Brompheniramine

What is Brompheniramine?

• Brompheniramine and chlorpheniramine maleate are first generation antihistamines that are widely used to treat symptoms of allergic rhinitis and the common cold.

Brompheniramine structure

What are the uses of this medicine?

• Brompheniramine relieves red, irritated, itchy, watery eyes; sneezing; and runny nose caused by allergies, hay fever, and the common cold. Brompheniramine helps control symptoms, but does not treat the cause of the symptoms or speed recovery.

Limitations of use:

• Brompheniramine should not be used to cause sleepiness in children.

How does this medicine work?

• Brompheniramine (brome" fen ir' a meen) and chlorpheniramine (klor" fen ir' a meen) are first generation antihistamines that are used widely in the therapy of the symptoms of sneezing, cough, runny note, watery eyes and itching.
• They are similar in chemical structure and constitute the alkylamine class of antihistamines.
• They are probably the most commonly used over-the-counter antihistamines, being present alone or in combination with other agents in more than 1000 products used for the symptoms of the common cold, sinusitis, urticaria and hay fever.
• Both agents are also available as their dextrorotatory isomers, dexbrompheniramine and dexchlorpheniramine, which have similar profiles of action and side effects.
• In allergic reactions an allergen interacts with and cross-links surface IgE antibodies on mast cells and basophils.
• Once the mast cell-antibody-antigen complex is formed, a complex series of events occurs that eventually leads to cell-degranulation and the release of histamine (and other chemical mediators) from the mast cell or basophil.
• Once released, histamine can react with local or widespread tissues through histamine receptors.
• Histamine, acting on H1-receptors, produces pruritis, vasodilatation, hypotension, flushing, headache, tachycardia, and bronchoconstriction. Histamine also increases vascular permeability and potentiates pain.
• Brompheniramine is a histamine H1 antagonist (or more correctly, an inverse histamine agonist) of the alkylamine class.
• It provides effective, temporary relief of sneezing, watery and itchy eyes, and runny nose due to hay fever and other upper respiratory allergies.

Who Should Not Use this medicine ?

This medicine cannot be used in patients with:

• Hypersensitivity to any of the ingredient
• Do not use in the newborn, in premature infants, in nursing mothers, or in patients with severe hypertension or severe coronary artery disease.

What drug interactions can this medicine cause?

• Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

Be sure to mention any of the following:

• medications for colds, hay fever, or allergies
• medications for depression or seizures; monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate)
• muscle relaxants
• narcotic medications for pain
• sedatives
• sleeping pills; and tranquilizers

Is this medicine FDA approved?

• It was patented in 1948 and came into medical use in 1955.

How should this medicine be used?

Recommended dosage: Adults:

• The typical oral dose in adults is 2 to 4 mg three or four times a day.

Administration:

• Brompheniramine comes in combination with other cough and cold medications as a chewable tablet, an extended-release (long-acting) capsule, an extended-release (long-acting) tablet, and a liquid to be taken by mouth.
• The chewable tablet and liquid are usually taken every 4 to 6 hours as needed.
• The extended-release tablets and capsules are usually taken every 8 or 12 hours as needed.
• Nonprescription cough and cold combination products, including products that contain brompheniramine, can cause serious side effects or death in young children.
• Do not give these products to children younger than 6 years of age.
• If you give these products to children 6-11 years of age, use caution and follow the package directions carefully.
• If you are taking the liquid, do not use a household spoon to measure your dose. Use the measuring spoon or cup that came with the medication or use a spoon made especially for measuring medication.
• If you are taking the extended-release tablets or capsules swallow them whole; do not crush, break, or chew them.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As an extended-release (long-acting) capsule, an extended-release (long-acting) tablet, and a liquid

This medicine is available in fallowing brand namesː

• Ala-Hist IR
• Dimetane
• Disomer
• J-Tan
• Veltane
• Chlor-Trimeton
• Drixoral
• Durahist

What side effects can this medication cause?

The most common side effects of this medicine include:

• sedation, impairment of motor function, confusion, dizziness, blurred vision, dry mouth and throat, palpitations, tachycardia, abdominal distress, constipation and headache. Antihistamines can worsen urinary retention and glaucoma.

Brompheniramine may cause some serious side effects which may include:

• vision problems
• difficulty urinating

What special precautions should I follow?

• This medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• Talk to your doctor about the safe use of alcohol while you are taking brompheniramine. Alcohol can make the side effects of brompheniramine worse.
• brompheniramine and dexbrompheniramine should not be used in premature or full-term neonates. Conventional or extended-release preparations of brompheniramine maleate should be used in children younger than 2 or 6 years of age, respectively, only under the direction of a clinician.
• Some patients, especially children, receiving antihistamines may experience paradoxical excitement characterized by restlessness, insomnia, tremors, euphoria, nervousness, delirium, palpitation, and even seizures.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking brompheniramine.
• talk to your doctor about the risks and benefits of taking brompheniramine if you are 65 years of age or older. Older adults should not usually take brompheniramine because it is not as safe or effective as other medications that can be used to treat the same condition.
• If your doctor has told you to take brompheniramine regularly, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
• Clinically apparent liver injury from brompheniramine or chlorpheniramine must be exceeding rare, if it occurs at all.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• fast or irregular heartbeat, mental or mood changes, tightness in the chest, and unusual tiredness or weakness.

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.
• Maintain an open airway and assist ventilation if necessary.
• Treat coma, seizures, hyperthermia, and atypical ventricular tachycardia if they occur.
• Monitor the patient for at least 6 to 8 hours after ingestion.

Specific drugs and antidotes:

• There is no specific antidote for antihistamine overdose.
• As for anticholinergic poisoning, physostigmine has been used for treatment of severe delirium or tachycardia.
• However because antihistamine overdose carry a greater risk for seizures physostigmine is not recommended routinely.
• Sodium bicarbonate may be useful for myocardial depression.

Decontamination:

• Administer activated charcoal orally if conditions are appropriate.
• Gastric lavage is not necessary after small to moderate ingestions if activated charcoal can be given promptly.
• Because of slowed gastrointestinal motility, gut decontamination procedures may be helpful even in late-presenting patients.

Enhanced elimination:

• Hemodialysis, hemoperfusion, peritoneal dialysis, and repeat dose activated charcoal are not effective in removing antihistamines.

Can this medicine be used in pregnancy?

• Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking brompheniramine, call your doctor.

Can this medicine be used in children?

• Brompheniramine and dexbrompheniramine should not be used in premature or full-term neonates.
• Conventional or extended-release preparations of brompheniramine maleate should be used in children younger than 2 or 6 years of age, respectively, only under the direction of a clinician.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• brompheniramine maleate

Inactive ingredients:

Who manufactures and distributes this medicine?

• Common brand name preparations include Chlor-Trimeton, Dimetane, Drixoral and Durahist, and most are available without a prescription and in combination with sympathomimetic agents (such as pseudoephedrine or phenylephrine) or analgesics or both.

What should I know about storage and disposal of this medication?

• Preparations containing brompheniramine maleate generally should be stored in tight, light-resistant containers at a controlled room temperature between 15 - 30 °C.

First Generation Antihistamines

• Brompheniramine
• Carbinoxamine
• Chlorcyclizine
• Chlorpheniramine
• Clemastine
• Cyclizine
• Cyproheptadine
• Dexbrompheniramine
• Dexchlorpheniramine
• Dimenhydrinate
• Diphenhydramine
• Doxylamine
• Hydroxyzine
• Meclizine
• Phenyltoloxamine
• Promethazine
• Triprolidine

Second Generation Antihistamines

• Acrivastine
• Cetirizine
• Fexofenadine
• Levocetirizine
• Loratadine
• Desloratadine

• Dailymed label info on Brompheniramine
• FDA Brompheniramine

Pharmacodynamics