Bromhexine + Dextromethorphan Hydrobromide + Guaifenesin

Usage

• This combination drug is prescribed for the relief of coughs associated with the common cold, influenza, and other respiratory tract infections. It helps loosen and thin mucus in the airways, making it easier to cough up. Dextromethorphan suppresses the cough reflex, while guaifenesin loosens and thins mucus. Bromhexine also breaks down thick mucus.

• Pharmacological classification: Expectorant (Guaifenesin), Mucolytic (Bromhexine), and Antitussive (Dextromethorphan).

• Mechanism of action: Bromhexine works by breaking down mucopolysaccharides, reducing the viscosity of mucus. Dextromethorphan acts on the cough center in the brain to suppress the urge to cough. Guaifenesin increases respiratory tract fluid volumes, making it easier to cough up mucus.

Alternate Names

• No commonly used alternate generic names.
• Brand names vary depending on the manufacturer and region. Some examples include Bisolvon Chesty, Solvin Cold, and Tussin.

How It Works

• Pharmacodynamics: Bromhexine reduces mucus viscosity, Dextromethorphan suppresses cough, and Guaifenesin thins and loosens phlegm.

• Pharmacokinetics:

  • Absorption: All three components are absorbed orally.
  • Metabolism: Dextromethorphan is metabolized in the liver, primarily by CYP2D6 and CYP3A4. Bromhexine is also metabolized in the liver. Guaifenesin’s metabolism is not fully understood.
  • Elimination: Primarily renal excretion for all three components.

• Mode of action: Bromhexine acts on mucus at a molecular level by depolymerizing mucopolysaccharides. Dextromethorphan acts centrally on the cough center in the medulla oblongata. Guaifenesin’s precise mode of action is unknown but it is thought to increase respiratory tract secretions by irritating the gastric mucosa.

• Receptor binding/Enzyme inhibition: Dextromethorphan is a non-selective serotonin reuptake inhibitor and sigma-1 receptor agonist. Bromhexine may stimulate lysosomal enzymes. No known receptor interactions for guaifenesin.

Dosage

Standard Dosage

Adults:

• Bromhexine: 8-16 mg three times daily
• Dextromethorphan: 10-20 mg every 4 hours or 30 mg every 6-8 hours, not exceeding 120mg/day
• Guaifenesin: 200-400 mg every 4 hours, not exceeding 2.4g/day
• Dosage may be adjusted based upon the specific product containing this drug combination. As always, prescribing information should be confirmed for the specific drug.

Children:

• Consult prescribing information before administering to children. The combination is generally not recommended for children under 4 years of age. Dosing adjustments for children are often made using specialized combination solutions formulated for this age group.

Special Cases:

• Elderly Patients: Dose adjustment may be necessary due to age-related decline in renal and hepatic function.
• Patients with Renal Impairment: Caution should be exercised and dose reduction may be necessary.
• Patients with Hepatic Dysfunction: Dose reduction may be necessary for dextromethorphan and bromhexine due to hepatic metabolism.
• Patients with Comorbid Conditions: Use with caution in patients with diabetes, cardiovascular disease, hyperthyroidism, glaucoma, prostatic hypertrophy.

Clinical Use Cases

• The Bromhexine, Dextromethorphan, and Guaifenesin combination is typically not used in clinical settings like intubation, surgical procedures, mechanical ventilation, or the ICU. Its use is primarily for symptomatic relief of cough in outpatient settings.

Dosage Adjustments

• Dosage adjustments may be necessary based on individual patient factors, including renal or hepatic impairment, or other underlying medical conditions. Always consult prescribing information.

Side Effects

Common Side Effects

• Nausea, vomiting, dizziness, drowsiness, headache, diarrhea, abdominal discomfort, indigestion.

Rare but Serious Side Effects

• Allergic reactions (rash, itching, swelling), difficulty breathing.

Long-Term Effects

• Generally not indicated for long-term use.

Adverse Drug Reactions (ADR)

• Severe allergic reactions (anaphylaxis), serotonin syndrome (with concomitant serotonergic drugs), respiratory depression (especially with other CNS depressants).

Contraindications

• Hypersensitivity to any of the components.
• Concomitant use or recent use (within 14 days) of MAO inhibitors.
• Patients with severe respiratory depression.

Drug Interactions

• MAO inhibitors, antidepressants (SSRIs, TCAs), opioid analgesics, alcohol, other CNS depressants, antihistamines.
• May interact with medications metabolized by CYP2D6 and CYP3A4.

Pregnancy and Breastfeeding

• Consult prescribing information before using during pregnancy and breastfeeding. Limited data is available for this specific combination product regarding effects on the fetus/infant.

Drug Profile Summary

• Mechanism of Action: Mucolytic, antitussive, and expectorant.
• Side Effects: Nausea, vomiting, dizziness, drowsiness, headache.
• Contraindications: Hypersensitivity, concomitant MAOI use.
• Drug Interactions: MAOIs, antidepressants, opioids, alcohol.
• Pregnancy & Breastfeeding: Consult prescribing information before using.
• Dosage: See detailed dosage section.
• Monitoring Parameters: Respiratory status, cough frequency and severity.

Popular Combinations

• Often combined with other medications for cold and flu symptoms, such as decongestants and analgesics.

Precautions

• Pre-existing medical conditions (renal/hepatic impairment, respiratory disease, diabetes, etc.).
• Use with caution in elderly patients and children.
• Avoid alcohol and other CNS depressants.
• Avoid driving or operating machinery if drowsiness occurs.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Bromhexine + Dextromethorphan Hydrobromide + Guaifenesin?

A: See detailed dosage section above. Specific dosages will vary depending on individual product formulations.

Q2: Can this combination be used in children?

A: Consult prescribing information. Generally not recommended for children under 4 years of age. Specific combination solutions are formulated for pediatric use.

Q3: What are the common side effects?

A: Nausea, vomiting, dizziness, drowsiness, and headache are common side effects.

Q4: Are there any serious drug interactions?

A: Yes, serious interactions can occur with MAO inhibitors, antidepressants, opioids, and alcohol.

Q5: Can this combination be used during pregnancy or breastfeeding?

A: Consult prescribing information for specific guidance. Limited data on the effects during pregnancy or breastfeeding may be available.

Q6: How does this combination work to relieve cough?

A: Bromhexine breaks down mucus, dextromethorphan suppresses the cough reflex, and guaifenesin thins and loosens phlegm.

Q7: What should I do if a patient experiences side effects?

A: Advise the patient to stop taking the medication and contact their healthcare provider if they experience any bothersome or persistent side effects.

Q8: Are there any contraindications to using this medication?

A: Yes, contraindications include hypersensitivity to any of the components and concurrent use of MAO inhibitors.

Q9: Can this drug be used for a dry cough?

A: It is generally more appropriate for relieving chesty coughs, as it primarily targets mucus production and clearance. However, the dextromethorphan component may provide some relief for dry coughs as well.

Q10: Can this medication impair driving ability?

A: Drowsiness is a potential side effect; patients should avoid driving or operating machinery if drowsiness occurs.