Bromhexine + Chlorpheniramine Maleate + Ephedrine + Guaifenesin + Paracetamol

Usage

This combination medication is prescribed for symptomatic relief of common cold and flu symptoms, including cough (especially productive cough), nasal and chest congestion, runny nose, sneezing, fever, headache, and body aches.

Pharmacological Classification: This combination includes drugs from several pharmacological classes:

• Bromhexine: Mucolytic
• Chlorpheniramine Maleate: Antihistamine (first-generation)
• Ephedrine: Decongestant, bronchodilator, sympathomimetic amine
• Guaifenesin: Expectorant
• Paracetamol: Analgesic, antipyretic

Mechanism of Action: The components of this combination medication work together to address various cold and flu symptoms. Bromhexine breaks down the mucus, making it less viscous and easier to expel. Chlorpheniramine maleate combats allergic symptoms like runny nose and sneezing by blocking histamine receptors. Ephedrine acts as a decongestant by constricting blood vessels in the nasal passages, and it also helps open up the airways. Guaifenesin aids in loosening and thinning mucus, making coughs more productive. Paracetamol reduces fever and relieves pain.

Alternate Names

There are no internationally recognized non-proprietary names for this specific five-drug combination. It is often referred to by its constituent drugs. Some brand names under which this combination is marketed include Frekof Tablet and Koff GO Tablet. Regional variations in brand names may exist.

How It Works

Pharmacodynamics: The combined action of the five ingredients provides comprehensive relief from cold and flu symptoms. Bromhexine reduces mucus viscosity, chlorpheniramine relieves allergy symptoms, ephedrine decongests and opens airways, guaifenesin thins mucus and promotes expectoration, and paracetamol alleviates pain and fever.

Pharmacokinetics:

• Absorption: All components are well-absorbed from the gastrointestinal tract.
• Metabolism: Primarily hepatic, though some components might have additional metabolic pathways.
• Elimination: Mainly renal excretion, but individual component pathways can vary.

Mode of Action:

• Bromhexine: Depolymerizes mucopolysaccharides, reducing mucus viscosity.
• Chlorpheniramine Maleate: Antagonizes H1 histamine receptors.
• Ephedrine: Stimulates α- and β-adrenergic receptors.
• Guaifenesin: Increases respiratory tract fluid secretions.
• Paracetamol: Inhibits prostaglandin synthesis in the CNS.

Dosage

Standard Dosage

Adults: One tablet every 4-6 hours as needed. The maximum daily dose should not exceed the recommended limits for the individual components, especially paracetamol.

Children: This specific combination is generally not recommended for children under 12 years of age. Alternative formulations are available for pediatric use. Consultation with a pediatrician is crucial for appropriate recommendations.

Special Cases:

• Elderly Patients: Initiate with a lower dose and closely monitor for adverse effects. Adjustments may be needed based on renal and hepatic function.
• Patients with Renal Impairment: Dose reduction may be necessary depending on the degree of impairment.
• Patients with Hepatic Dysfunction: Dose reduction is crucial due to the hepatic metabolism of several components, especially paracetamol. Careful monitoring of liver function is necessary.
• Patients with Comorbid Conditions: Exercise caution in patients with cardiovascular disease, hypertension, diabetes, hyperthyroidism, glaucoma, or prostatic hypertrophy. Dosage adjustments or alternative medications may be required.

Clinical Use Cases

This combination is typically not used in clinical settings like intubation, surgical procedures, mechanical ventilation, or ICU. Its primary use is for symptomatic relief of cold and flu symptoms. Individual components like paracetamol might be used in hospital settings for other purposes.

Dosage Adjustments

Dosage should be adjusted based on renal and hepatic function, age, concurrent medications, and the patient’s overall health status.

Side Effects

Common Side Effects:

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

Rare but Serious Side Effects:

• Allergic reactions (e.g., skin rash, hives, angioedema)
• Hepatotoxicity (especially with paracetamol overdose)
• Cardiac arrhythmias (due to ephedrine)
• Seizures (rare)

Long-Term Effects:

Chronic use is not advised due to the potential for adverse effects and tolerance to the decongestant. Prolonged, high-dose paracetamol use can elevate the risk of liver damage.

Adverse Drug Reactions (ADR): Any severe or persistent side effects should be considered an ADR and require immediate medical attention.

Contraindications

• Hypersensitivity to any component of the medication
• Severe liver or kidney impairment
• Severe coronary artery disease or hypertension
• Acute asthma attack or COPD
• Conditions like narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, bladder neck obstruction

Drug Interactions

This combination can interact with:

• Other antihistamines (e.g., diphenhydramine, cetirizine)
• Antidepressants (e.g., duloxetine, sertraline)
• Monoamine oxidase inhibitors (MAOIs) (e.g., phenelzine)
• Anticholinergic drugs (e.g., atropine)
• Antacids (e.g., ranitidine)
• CNS stimulants (e.g., methylphenidate)
• Cough suppressants (e.g., dextromethorphan)
• Narcotic analgesics (e.g., hydrocodone)
• Antianxiety drugs (e.g., alprazolam)
• Foods rich in carbohydrates and pectin
• Alcohol

Pregnancy and Breastfeeding

Safety during pregnancy and breastfeeding has not been definitively established for this specific combination. It’s best to avoid use during these periods unless the benefits clearly outweigh the potential risks. Some individual components, like paracetamol, might be considered safer than others. Consulting a doctor is crucial before use during pregnancy or breastfeeding.

Drug Profile Summary

• Mechanism of Action: See above.
• Side Effects: See above.
• Contraindications: See above.
• Drug Interactions: See above.
• Pregnancy & Breastfeeding: Consult a physician; generally avoid.
• Dosage: See above.
• Monitoring Parameters: Liver function tests, renal function, blood pressure, heart rate.

Popular Combinations

This combination itself is commonly prescribed. It is not generally combined with other medications.

Precautions

• Pre-existing medical conditions: Screen patients for conditions listed in contraindications.
• Pregnancy and breastfeeding: See above.
• Children and elderly: See dosage adjustments.
• Lifestyle: Advise patients to avoid alcohol and activities requiring alertness.

FAQs (Frequently Asked Questions)

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

A: See dosage section above.

Q2: Can this combination be used in children?

A: Generally not recommended for children under 12. Consult a pediatrician.

Q3: What are the common side effects?

A: Drowsiness, dizziness, nausea, vomiting, dry mouth, headache are common.

Q4: Are there any serious side effects?

A: Yes, rare but serious side effects include allergic reactions, hepatotoxicity, cardiac arrhythmias, and seizures.

Q5: Can this drug interact with other medications?

A: Yes, it can interact with a wide range of medications. See drug interactions above.

Q6: Can pregnant or breastfeeding women take this combination?

A: It’s generally best avoided during pregnancy and breastfeeding. Consult a doctor.

Q7: What precautions should be taken while using this drug?

A: Avoid alcohol, driving, and operating machinery. Monitor for adverse effects.

Q8: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember unless it’s close to the next scheduled dose. Do not double the dose.

Q9: What should I do in case of an overdose?

A: Seek immediate medical attention.