Usage
- This combination medication is primarily prescribed for the symptomatic relief of cough associated with the common cold, bronchitis, and other respiratory tract infections. It helps to loosen and thin mucus (Bromhexine), suppress cough (Dextromethorphan), decongest nasal passages (Phenylephrine), and soothe throat irritation (Menthol).
- Pharmacological Classification: This is a combination product containing a mucolytic (Bromhexine), cough suppressant (Dextromethorphan), decongestant (Phenylephrine), and a counterirritant (Menthol).
- Mechanism of Action: Bromhexine breaks down mucopolysaccharides, reducing mucus viscosity. Dextromethorphan suppresses the cough reflex by acting on the cough center in the brain. Phenylephrine constricts blood vessels in the nasal mucosa, reducing congestion. Menthol stimulates cold receptors, providing a cooling sensation and relieving throat irritation.
Alternate Names
- No widely recognized alternate names exist for this specific four-ingredient combination. However, it may be referred to by different brand names depending on the manufacturer and region.
- Brand Names: Several brand names exist, including Coughdip-P, Oxidyne P, Bromo D, and others. Brand names can vary by region.
How It Works
- Pharmacodynamics: Bromhexine decreases mucus viscosity, facilitating expectoration. Dextromethorphan suppresses the cough reflex centrally. Phenylephrine constricts nasal blood vessels, reducing congestion. Menthol provides a cooling sensation and relieves throat irritation.
- Pharmacokinetics: The components are absorbed orally. Dextromethorphan is metabolized primarily in the liver by CYP2D6. Phenylephrine is metabolized by monoamine oxidase. Bromhexine is metabolized in the liver. Menthol is metabolized in the liver. Specific pharmacokinetic data for the combination product may vary. Elimination pathways are primarily renal and hepatic.
- Mode of Action: Bromhexine depolymerizes mucopolysaccharides in mucus. Dextromethorphan acts on sigma opioid receptors and NMDA glutamate receptors. Phenylephrine activates alpha-adrenergic receptors. Menthol activates TRPM8 receptors.
- Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Dextromethorphan acts on sigma opioid receptors and NMDA receptors. Phenylephrine activates alpha-adrenergic receptors. Bromhexine has no known specific receptor binding.
Dosage
Standard Dosage
Adults:
- Syrup: Typically, 10ml every 4-6 hours, not exceeding 4 doses per day.
- Tablets: Two tablets every 4-6 hours, maximum 4 doses/day. This can vary based on the specific product.
Children:
- Not generally recommended for children under 12 years of age. Consult a pediatrician for appropriate cough and cold medication for younger children.
Special Cases:
- Elderly Patients: Dose adjustments may be needed based on individual patient health, considering kidney and liver function.
- Patients with Renal Impairment: Consult a physician; dose adjustment may be necessary.
- Patients with Hepatic Dysfunction: Use with caution; dose adjustment may be necessary.
- Patients with Comorbid Conditions: Use with caution in patients with heart disease, hypertension, diabetes, hyperthyroidism, glaucoma, or prostatic hypertrophy.
Clinical Use Cases
This combination is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, or the ICU. Its primary use is for symptomatic relief of cough and cold symptoms in an outpatient setting.
Dosage Adjustments
Dose modification may be necessary in elderly patients, and those with renal or hepatic dysfunction, always consult a doctor for specific advice.
Side Effects
Common Side Effects
- Nausea, vomiting, diarrhea, stomach upset, dizziness, headache, skin rash, drowsiness, sweating, insomnia.
Rare but Serious Side Effects
- Allergic reactions, cardiac arrhythmias, CNS disturbances.
Long-Term Effects
- No specific long-term effects have been identified for this combination, however, prolonged use of dextromethorphan can lead to dependence.
Adverse Drug Reactions (ADR)
- Severe allergic reactions (anaphylaxis), cardiac arrhythmias, and severe CNS disturbances require immediate medical attention.
Contraindications
- Hypersensitivity to any components; concurrent or recent MAOI use; severe cardiovascular disease, glaucoma, urinary retention, peptic ulcer; pregnancy and breastfeeding (unless deemed absolutely necessary); children under 12. The Indian government has banned several fixed-dose combination cough syrups, and the status of this specific combination should be verified.
Drug Interactions
- MAOIs, serotonergic medications (SSRIs, SNRIs), antihistamines, tricyclic antidepressants, antihypertensives, CNS stimulants, alcohol, opioid pain relievers, antiepileptic drugs, anxiolytics, and medications affecting heart rhythm.
Pregnancy and Breastfeeding
- Use with caution during pregnancy and breastfeeding. Consult a physician. Safety profiles are not well-established. Safer alternatives may be recommended.
Drug Profile Summary (See above for details)
Popular Combinations
- This product is already a combination of four active ingredients. Combining it with other drugs is generally not recommended and may be unsafe.
Precautions
- Assess for allergies, pre-existing cardiac, renal, or hepatic dysfunction, and potential drug interactions before prescribing. Exercise caution in pregnant/breastfeeding women, children, and the elderly. Advise patients to avoid alcohol and other CNS depressants, driving, and operating machinery if drowsiness occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Dextromethorphan Hydrobromide + Menthol + Phenylephrine?
A: For adults, typical dosages are 10ml syrup or two tablets every 4-6 hours, not exceeding 4 doses per day. Not recommended for children under 12.
Q2: What are the common side effects?
A: Common side effects include nausea, dizziness, drowsiness, and stomach upset.
Q3: Can this combination be used during pregnancy or breastfeeding?
A: Use with extreme caution and only if absolutely necessary. Consult a physician for guidance.
Q4: Are there any contraindications to using this drug?
A: Yes. Contraindications include hypersensitivity to any component, concurrent use of MAOIs, severe cardiovascular disease, glaucoma, and use in children under 12.
Q5: What are the potential drug interactions?
A: This combination can interact with numerous medications, including MAOIs, antidepressants, antihistamines, and certain heart medications.
Q6: How does this combination work to relieve cough and cold symptoms?
A: It works through multiple mechanisms: Bromhexine thins mucus, dextromethorphan suppresses cough, phenylephrine reduces nasal congestion, and menthol soothes throat irritation.
Q7: Can this medication be used long-term?
A: Long-term use is generally not recommended due to the potential for dextromethorphan dependence.
Q8: What should patients avoid while taking this medication?
A: Patients should avoid alcohol and operating heavy machinery due to potential drowsiness. They should also avoid other medications without consulting a physician.
Q9: What should I do if a patient experiences an allergic reaction?
A: Discontinue the medication immediately and seek emergency medical assistance.
Q10: Is this drug banned in India?
A: The Indian government has banned several fixed-dose combination cough and cold medications. Verify the current regulatory status of this combination before prescribing in India.
