Bromfed Dosing for 20.64 kg Child
For a child weighing 20.64 kg, administer 5 mL (1 teaspoonful) of Bromfed syrup every 4-6 hours, not to exceed 4 doses in 24 hours.
Formulation Details
Bromfed syrup contains per 5 mL 1:
- Brompheniramine maleate: 2 mg
- Pseudoephedrine hydrochloride: 30 mg
- Dextromethorphan hydrobromide: 10 mg
Weight-Based Dose Calculation
For this 20.64 kg child, one 5 mL dose provides:
- Brompheniramine: 0.097 mg/kg (2 mg ÷ 20.64 kg)
- Pseudoephedrine: 1.45 mg/kg (30 mg ÷ 20.64 kg)
- Dextromethorphan: 0.48 mg/kg (10 mg ÷ 20.64 kg)
Safety Considerations
Dextromethorphan Safety Margin
The dose of 0.48 mg/kg per dose is well below concerning thresholds. Research indicates:
- Doses of 5-7.5 mg/kg require monitoring 2
- Doses >7.5 mg/kg warrant emergency department evaluation 2
- Optimal antitussive dosing appears to be around 0.5 mg/kg 3
This child's dose is approximately 1/10th the threshold requiring medical monitoring, providing an excellent safety margin.
Brompheniramine Considerations
The dose of 0.097 mg/kg is conservative. Pharmacokinetic studies show brompheniramine 4 mg (approximately 0.4 mg/kg in children) produces effective H1-blockade lasting 24-30 hours 4. The standard 2 mg dose in this formulation provides adequate antihistamine effect with minimal sedation risk.
Pseudoephedrine Toxicity Threshold
The toxic dose of pseudoephedrine is estimated at <50 mg/kg 1, 5. At 1.45 mg/kg per dose, this represents only 3% of the toxic threshold, even with maximum daily dosing (4 doses = 5.8 mg/kg/day).
Critical Warnings
Overdose Recognition
Monitor for these signs requiring immediate emergency evaluation 1, 5:
- CNS effects: Excessive drowsiness, agitation, or seizures
- Cardiovascular: Tachycardia, hypertension, arrhythmias
- Dextromethorphan toxicity: Ataxia, nystagmus, opisthotonos
Drug Interactions
Do not use if the child is taking 2:
- Monoamine oxidase inhibitors (MAOIs)
- Selective serotonin reuptake inhibitors (SSRIs)
- Other serotonergic medications
These combinations risk serotonin syndrome and require 8 hours of monitoring even at therapeutic doses.
Contraindications to Home Management
Refer to emergency department if 2:
- Suicidal intent or intentional abuse suspected
- More than mild symptoms develop (beyond light somnolence or infrequent vomiting)
- Accidental ingestion >7.5 mg/kg dextromethorphan
Practical Administration
- Frequency: Every 4-6 hours as needed
- Maximum: 4 doses (20 mL total) in 24 hours
- Duration: Do not exceed 7 days without physician consultation
- Measurement: Use calibrated measuring device, not household spoons