Usage
This combination medication is prescribed for the symptomatic relief of common cold, flu, and allergies, particularly upper respiratory tract infections. It addresses symptoms such as nasal and sinus congestion, runny nose, sneezing, headache, fever, body aches, and productive cough. It falls under several pharmacological classifications due to its combined ingredients:
- Mucolytic (Bromhexine): Thins and loosens mucus.
- Antihistamine (Chlorpheniramine): Reduces allergic reactions.
- Analgesic and Antipyretic (Paracetamol): Relieves pain and reduces fever.
- Decongestant (Phenylephrine): Constricts blood vessels to reduce nasal congestion.
The combined mechanism of action involves thinning mucus, reducing histamine response, inhibiting prostaglandin synthesis (reducing pain and fever), and vasoconstriction in the nasal passages.
Alternate Names
While this specific combination may not have a unique international non-proprietary name (INN), it’s often referred to by its component drugs. Brand names vary widely depending on the manufacturer and region, with some examples being “Kuff Q,” and “Koldocin.”
How It Works
Pharmacodynamics
- Bromhexine: Depolymerizes mucopolysaccharides, reducing mucus viscosity and promoting expectoration.
- Chlorpheniramine: A first-generation antihistamine that competes with histamine for H1-receptor sites, minimizing allergy symptoms. It can cause significant drowsiness.
- Paracetamol: Inhibits prostaglandin synthesis in the central nervous system, reducing fever and pain. Its effect on peripheral COX enzymes is limited.
- Phenylephrine: An alpha-adrenergic agonist, causing vasoconstriction, which reduces nasal congestion.
Pharmacokinetics
- Absorption: All components are generally well-absorbed orally.
- Metabolism: Primarily hepatic metabolism via various pathways, including CYP450 enzymes for chlorpheniramine. Paracetamol undergoes glucuronidation and sulfation.
- Elimination: Mainly renal excretion, with some biliary elimination for certain metabolites.
Dosage
Standard Dosage
Adults:
One tablet every 4-6 hours, or as directed by the physician. Should be taken with food. Do not exceed the recommended dose. It is recommended not to use this medication for more than 10 days without consulting a doctor.
Children:
Dosing varies based on age and formulation. Consult the specific product labeling and pediatric guidelines. Generally, this combination is not recommended for children under 6 years of age. For children between 6-12 year of age, 1/2 tablet is recommended three times per day.
Special Cases:
- Elderly Patients: Reduce dose as per individual needs.
- Patients with Renal Impairment: Dosage adjustment needed based on creatinine clearance.
- Patients with Hepatic Dysfunction: Dose reduction and careful monitoring are required.
- Patients with Comorbid Conditions: Individualized dosing based on specific conditions like hypertension, diabetes, and glaucoma.
Side Effects
Common Side Effects
Drowsiness, dizziness, dry mouth, nausea, constipation, blurred vision, insomnia.
Rare but Serious Side Effects
Allergic reactions (rash, itching, difficulty breathing), liver damage (with paracetamol overdose), cardiac arrhythmias, hallucinations.
Adverse Drug Reactions (ADR)
Severe skin reactions (Stevens-Johnson syndrome), hepatotoxicity, blood dyscrasias.
Contraindications
Hypersensitivity to any component, severe hypertension, closed-angle glaucoma, urinary retention, severe liver or kidney disease, MAOI therapy, concurrent use of other paracetamol-containing products.
Drug Interactions
MAOIs, CNS depressants (alcohol, sedatives), antihypertensives, tricyclic antidepressants, anticoagulants.
Pregnancy and Breastfeeding
Consult a doctor before use during pregnancy or while breastfeeding. Use with caution. There is limited data on the safety of bromhexine and phenylephrine in pregnancy.
Drug Profile Summary
- Mechanism of Action: See “How It Works.”
- Side Effects: Drowsiness, dizziness, dry mouth, nausea, constipation, rare allergic reactions or liver damage.
- Contraindications: Hypersensitivity, severe hypertension, glaucoma, urinary retention, severe liver/kidney disease.
- Drug Interactions: MAOIs, CNS depressants, antihypertensives, tricyclic antidepressants.
- Pregnancy & Breastfeeding: Consult a doctor before use.
- Dosage: See “Dosage” section.
- Monitoring Parameters: Liver function tests (especially with prolonged use or high doses).
Popular Combinations
Often combined with other cough and cold medications, but caution is advised due to potential additive effects and interactions.
Precautions
- General Precautions: Evaluate for pre-existing conditions (especially liver/kidney disease, hypertension, diabetes).
- Specific Populations: Caution in pregnant/breastfeeding women, children, and the elderly.
- Lifestyle Considerations: Avoid alcohol as it can worsen drowsiness and increase the risk of liver damage. Avoid driving or operating machinery until the effects are known.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Chlorpheniramine Maleate + Paracetamol + Phenylephrine?
A: See “Dosage” section for adult, pediatric, and special population dosing.
Q2: Can this combination be used in patients with asthma?
A: Use with caution in asthmatic patients, as it can potentially exacerbate symptoms. Consult a pulmonologist.
Q3: Are there any dietary restrictions while taking this medication?
A: No specific dietary restrictions, but maintain adequate hydration.
Q4: Can I take this medicine with alcohol?
A: Avoid alcohol as it can potentiate drowsiness and increase the risk of liver damage (with paracetamol).
Q5: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it’s nearly time for the next dose. Do not double the dose.
Q6: Can this medication be used for dry cough?
A: It’s more effective for productive cough as bromhexine and guaifenesin work by thinning and loosening mucus.
Q7: Is it safe to operate machinery while taking this combination?
A: Avoid driving or operating heavy machinery, as drowsiness and dizziness are common side effects.
Q8: How long can I take this medication?
A: Consult a physician. Short-term use is generally recommended. Don’t exceed 10 days of continuous use without consulting a doctor.
Q9: What should I do if I experience an allergic reaction?
A: Discontinue use immediately and seek medical attention.
Q10: Can this combination be used during pregnancy?
A: Consult a doctor before use during pregnancy, especially during the first trimester.
