Bromfed Dosing for a 30-Pound Child
For a 30-pound (approximately 13.6 kg) child aged 2 to under 6 years, administer 2.5 mL (½ teaspoonful) of Bromfed every 4 hours, not exceeding 6 doses in 24 hours 1.
Weight-Based Dosing Guidance
A 30-pound child typically falls into the 2 to under 6 years age category. The FDA-approved dosing for Bromfed (brompheniramine 2mg, pseudoephedrine 10mg, guaifenesin 30mg per 5mL) is:
- 2 to under 6 years: 2.5 mL every 4 hours 1
- 6 to under 12 years: 5 mL every 4 hours 1
- Maximum: 6 doses per 24-hour period 1
Critical Safety Considerations
Age-Related Risks with Decongestants
Oral decongestants carry significant risks in young children. Use in infants and children under 6 years has been associated with serious adverse events including agitated psychosis, ataxia, hallucinations, and death 2. Even at recommended doses, pseudoephedrine may cause:
- Tachyarrhythmias
- Insomnia and hyperactivity
- Loss of appetite and irritability
- Palpitations 2
Important Contraindications and Precautions
Avoid or use with extreme caution if the child has:
- Concurrent stimulant medications (e.g., ADHD medications) - may increase adverse events 2
- Cardiovascular disease
- Hyperthyroidism
- Closed-angle glaucoma
- Bladder neck obstruction 2
Monitoring Requirements
- Blood pressure monitoring may be warranted, though elevation is rare in normotensive children 2
- Watch for CNS stimulation (hyperactivity, insomnia) or paradoxical depression
- Avoid concurrent caffeine or other stimulants 2
Pharmacologic Rationale
The brompheniramine component (first-generation antihistamine) provides H1-receptor blockade with anticholinergic drying effects. In children, a single 4 mg dose produces prompt onset (0.5 hours) with sustained peripheral H1-blockade lasting up to 30 hours, with a terminal elimination half-life of 12.4 hours 3. Pseudoephedrine acts as a nasal decongestant through α-sympathetic receptor-mediated vasoconstriction, with onset within 30 minutes and peak effect at 1 hour 1. The elimination half-life in children (3.1 hours) is significantly shorter than in adults 4.
Common Pitfalls to Avoid
- Do not exceed the recommended dose - toxic doses of pseudoephedrine can cause CNS stimulation, tachycardia, hypertension, and cardiac arrhythmias 1
- Do not combine with other cold medications - risk of ingredient duplication and overdose
- Carefully assess risk-benefit in children under 6 years given documented safety concerns with oral decongestants in this age group 2
- Be aware of serotonin syndrome risk if the child is on SSRIs or other serotonergic medications, as both dextromethorphan and brompheniramine have serotonergic potential 5