Usage
Bromhexine + Phenylephrine is prescribed for the relief of symptoms associated with the common cold, flu, and other respiratory tract infections, specifically productive cough accompanied by nasal congestion.
Pharmacological Classification:
- Bromhexine: Mucolytic, expectorant
- Phenylephrine: Decongestant, sympathomimetic
Mechanism of Action:
Bromhexine reduces the viscosity of mucus by breaking down mucopolysaccharide fibers, making it easier to expectorate. Phenylephrine acts as a decongestant by constricting blood vessels in the nasal mucosa, reducing swelling and congestion.
Alternate Names
While there isn’t a specific international nonproprietary name for this combination, the individual components are recognized globally. Several brand names exist depending on the region and manufacturer.
How It Works
Pharmacodynamics:
- Bromhexine: Increases serous secretions in the respiratory tract, thereby hydrating mucus and facilitating expectoration. Stimulates ciliary activity, aiding in mucus clearance.
- Phenylephrine: Alpha-adrenergic agonist, primarily constricting blood vessels in the nasal mucosa, reducing congestion.
Pharmacokinetics:
-
Bromhexine:
- Absorption: Readily absorbed orally.
- Metabolism: Extensive hepatic metabolism, involving CYP enzymes.
- Elimination: Primarily renal excretion.
-
Phenylephrine:
- Absorption: Well-absorbed orally.
- Metabolism: Primarily metabolized by monoamine oxidase (MAO) in the gastrointestinal tract and liver.
- Elimination: Renal excretion.
Mode of Action:
- Bromhexine: Depolymerizes mucopolysaccharide fibers, reducing mucus viscosity.
- Phenylephrine: Binds to alpha-adrenergic receptors in the nasal mucosa, causing vasoconstriction.
Dosage
Standard Dosage:
Adults: The typical dose is 8 mg of Bromhexine and 5 mg of Phenylephrine, taken orally, three times a day. Dosages may vary according to brand and formulation. Always follow the instructions provided on the packaging or as advised by the prescribing physician.
Children: Dosage in children under 12 should be determined and supervised by a physician. Formulations and dosages specific to pediatric use are available. Avoid use in children under 2 years unless specifically directed by a doctor.
Special Cases:
- Elderly Patients: Dose adjustments may be needed based on renal and hepatic function.
- Patients with Renal Impairment: Caution advised; dose reduction might be necessary.
- Patients with Hepatic Dysfunction: Caution advised; dose reduction might be necessary.
- Patients with Comorbid Conditions: Use with caution in patients with diabetes, hypertension, hyperthyroidism, coronary artery disease, and prostatic hypertrophy.
Clinical Use Cases
Dosage in clinical scenarios such as intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations would be determined based on patient needs and overseen by the attending physician. Bromhexine + Phenylephrine is not typically used in these settings.
Dosage Adjustments
Dose modifications are based on individual patient factors like renal and hepatic function, as well as other comorbidities. Patients with severe cardiovascular disease, glaucoma, and those taking MAO inhibitors should avoid this combination.
Side Effects
Common Side Effects
- Nausea, vomiting, gastrointestinal upset
- Dizziness, drowsiness, headache
- Nervousness, insomnia
- Increased heart rate, palpitations
- Allergic reactions (skin rash, itching)
Rare but Serious Side Effects
- Severe allergic reactions (anaphylaxis, angioedema)
- Cardiac arrhythmias
- Hallucinations
Long-Term Effects
Long-term use of phenylephrine can lead to rebound congestion. Long-term use of bromhexine is not associated with significant side effects.
Adverse Drug Reactions (ADR)
- Stevens-Johnson syndrome (rare)
- Toxic epidermal necrolysis (rare)
Contraindications
- Hypersensitivity to bromhexine or phenylephrine.
- Concurrent or recent use of MAO inhibitors.
- Severe cardiovascular disease, uncontrolled hypertension.
- Narrow-angle glaucoma.
- Pheochromocytoma.
Drug Interactions
- MAO inhibitors: Can cause hypertensive crisis.
- Beta-blockers: May antagonize the effects of phenylephrine.
- Tricyclic antidepressants: May potentiate the cardiovascular effects of phenylephrine.
- Other sympathomimetics: Additive effects.
- Antihistamines: Increased anticholinergic effects.
- Digoxin: May increase the risk of cardiac arrhythmias.
Pregnancy and Breastfeeding
The safety of Bromhexine + Phenylephrine during pregnancy and breastfeeding is not fully established. Consult a physician before use. If the benefits outweigh the risks, the lowest effective dose should be used for the shortest possible duration.
Drug Profile Summary
- Mechanism of Action: Bromhexine breaks down mucus; phenylephrine decongests nasal passages.
- Side Effects: Nausea, dizziness, headache, insomnia, nervousness, palpitations, allergic reactions.
- Contraindications: Hypersensitivity, MAO inhibitor use, severe cardiovascular disease, narrow-angle glaucoma.
- Drug Interactions: MAOIs, beta-blockers, tricyclic antidepressants, other sympathomimetics.
- Pregnancy & Breastfeeding: Consult a physician; safety not fully established.
- Dosage: Adults: 8mg Bromhexine/ 5mg Phenylephrine thrice daily. Pediatric dosages are adjusted based on age/weight and prescribed by a physician.
- Monitoring Parameters: Blood pressure, heart rate, respiratory status.
Popular Combinations
Bromhexine is often combined with other medications such as guaifenesin, dextromethorphan, and salbutamol. Phenylephrine can be combined with antihistamines and other decongestants.
Precautions
Pre-existing cardiovascular disease, renal or hepatic impairment, diabetes, hyperthyroidism, and asthma require cautious use. Avoid alcohol and activities requiring alertness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Phenylephrine?
A: The usual adult dose is 8 mg bromhexine and 5 mg phenylephrine taken orally three times a day. Pediatric doses should be determined by a physician.
Q2: Can pregnant or breastfeeding women take Bromhexine + Phenylephrine?
A: Consult a physician. Safety is not well established. If benefits outweigh the risks, the lowest effective dose should be used for the shortest duration.
Q3: What are the common side effects?
A: Nausea, dizziness, headache, insomnia, and nervousness.
Q4: What are the serious side effects?
A: Allergic reactions (including anaphylaxis), cardiac arrhythmias, and hallucinations (rare).
Q5: What drugs interact with Bromhexine + Phenylephrine?
A: MAO inhibitors, beta-blockers, tricyclic antidepressants, other sympathomimetics, and digoxin.
Q6: Can this combination be used in children?
A: Yes, but the dosage must be determined by a physician based on age and weight. Generally avoided in children under 2.
Q7: What conditions make this medication contraindicated?
A: Hypersensitivity, current or recent use of MAOIs, severe cardiovascular disease, narrow-angle glaucoma, pheochromocytoma.
Q8: Can I drive or operate machinery after taking this medication?
A: Use caution, as dizziness and drowsiness may occur. Avoid driving if affected.
Q9: 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. Don’t double the dose to catch up.
Q10: What should I do if I experience side effects?
A: Consult your physician if side effects persist or worsen. For mild effects, supportive measures may be sufficient.
