Usage
This combination medication is used for symptomatic relief of productive cough (cough with mucus) associated with the common cold, allergies, and other respiratory tract infections.
Pharmacological Classification:
- Bromhexine: Mucolytic
- Chlorpheniramine Maleate: Antihistamine (first-generation)
- Guaifenesin: Expectorant
Mechanism of Action: This combination works by thinning and loosening mucus in the airways, making it easier to cough up. Bromhexine breaks down the chemical structure of mucus, reducing its viscosity. Chlorpheniramine reduces allergic symptoms like runny nose and sneezing by blocking histamine. Guaifenesin increases the volume of fluids in the airways, further aiding in mucus removal.
Alternate Names
Bromhexine-Chlorpheniramine-Guaifenesin; Bromhexine Hydrochloride + Chlorpheniramine Maleate + Guaifenesin.
Brand Names: Cheston Expectorant, Kuff Q, and others.
How It Works
Pharmacodynamics: Bromhexine reduces mucus viscosity, Chlorpheniramine counteracts histamine’s effects, and Guaifenesin increases airway fluid volume to facilitate expectoration.
Pharmacokinetics:
- Absorption: All three drugs are absorbed orally.
- Metabolism: Primarily hepatic metabolism via CYP450 enzymes.
- Elimination: Mainly renal excretion, though some metabolites may be eliminated through bile.
Mode of Action:
- Bromhexine: Depolymerizes mucopolysaccharides in mucus, reducing its viscosity.
- Chlorpheniramine: Competitively antagonizes histamine at H1 receptors, mitigating allergic manifestations.
- Guaifenesin: Believed to stimulate receptors in the gastric mucosa, increasing respiratory tract fluid secretions.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation:
- Chlorpheniramine: H1 receptor antagonist.
Elimination pathways: Predominantly renal excretion.
Dosage
Standard Dosage
Adults:
8 mg Bromhexine, 4 mg Chlorpheniramine Maleate, and 100-200 mg Guaifenesin, orally, three to four times daily. The maximum daily dose should not exceed 32 mg Bromhexine, 24 mg Chlorpheniramine Maleate, and 2400 mg Guaifenesin.
Children:
Dosage must be determined by a physician based on the child’s weight or age. Use with caution in children younger than 6 years old.
Special Cases:
- Elderly Patients: Dose reduction may be needed due to decreased hepatic and renal function.
- Patients with Renal Impairment: Careful dose adjustment is necessary.
- Patients with Hepatic Dysfunction: Dose reduction may be required.
- Patients with Comorbid Conditions: Use with caution in patients with diabetes, hypertension, cardiovascular disease, glaucoma, peptic ulcer, hyperthyroidism, or prostatic hypertrophy.
Clinical Use Cases
Dosage in specialized clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations should be determined on a case-by-case basis by a physician.
Dosage Adjustments
Dose modifications may be necessary for renal/hepatic impairment, metabolic disorders, or potential drug interactions.
Side Effects
Common Side Effects
Drowsiness, dizziness, dry mouth/nose/throat, headache, nausea, vomiting, upset stomach, constipation, trouble sleeping.
Rare but Serious Side Effects
Allergic reactions (rash, itching, swelling), breathing difficulty, hallucinations, confusion, irregular heartbeat.
Long-Term Effects
Chronic complications are not typically associated with short-term use.
Adverse Drug Reactions (ADR)
Severe allergic reactions, significant respiratory depression, cardiac arrhythmias.
Contraindications
Hypersensitivity to any component, severe liver or kidney impairment, severe coronary artery disease, severe hypertension, acute asthma attack, chronic obstructive pulmonary disease (COPD), porphyria. MAOI use within the past 14 days.
Drug Interactions
Antihistamines, antidepressants (especially MAOIs), anticholinergics, alcohol, sedatives.
Pregnancy and Breastfeeding
Use only if clearly needed and under the supervision of a doctor. Safety during pregnancy and breastfeeding hasn’t been fully established. This drug may pass into breastmilk.
Drug Profile Summary
- Mechanism of Action: Bromhexine: Mucolytic, Chlorpheniramine: Antihistamine, Guaifenesin: Expectorant.
- Side Effects: Drowsiness, dizziness, dry mouth, nausea, constipation.
- Contraindications: Hypersensitivity, severe hepatic/renal impairment, severe cardiovascular disease.
- Drug Interactions: MAOIs, anticholinergics, alcohol.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
- Dosage: Adults: 8 mg/4 mg/100-200 mg three to four times daily. Children: As directed by a physician.
- Monitoring Parameters: Respiratory status, allergy symptoms, side effects.
Popular Combinations
Often combined with paracetamol/acetaminophen and phenylephrine for enhanced relief of cold and flu symptoms.
Precautions
Evaluate patients for pre-existing conditions, allergies, and potential drug interactions before initiating therapy. Advise caution with alcohol consumption and driving. Monitor for adverse effects.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Chlorpheniramine Maleate + Guaifenesin?
A: Adults: 8 mg Bromhexine, 4 mg Chlorpheniramine Maleate, and 100-200 mg Guaifenesin, orally, three to four times a day. Children: Dosage should be determined by a physician.
Q2: Can this combination be used in children?
A: It can be used in children, but with caution and appropriate dose adjustments as advised by a physician. Some formulations may not be suitable for young children.
Q3: Is it safe to use during pregnancy or while breastfeeding?
A: It is generally not recommended unless absolutely necessary and under strict medical supervision. The safety profile in these populations has not been definitively established.
Q4: What are the common side effects?
A: Drowsiness, dizziness, dry mouth, nausea, and constipation are the most frequently reported side effects.
Q5: Are there any serious side effects to be aware of?
A: While rare, serious side effects can include allergic reactions, difficulty breathing, hallucinations, confusion, and irregular heartbeat. Immediate medical attention is required if these occur.
Q6: Can I take this medication with alcohol?
A: Alcohol should be avoided while taking this medication as it can potentiate the sedative effects of chlorpheniramine, leading to increased drowsiness and impaired coordination.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is almost time for your next dose. Do not double the dose to catch up.
Q8: How long should I take this medication?
A: Consult your physician for the appropriate duration of treatment. Generally, this medication is taken for short-term symptomatic relief. Do not discontinue use abruptly without consulting your doctor.
Q9: Can I drive or operate machinery while taking this medication?
A: Use caution when driving or operating machinery as this medication may cause drowsiness or dizziness in some individuals.
Q10: What are the main drug interactions to consider?
A: Avoid concurrent use with MAO inhibitors, other antihistamines, antidepressants, and anticholinergics. Inform your physician about all medications, including OTC drugs and supplements, that you are currently taking.
