Bromhexine + Chlorpheniramine Maleate + Dextromethorphan Hydrobromide + Menthol

Usage

This combination medication is primarily prescribed for the symptomatic relief of cough associated with the common cold, allergies, or other respiratory tract infections. It is indicated for productive coughs where thinning and loosening of mucus is beneficial. It combines several drug classes for a multi-pronged approach:

• Mucolytic (Bromhexine): Breaks down mucus, making it less viscous and easier to expectorate.
• Antihistamine (Chlorpheniramine Maleate): Reduces allergic symptoms like sneezing, runny nose, and itchy throat.
• Cough Suppressant (Dextromethorphan Hydrobromide): Suppresses the cough reflex by acting on the cough center in the brain.
• Topical Anesthetic/Cooling Agent (Menthol): Soothes throat irritation.

Alternate Names

While there isn’t a universally recognized alternate name for this specific four-drug combination, each individual ingredient has various names. It is essential to carefully check the composition when encountering similar formulations. Some brand names may exist in different regions, but a comprehensive international list is currently unavailable. It is important to note that as of June 3, 2023, this specific combination, along with several others containing similar ingredients, has been banned in India due to lack of therapeutic justification and potential risks.

How It Works

Pharmacodynamics:

• Bromhexine: Depolymerizes mucopolysaccharides, reducing mucus viscosity.
• Chlorpheniramine: A first-generation antihistamine that competitively antagonizes H1 receptors.
• Dextromethorphan: NMDA receptor antagonist and sigma-1 receptor agonist, suppressing the cough reflex.
• Menthol: TRPM8 receptor agonist producing a cooling sensation and mild local anesthetic effect.

Pharmacokinetics:

• Bromhexine: Well-absorbed orally. Metabolized in the liver and excreted primarily in urine.
• Chlorpheniramine: Readily absorbed from the GI tract. Metabolized in the liver, with some renal excretion.
• Dextromethorphan: Extensively metabolized in the liver, primarily by CYP2D6. Excreted in urine.
• Menthol: Absorbed through skin and mucous membranes. Metabolized in the liver and excreted in urine and bile.

Dosage

As of June 3, 2023, the Indian government has banned this combination. The information below is provided for historical context and for informational purposes only, and should not be interpreted as a recommendation for use.

Standard Dosage (Pre-Ban Information, India): It was recommended to consult a doctor for dosage specifics as the combination was not officially approved. The individual components have their own dosing guidelines.

• Adults: The usual adult dose of Bromhexine is 8-16mg thrice daily. The usual adult dose of Chlorpheniramine Maleate is 4 mg every 4-6 hours. The usual adult dose of Dextromethorphan Hydrobromide is 10-30 mg every 4-8 hours. The dosage of Menthol varies depending on the formulation.
• Children: Dosage was based on age and weight; however, this combination was not officially approved for pediatric use. The pediatric dose of Bromhexine is 2mg thrice daily for children aged 2–5 years, 4mg thrice daily for children aged 6-12 years and 8 mg thrice daily in children older than 12 years.

Side Effects

Common Side Effects:

• Drowsiness
• Dizziness
• Nausea
• Vomiting
• Headache
• Dry mouth
• Constipation

Rare but Serious Side Effects:

• Allergic reactions (rash, itching, swelling)
• Breathing difficulty
• Hallucinations
• Seizures
• Irregular heartbeat

Contraindications

• Hypersensitivity to any of the components
• Concurrent or recent use of MAO inhibitors
• Narrow-angle glaucoma
• Urinary retention
• Severe hypertension or coronary artery disease

Drug Interactions

• MAO inhibitors
• Alcohol
• CNS depressants (e.g., sedatives, hypnotics)
• Anticholinergic agents
• Tricyclic antidepressants
• Certain antihypertensives

Pregnancy and Breastfeeding

The safety of this specific combination has not been established. Consult a doctor if pregnant or breastfeeding. Some individual components have known risks.

Drug Profile Summary

(Note: This profile is incomplete as the combination is not standardized.)

Popular Combinations

This specific combination was not popular and is now banned.

Precautions

• Use with caution in patients with cardiovascular disease, glaucoma, prostatic hypertrophy, hyperthyroidism, or renal/hepatic impairment.
• Avoid alcohol and other CNS depressants.
• May impair driving or operating machinery.

FAQs

(The combination is banned, and FAQs are not relevant in this specific format.)