Bromfed DM Dosing
For adults and children ≥12 years: 5 mL (1 teaspoonful) every 4 hours, not to exceed 6 doses in 24 hours; for children 6-12 years: 2.5 mL (½ teaspoonful) every 4 hours, not to exceed 6 doses in 24 hours. 1
Formulation Details
Each 5 mL of Bromfed DM syrup contains:
- Brompheniramine maleate: 2 mg (antihistamine)
- Pseudoephedrine hydrochloride: 30 mg (decongestant)
- Dextromethorphan hydrobromide: 10 mg (cough suppressant)
- Alcohol: 0.95% v/v 1, 2
Age-Specific Dosing
Adults and Children ≥12 Years
- Dose: 5 mL every 4 hours
- Maximum: 30 mL per 24 hours (6 doses)
- This provides 12 mg brompheniramine, 180 mg pseudoephedrine, and 60 mg dextromethorphan daily
Children 6-12 Years
- Dose: 2.5 mL every 4 hours
- Maximum: 15 mL per 24 hours (6 doses)
- This provides 6 mg brompheniramine, 90 mg pseudoephedrine, and 30 mg dextromethorphan daily
Children <6 Years
- Not recommended - OTC cough and cold medications should generally be avoided in children below 6 years due to lack of established efficacy and potential toxicity 3
Clinical Context and Caveats
Important safety considerations:
The FDA and advisory committees have recommended against using OTC cough/cold medications in children <6 years following reports of 54 fatalities with decongestants and 69 with antihistamines in children ≤6 years, with most occurring in infants 3
Brompheniramine demonstrates a 12.4-hour half-life in children with peak concentrations at 3.2 hours, providing 24-hour peripheral H1-blockade from a single 4 mg dose 4. The twice-daily dosing in this formulation may lead to drug accumulation
Pseudoephedrine can cause CNS stimulation, tachyarrhythmias, insomnia, and hyperactivity, especially when combined with other stimulants (e.g., ADHD medications) 3. Use with extreme caution in patients with cardiovascular disease, hypertension, hyperthyroidism, or closed-angle glaucoma
Dextromethorphan shows modest efficacy for cough suppression in acute bronchitis but limited benefit for URI-related cough 5, 6. Recent evidence in children aged 6-11 years showed 21% reduction in total coughs over 24 hours compared to placebo 7
Monitor for overdose risk: Accidental overdoses have resulted from using multiple cold/cough products simultaneously, medication errors, and accidental exposures 3
Store at 20-25°C (68-77°F) in a tight, light-resistant container 1