Dextromethorphan can lead to psychological dependence.

Contraindications

• Hypersensitivity to any component.
• Severe respiratory depression.
• Monoamine oxidase inhibitors (MAOIs).
• Narrow-angle glaucoma.
• Urinary retention.
• Severe cardiovascular disease.

Drug Interactions

• MAOIs
• Alcohol
• Sedatives
• Tricyclic antidepressants
• Other anticholinergic medications

Pregnancy and Breastfeeding

The safety of this combination during pregnancy and breastfeeding has not been established. Consult specialist guidelines.

Drug Profile Summary (for a similar combination containing phenylephrine)

• Mechanism of Action: See “How It Works”
• Side Effects: See “Side Effects”
• Contraindications: See “Contraindications”
• Drug Interactions: See “Drug Interactions”
• Pregnancy & Breastfeeding: Consult specialist guidelines
• Dosage: See “Dosage”

Popular Combinations

Not applicable for this specific combination.

Precautions

See “Contraindications” and “Drug Interactions.” Avoid alcohol and other sedatives. Use caution in patients with hepatic or renal impairment, cardiovascular disease, or respiratory problems.

FAQs

Q1: What is the recommended dosage for a combination containing Bromhexine, Chlorpheniramine, Dextromethorphan, Guaifenesin, and Phenylephrine?

A: See the “Dosage” section above.

Q2: What are the common side effects?

A: Common side effects include drowsiness, dizziness, headache, nausea, vomiting, constipation, and blurred vision.

Q3: Is this combination safe during pregnancy?

A: Safety in pregnancy and breastfeeding has not been definitively established. Consult specialist guidelines.

Q4: What are the potential drug interactions?

A: Potentially interacting medications include MAOIs, alcohol, sedatives, tricyclic antidepressants, and other anticholinergic drugs.

Q5: What are the contraindications for this combination?

A: Contraindications include hypersensitivity to any component, severe respiratory depression, MAOI use, narrow-angle glaucoma, urinary retention, and severe cardiovascular disease.

Q6: How does this combination work to relieve cough and cold symptoms?

A: The individual components work synergistically by thinning mucus, suppressing cough, reducing allergic responses, and relieving nasal congestion.

Q7: What should patients avoid while taking this medication?

A: Patients should avoid alcohol and other sedatives, as they can exacerbate drowsiness and other side effects.

Q8: Are there any long-term effects associated with this combination?

A: No specific long-term effects are associated with short-term use. Chronic use of dextromethorphan can potentially lead to dependence.

Q9: What should I do if a patient experiences an allergic reaction to this medication?

A: Discontinue the medication immediately and seek emergency medical assistance.