Bromhexine + Chlorpheniramine Maleate + Phenylephrine

Usage

This combination medication is prescribed for symptomatic relief of common cold, flu, and allergies affecting the upper respiratory tract. It addresses symptoms like cough with mucus, nasal congestion, runny nose, sneezing, itchy and watery eyes, and sinus pressure.

• Pharmacological Classification: This is a combination drug containing a mucolytic (bromhexine), an antihistamine (chlorpheniramine maleate), and a decongestant (phenylephrine).

• Mechanism of Action: Bromhexine breaks down thick mucus, making it easier to expel. Chlorpheniramine maleate blocks histamine, reducing allergic symptoms. Phenylephrine constricts blood vessels in the nasal passages, relieving congestion.

Alternate Names

There are no widely recognized alternate names for this specific combination. However, each individual component has various synonyms (e.g., bromhexine hydrochloride), and the combination itself might be marketed under different brand names depending on the region and manufacturer.

• Brand Names: While specific brand names are numerous and vary by region, they typically combine elements suggesting cold and cough relief. Consult local pharmaceutical resources for prevalent brand names in India.

How It Works

• Pharmacodynamics: Bromhexine decreases mucus viscosity. Chlorpheniramine maleate opposes histamine’s effects, reducing vascular permeability, edema, and itching. Phenylephrine, an alpha-adrenergic agonist, causes vasoconstriction, reducing nasal congestion.

• Pharmacokinetics:

  • Bromhexine: Well-absorbed orally, metabolized in the liver, and excreted primarily in the urine.
  • Chlorpheniramine Maleate: Readily absorbed from the gastrointestinal tract, metabolized in the liver, primarily excreted in the urine.
  • Phenylephrine: Less well-absorbed orally than other components. Metabolized by monoamine oxidase in the intestine and liver, eliminated in the urine.

• Mode of Action:

  • Bromhexine: Depolymerizes mucopolysaccharide fibers in mucus, reducing viscosity.
  • Chlorpheniramine Maleate: Competes with histamine for H1-receptor sites, antagonizing its actions.
  • Phenylephrine: Stimulates alpha-adrenergic receptors in vascular smooth muscle, causing vasoconstriction.

• Elimination Pathways: Predominantly renal excretion for all three components.

Dosage

Standard Dosage

Adults: A common dosage is one tablet or 10ml syrup every 6-8 hours. However, always follow the specific formulation guidelines. Do not exceed the maximum daily dose as indicated on the product packaging or prescribed by the physician.

Children: Dosage should be determined by a healthcare professional based on the child’s weight and age. Use pediatric formulations when available.

Special Cases:

• Elderly Patients: Start with a lower dose and adjust as needed. Monitor for dizziness and drowsiness.
• Patients with Renal Impairment: Dose adjustments are needed. Consult with a nephrologist or physician experienced in managing medications in renally impaired patients.
• Patients with Hepatic Dysfunction: Reduce the dosage. Careful monitoring of liver function is recommended.
• Patients with Comorbid Conditions: Use cautiously in patients with hypertension, diabetes, hyperthyroidism, glaucoma, prostatic hypertrophy, and cardiovascular disease. Dosage adjustments may be necessary.

Clinical Use Cases

This combination is generally not recommended for the clinical settings mentioned (intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations). It is mainly used for symptomatic relief of common cold and flu symptoms and is not intended for critical care settings.

Dosage Adjustments

Dosage adjustments are necessary in patients with renal or hepatic dysfunction, as well as those with comorbid conditions mentioned earlier. Genetic polymorphisms affecting drug metabolism should also be considered.

Side Effects

Common Side Effects:

Drowsiness, dizziness, dry mouth, nausea, vomiting, constipation, blurred vision, headache, nervousness, restlessness, insomnia, gastrointestinal upset, and changes in heart rate or blood pressure.

Rare but Serious Side Effects:

Allergic reactions (rash, itching, swelling, severe dizziness, trouble breathing), hallucinations, seizures, difficulty urinating, vision changes, irregular heartbeat.

Long-Term Effects:

Chronic complications from prolonged use are rare but can include tolerance to the decongestant effect and rebound congestion.

Adverse Drug Reactions (ADR):

Severe allergic reactions, cardiac arrhythmias, significant blood pressure changes, and neuropsychiatric effects require immediate intervention.

Contraindications

• Hypersensitivity to any component of the formulation.
• Severe hypertension or coronary artery disease.
• Narrow-angle glaucoma.
• Monoamine oxidase inhibitor (MAOI) therapy.
• Severe liver or kidney disease.

Drug Interactions

• MAOIs: Can precipitate hypertensive crisis.
• Alcohol and other CNS depressants: Can increase drowsiness and impair cognitive function.
• Beta-blockers, tricyclic antidepressants, and other antihistamines or decongestants: May potentiate effects or adverse reactions.
• Anticholinergics: Can enhance anticholinergic side effects (dry mouth, constipation, urinary retention).

Pregnancy and Breastfeeding

• Pregnancy Safety Category: The safety during pregnancy and breastfeeding is not definitively established. Use only when clearly needed and under medical supervision.
• Fetal risks: Potential risks are not fully understood.
• Neonatal side effects: Possible exposure through breast milk.

Drug Profile Summary

• Mechanism of Action: Bromhexine reduces mucus viscosity, chlorpheniramine maleate antagonizes histamine, and phenylephrine acts as a decongestant.
• Side Effects: Drowsiness, dizziness, dry mouth, nausea, gastrointestinal upset. Serious side effects are rare.
• Contraindications: Hypersensitivity, severe hypertension, MAOI therapy, severe liver/kidney disease.
• Drug Interactions: MAOIs, alcohol, CNS depressants, beta-blockers, other antihistamines/decongestants.
• Pregnancy & Breastfeeding: Use cautiously if potential benefits outweigh risks.
• Dosage: Adults: typically one tablet/10ml syrup every 6-8 hrs. Pediatric: dose based on weight and age.
• Monitoring Parameters: Blood pressure, heart rate, respiratory status, and mental status.

Popular Combinations

This combination itself is a popular formulation. Other cold and cough remedies may include analgesics/antipyretics like paracetamol or guaifenesin.

Precautions

• General Precautions: Assess for allergies, pre-existing medical conditions, and concomitant medications.
• Specific Populations: Use cautiously in pregnant/breastfeeding women, children, and the elderly.
• Lifestyle Considerations: Avoid alcohol and operating machinery due to potential drowsiness.

FAQs (Frequently Asked Questions)

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

A: The typical adult dosage is one tablet or 10ml of syrup every 6-8 hours, but always adhere to the prescribing physician’s instructions and the specific product labeling. Pediatric doses are weight and age-dependent.

Q2: Can this combination be used in patients with hypertension?

A: Use with caution. Phenylephrine can raise blood pressure. Close monitoring is essential.

Q3: What are the common side effects?

A: Drowsiness, dizziness, dry mouth, nausea, and constipation are frequently reported.

Q4: Can pregnant or breastfeeding women take this medication?

A: Safety is not well-established. Consult a physician to assess the benefit-risk ratio.

Q5: What are the potential drug interactions?

A: Interactions can occur with MAOIs, alcohol, CNS depressants, and other medications metabolized by the liver. Always disclose all current medications and supplements to your doctor.

Q6: Can this combination be used for a dry cough?

A: It is primarily indicated for coughs with mucus production.

Q7: What should I do if I miss a dose?

A: Take the missed dose as soon as remembered, unless it’s close to the next dose. Do not double the dose.

Q8: Can this combination be used long-term?

A: Generally, it’s recommended for short-term symptomatic relief. Consult a physician for prolonged use.

Q9: Are there any dietary restrictions while taking this medication?

A: No specific dietary restrictions are typically associated with this combination, but maintaining adequate hydration is always advisable, especially during illness.

Q10: How should this medication be stored?

A: Store in a cool, dry place away from direct sunlight and out of reach of children. Always refer to specific storage instructions on the product packaging.