Usage
- This combination medication is primarily prescribed for the relief of cough associated with the common cold, allergies, and other respiratory tract infections. It helps to loosen and thin mucus, making it easier to cough up. It also helps reduce allergy symptoms like sneezing, runny nose, and itchy eyes.
- Pharmacological Classification: This is a combination product containing a mucolytic (bromhexine), an antihistamine (diphenhydramine), and an expectorant (guaifenesin).
- Mechanism of Action: Bromhexine breaks down the mucus, making it less viscous. Guaifenesin thins the mucus and makes it easier to cough out. Diphenhydramine blocks the action of histamine, reducing allergy symptoms.
Alternate Names
- No widely recognized alternate names exist for this specific three-drug combination internationally, although regional variations may occur.
- Brand names for products containing these three ingredients vary depending on the country and manufacturer. Several brands market cough and cold medications containing these ingredients.
How It Works
- Pharmacodynamics: Bromhexine acts as a mucolytic, decreasing the viscosity of mucus. Guaifenesin increases the volume and reduces the viscosity of secretions in the respiratory tract. Diphenhydramine acts as an antihistamine, blocking H1 receptors and reducing the effects of histamine, which causes allergy symptoms.
- Pharmacokinetics:
- Absorption: All three drugs are absorbed well from the gastrointestinal tract.
- Metabolism: Bromhexine is extensively metabolized in the liver. Diphenhydramine is also metabolized in the liver. Guaifenesin is metabolized to a lesser extent.
- Elimination: Bromhexine metabolites are primarily excreted in the urine. Diphenhydramine is excreted in the urine, mainly as metabolites. Guaifenesin is excreted in the urine, both unchanged and as metabolites.
- Mode of Action: Bromhexine breaks down disulfide bonds in mucoproteins, reducing mucus viscosity. Guaifenesin increases respiratory tract fluid, making it easier to expectorate. Diphenhydramine competitively antagonizes H1 receptors, reducing allergy symptoms.
Dosage
Standard Dosage
Children: This combination is generally not recommended for children under 6 years old without doctor consultation. For children aged 6 to 12, 5 mL (or one teaspoonful) of syrup, three times a day is generally recommended, but dosage should be adjusted according to the child’s weight and the physician’s advice.
Special Cases: Dosage adjustments are recommended based on kidney and liver function and any existing medical conditions such as asthma or COPD. Consult with a physician. Elderly individuals should exercise caution due to potential drowsiness and other side effects.
Clinical Use Cases
The Bromhexine + Diphenhydramine + Guaifenesin combination isn’t typically employed in critical care settings or surgical procedures.
Side Effects
Common Side Effects:
- Nausea
- Vomiting
- Diarrhea
- Dizziness
- Drowsiness
- Dry mouth
- Headache
Rare but Serious Side Effects:
- Allergic reactions (skin rash, itching, swelling)
- Difficulty breathing
- Confusion
- Hallucinations
Adverse Drug Reactions (ADR): Significant adverse drug reactions are rare but may include severe allergic reactions and respiratory distress.
Contraindications
- Hypersensitivity to any of the components.
- Severe liver or kidney impairment.
- Pre-existing respiratory conditions like asthma or COPD should be considered.
Drug Interactions
- Alcohol should be avoided as it may increase drowsiness.
- This combination can interact with other medications, including some antihistamines, antidepressants, and MAO inhibitors.
- It is advisable to check for potential interactions with other prescribed or over-the-counter medications.
Pregnancy and Breastfeeding
- Caution is advised during pregnancy and breastfeeding. Consult a physician to assess the benefits versus risks. There is limited information on the safety of Bromhexine during pregnancy. Diphenhydramine is generally considered safe in pregnancy when taken in recommended dosages. Use of Guaifenesin during pregnancy has been associated with inguinal hernias in male infants and small reductions in psychomotor developmental index scores. Its use during pregnancy and breastfeeding requires physician consultation.
Drug Profile Summary
- Mechanism of Action: Mucolytic, expectorant, and antihistamine.
- Side Effects: Nausea, dizziness, drowsiness, dry mouth.
- Contraindications: Hypersensitivity, severe liver/kidney impairment.
- Drug Interactions: Alcohol, other antihistamines, antidepressants, MAO inhibitors.
- Pregnancy & Breastfeeding: Use with caution. Consult a physician.
- Dosage: Varies depending on age and condition.
- Monitoring Parameters: Respiratory status and any allergic reactions.
Popular Combinations
This particular combination isn’t a routinely employed fixed-dose combination, although these drugs may be co-administered as individual drugs or as components of other combination products.
Precautions
- General Precautions: Pre-existing medical conditions, especially respiratory or liver/kidney issues, should be evaluated before use.
- Specific Populations: Use cautiously in pregnant/breastfeeding women, children and the elderly.
- Lifestyle Considerations: Avoid alcohol. May cause drowsiness and affect ability to drive or operate machinery.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Diphenhydramine + Guaifenesin?
A: The standard adult dosage is typically 10 mL of syrup three times daily, not to exceed 6 doses in 24 hours. Pediatric dosages should be determined by a physician.
Q2: Can this combination be used in children?
A: It’s generally not recommended for children under 6. Physician consultation is advised for children over 6.
Q3: What are the common side effects?
A: Common side effects include nausea, dizziness, drowsiness, and dry mouth.
Q4: Are there any serious side effects?
A: Rarely, serious side effects like allergic reactions and breathing difficulties can occur.
Q5: Can pregnant or breastfeeding women take this medication?
A: Caution is advised during pregnancy and breastfeeding. Consult a doctor to weigh the potential benefits and risks.
Q6: Does this medication interact with other drugs?
A: Yes, it can interact with alcohol, some antihistamines, antidepressants, and MAO inhibitors. Consult a physician about potential drug interactions.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it’s almost time for your next dose. Do not double the dose.
Q8: What are the main contraindications for this combination?
A: Contraindications include hypersensitivity to any of the components and severe liver or kidney impairment. Certain respiratory conditions may also warrant caution.
Q9: How does Bromhexine + Diphenhydramine + Guaifenesin work to relieve cough?
A: It acts as a mucolytic, expectorant and antihistamine, thinning and loosening mucus while also addressing allergy-related cough triggers.
