Bromhexine + Chlorpheniramine Maleate + Ephedrine + Guaifenesin

Usage

• This combination medication is prescribed for the symptomatic relief of common cold and flu symptoms, including cough (particularly productive cough), nasal and chest congestion, runny nose, sneezing, and itchy or watery eyes. It is indicated for productive coughs where thinning of mucus is beneficial.
• Pharmacological Classification: This is a combination product containing drugs from different classifications:
  • Bromhexine: Mucolytic
  • Chlorpheniramine: Antihistamine
  • Ephedrine: Decongestant, Bronchodilator
  • Guaifenesin: Expectorant
• Mechanism of Action: This combination works by thinning and loosening mucus (Bromhexine, Guaifenesin), reducing allergic responses like sneezing and runny nose (Chlorpheniramine), and relieving nasal congestion by constricting blood vessels (Ephedrine). Ephedrine also acts as a bronchodilator.

Alternate Names

• There is no internationally recognized non-proprietary name for this specific four-drug combination. Brand names vary regionally. It’s sometimes referred to as a cough and cold preparation.
• Some brand names include: Sudin Plus. More brand names may exist depending on the region and specific manufacturer.

How It Works

• Pharmacodynamics:
  • Bromhexine: Depolymerizes mucopolysaccharides, reducing mucus viscosity.
  • Chlorpheniramine: Antagonizes histamine H1 receptors.
  • Ephedrine: Stimulates alpha and beta-adrenergic receptors, leading to vasoconstriction and bronchodilation.
  • Guaifenesin: Increases respiratory tract fluid secretions.
• Pharmacokinetics: Absorption, metabolism, and elimination data for this specific combination are limited. Individual drug components have the following characteristics:
  • Bromhexine: Well-absorbed orally, metabolized in the liver, and excreted renally.
  • Chlorpheniramine: Well-absorbed orally, metabolized in the liver, and excreted renally.
  • Ephedrine: Readily absorbed orally, partially metabolized in the liver, and excreted renally.
  • Guaifenesin: Readily absorbed orally, metabolized in the liver, and excreted renally.
• Mode of Action:
  • Bromhexine: Acts on the mucus at a molecular level, breaking down the long chain-like structures, making it thinner and less sticky.
  • Chlorpheniramine: Blocks the action of histamine at H1 receptors, reducing allergic symptoms.
  • Ephedrine: Stimulates adrenergic receptors, causing vasoconstriction in the nasal passages and bronchodilation in the airways.
  • Guaifenesin: Irritates the gastric mucosa, indirectly increasing respiratory tract secretions, thus thinning mucus.
• Elimination Pathways: Primarily renal excretion for all components, with varying degrees of hepatic metabolism.

Dosage

Specific dosage guidelines for this four-drug combination are limited. Dosage is best determined by a physician based on individual patient needs. Please consult the prescribing information for the specific product used.

Standard Dosage

Adults: Information not available in the provided sources.

Children: This combination is generally not recommended for young children. A doctor should be consulted for appropriate pediatric use. Refer to source [14] for similar combinations dosing in children.

Special Cases: Dosage adjustments are typically made based on individual patient characteristics, including renal and hepatic function.

Clinical Use Cases

Dosage recommendations for specific clinical situations (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations) are not available for this specific drug combination.

Dosage Adjustments

Dose modifications may be required based on renal/hepatic function and other patient-specific factors. A physician should be consulted for guidance.

Side Effects

Common Side Effects

• Nausea
• Vomiting
• Dizziness
• Headache
• Sleepiness
• Dry mouth
• Anxiety
• Restlessness
• Insomnia
• Increased heart rate

Rare but Serious Side Effects

• Allergic reactions (rash, hives)
• Hallucinations (particularly in elderly patients and children)

Long-Term Effects

Data on long-term effects are limited.

Adverse Drug Reactions (ADR)

Clinically significant ADRs warranting immediate attention include severe allergic reactions, significant changes in heart rate or blood pressure, and hallucinations.

Contraindications

• Hypersensitivity to any of the components.
• Severe hypertension or significant cardiovascular disease.
• Hyperthyroidism.
• Patients who have taken an MAO inhibitor in the past 14 days.

Drug Interactions

• MAO inhibitors: Increased risk of hypertensive crisis.
• Tricyclic antidepressants: Enhanced pressor effect of ephedrine.
• Beta-blockers: Reduced bronchodilator effects of ephedrine.
• Alcohol: Increased risk of side effects, especially drowsiness and dizziness. It may also interact with the individual components.

Pregnancy and Breastfeeding

Safety during pregnancy and breastfeeding has not been fully established. It is recommended to consult a physician before use.

Drug Profile Summary

Refer to the sections above for a detailed summary.

Popular Combinations

This combination itself is a commonly used formulation. Additional ingredients like analgesics (e.g., paracetamol) or antitussives (e.g., dextromethorphan) may be included in some formulations.

Precautions

• General Precautions: Pre-existing medical conditions (especially renal or hepatic impairment, cardiovascular disease, and hyperthyroidism) should be assessed before initiating therapy. Concomitant medications should be carefully reviewed for potential interactions.
• Specific Populations:
  • Pregnant Women: Consult a physician before use.
  • Breastfeeding Mothers: Consult a physician before use.
  • Children & Elderly: Use with caution due to increased risk of side effects. Dosage adjustments might be required.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Bromhexine + Chlorpheniramine Maleate + Ephedrine + Guaifenesin?

A: Dosage information for this specific four-drug combination is limited and should be determined by a physician.

Q2: What are the primary uses of this combination?

A: It’s primarily used to relieve symptoms of the common cold, flu, and other upper respiratory tract infections, particularly productive cough with associated congestion.

Q3: Can this combination be used during pregnancy or while breastfeeding?

A: Safety during pregnancy and breastfeeding hasn’t been fully established. Consult a physician before use.

Q4: What are the common side effects?

A: Common side effects include nausea, vomiting, dizziness, headache, dry mouth, drowsiness, anxiety, insomnia, and increased heart rate.

Q5: Are there any serious side effects I should be aware of?

A: While rare, allergic reactions and hallucinations can occur. Changes in heart rate and blood pressure should also be monitored.

Q6: What are the contraindications to using this medication?

A: Contraindications include hypersensitivity to any of the components, severe hypertension or cardiovascular disease, hyperthyroidism, and recent MAOI use.

Q7: Does this combination interact with other medications?

A: Yes, it can interact with MAO inhibitors, tricyclic antidepressants, and beta-blockers. Alcohol should also be avoided. Consult a doctor for other interactions.

Q8: What precautions should be taken when prescribing this medication?

A: Assess pre-existing medical conditions, drug allergies, and potential drug interactions before initiating therapy. Monitor blood pressure and heart rate, particularly in patients with cardiovascular disease. Exercise caution in patients with renal or hepatic impairment, and in children and the elderly. A physician should be consulted.

Q9: How does each component of the medication contribute to its overall effect?

A: Bromhexine and Guaifenesin thin and loosen mucus, Chlorpheniramine reduces allergic symptoms, and Ephedrine acts as a decongestant and bronchodilator.