Usage
Bromhexine + Phenylpropanolamine is prescribed for the relief of symptoms associated with the common cold, flu, and other respiratory tract infections. Specifically, it targets cough and nasal congestion.
Pharmacological Classification:
This combination drug falls into multiple categories:
- Bromhexine: Mucolytic, Expectorant
- Phenylpropanolamine: Decongestant, α-adrenergic agonist
Mechanism of Action:
- Bromhexine: Thins and loosens mucus (phlegm) in the airways, making it easier to cough up. It also increases ciliary activity, further aiding mucus clearance.
- Phenylpropanolamine: Constricts blood vessels in the nasal passages, reducing swelling and congestion.
Alternate Names
No internationally recognized alternate names were found within the provided sources. However, regional variations may exist. Several brand names containing this combination exist, although sources focus more on Bromhexine + Dextromethorphan + Phenylpropanolamine formulations. A few of the available brand names for Bromhexine + Phenylpropanolamine include Alvex P syrup and Borac syrup (the exact compositions may vary slightly).
How It Works
Pharmacodynamics:
- Bromhexine: Depolymerizes mucopolysaccharides, reducing mucus viscosity. Stimulates serous glands to increase watery secretions, further thinning the mucus.
- Phenylpropanolamine: Acts as an α-adrenergic agonist, causing vasoconstriction in the nasal mucosa.
Pharmacokinetics:
- Bromhexine: Readily absorbed orally. Metabolized in the liver. Eliminated primarily via the kidneys.
- Phenylpropanolamine: Well-absorbed orally. Metabolized in the liver. Excreted mainly through the kidneys.
Mode of Action (Cellular/Molecular):
- Bromhexine: Acts on mucus glands, breaking down the complex structure of mucus. Increases ciliary beat frequency, promoting mucus clearance.
- Phenylpropanolamine: Stimulates α-adrenergic receptors on vascular smooth muscle, leading to vasoconstriction.
Elimination Pathways:
- Bromhexine: Primarily renal excretion.
- Phenylpropanolamine: Primarily renal excretion.
Dosage
Standard Dosage
Adults:
Phenylpropanolamine: 25 mg orally every 4 hours, or 75 mg extended-release every 12 hours. The maximum daily dose is 150 mg.
Bromhexine: 8 mg three times daily. Some sources mention 16 mg three times daily for the first 7 days for some conditions.
Children:
Dosages vary based on age and formulation.
- Bromhexine:
- <2 years: 1 mg three times daily
- 2-6 years: 2 mg three times daily.
- 6-12 years old: 4mg (in 5mL syrup) three times daily.
- Phenylpropanolamine:
- 2 to 6 years: 6.25 mg orally every 4 hours (maximum daily dose is 37.5 mg)
- 6 to 12 years: 12.5 mg orally every 4 hours (maximum daily dose is 75 mg)
-
12 years: 25mg every 4 hours.
Pediatric safety should be carefully considered, especially in younger children. Precise dosing and appropriate formulation are crucial.
Special Cases:
- Elderly Patients: Start with lower doses and monitor closely due to potential age-related decline in renal and hepatic function.
- Patients with Renal Impairment: Caution is advised, and dosage adjustments may be necessary depending on the degree of impairment. Reduced doses are often required. Close monitoring for signs of toxicity is essential.
- Patients with Hepatic Dysfunction: Exercise caution; dosage adjustment may be required.
- Patients with Comorbid Conditions: Use with caution in patients with hypertension, heart disease, diabetes, thyroid disorders, glaucoma, or prostatic hypertrophy. Close monitoring is essential.
Clinical Use Cases
Dosage in specialized clinical settings (Intubation, Surgical Procedures, Mechanical Ventilation, ICU Use, Emergency Situations) should be determined on a case-by-case basis by consulting a specialist and considering patient-specific factors and the severity of the condition. Standard or adjusted dosages based on patient condition are typically utilized.
Dosage Adjustments
Dosage adjustments are necessary for patients with renal or hepatic impairment, elderly patients, and those with specific comorbid conditions. Individualized dosing strategies are required based on the patient’s clinical status.
Side Effects
Common Side Effects:
Dizziness, headache, nausea, vomiting, dry mouth, drowsiness, insomnia, restlessness, stomach upset.
Rare but Serious Side Effects:
Allergic reactions (rash, itching, difficulty breathing, swelling of face, tongue or throat), hallucinations, seizures, irregular heartbeat, tachycardia, increased blood pressure (hypertensive crisis).
Long-Term Effects:
Chronic use of phenylpropanolamine can potentially lead to hypertension and other cardiovascular complications.
Adverse Drug Reactions (ADR):
Serious ADRs like Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis have been rarely reported.
Contraindications
Hypersensitivity to any component, severe liver/kidney disease, monoamine oxidase inhibitor (MAOI) use within the past 14 days, severe heart disease, uncontrolled hypertension, hyperthyroidism, closed-angle glaucoma, prostatic hypertrophy, pregnancy (especially the first trimester), breastfeeding.
Drug Interactions
MAOIs, antidepressants, antihypertensives, digoxin, sympathomimetics, caffeine, alcohol. The provided sources also mention interactions with antibiotics, non-steroidal anti-inflammatory drugs, anticancer agents, quinidine, ranolazine, ritonavir, sibutramine, terbinafine, guanethidine, methyldopa, furazolidone, and theophylline.
Pregnancy and Breastfeeding
The safety of this combination during pregnancy and breastfeeding has not been firmly established. Phenylpropanolamine may decrease milk production. It’s best to avoid use during pregnancy, especially in the first trimester, and during breastfeeding. Consult a physician for safer alternatives.
Drug Profile Summary
- Mechanism of Action: Bromhexine: Mucolytic, increases ciliary activity. Phenylpropanolamine: Decongestant, α-adrenergic agonist.
- Side Effects: Dizziness, headache, nausea, vomiting, dry mouth, drowsiness, insomnia, allergic reactions, cardiovascular effects.
- Contraindications: Hypersensitivity, MAOI use, severe cardiovascular disease, pregnancy (especially first trimester), breastfeeding.
- Drug Interactions: MAOIs, antidepressants, beta-blockers, sympathomimetics, caffeine, alcohol.
- Pregnancy & Breastfeeding: Not recommended. Consult a physician.
- Dosage: Refer to detailed dosage section above.
- Monitoring Parameters: Respiratory status, blood pressure, heart rate.
Popular Combinations
While data on popular combinations specifically with Bromhexine + Phenylpropanolamine is limited, combinations with analgesics (e.g., paracetamol), antihistamines (e.g., chlorpheniramine), and antipyretics may exist clinically. Sources frequently mention combinations of Bromhexine, Phenylpropanolamine, and Dextromethorphan.
Precautions
- General Precautions: Pre-screening for allergies, metabolic disorders, and organ dysfunction is necessary.
- Pregnant Women: Avoid use, especially during the first trimester.
- Breastfeeding Mothers: Avoid use due to potential neonatal exposure and decreased milk production.
- Children & Elderly: Use with caution and adjust dosage as needed.
- Lifestyle Considerations: Avoid alcohol and operating machinery if drowsiness occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Phenylpropanolamine?
A: Refer to the detailed dosage section above, as it varies based on age, condition, and individual patient factors.
Q2: What are the common side effects?
A: Common side effects include dizziness, headache, nausea, vomiting, dry mouth, drowsiness, insomnia, and gastrointestinal upset.
Q3: What are the contraindications for this combination?
A: Contraindications include hypersensitivity, severe liver or kidney disease, recent MAOI use, severe cardiovascular disease, uncontrolled hypertension, hyperthyroidism, closed-angle glaucoma, prostatic hypertrophy, and pregnancy (especially the first trimester).
Q4: Can I take this medication if I am pregnant or breastfeeding?
A: It is generally not recommended during pregnancy or breastfeeding. Consult a physician before use.
Q5: How does Bromhexine work to relieve cough?
A: Bromhexine acts as a mucolytic, breaking down the thick mucus in the airways, making it easier to cough up. It also stimulates ciliary activity which aids mucus clearance.
Q6: How does Phenylpropanolamine help with nasal congestion?
A: Phenylpropanolamine is a decongestant that works by constricting blood vessels in the nasal passages, reducing swelling and congestion.
Q7: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Q8: Are there any drug interactions I should be aware of?
A: Yes, several clinically significant drug interactions exist. Refer to the drug interaction section above. Inform your doctor about all medications, including over-the-counter drugs and supplements, that you are currently taking.
Q9: Can I drink alcohol while taking this medication?
A: It’s best to avoid alcohol as it may increase the risk of side effects such as drowsiness and dizziness.
Q10: What should I do if I experience any side effects?
A: If you experience any side effects, especially severe or persistent ones, contact your physician immediately.
