Bromfed (Brompheniramine and Pseudoephedrine) Dosing
The recommended dosing for Bromfed (brompheniramine and pseudoephedrine) is 4 mg of brompheniramine maleate and 60 mg of pseudoephedrine hydrochloride every 6 hours for standard formulation, or 8 mg brompheniramine and 120 mg pseudoephedrine every 12 hours for sustained-release formulation.
Standard Dosing Recommendations
Adults and Children ≥12 years:
- Standard formulation: 1 tablet/5 mL (4 mg brompheniramine + 60 mg pseudoephedrine) every 6 hours
- Sustained-release formulation: 1 capsule (8 mg brompheniramine + 120 mg pseudoephedrine) every 12 hours
Children 6-12 years:
- Standard formulation: Half the adult dose (2 mg brompheniramine + 30 mg pseudoephedrine) every 6 hours
- Sustained-release formulation: Not recommended
Children <6 years:
- Not recommended due to risk of adverse effects
Pharmacokinetics
Research demonstrates that the sustained-release formulation of brompheniramine and pseudoephedrine maintains therapeutic blood levels comparable to the standard formulation when dosed appropriately 1. The biological half-life of brompheniramine is approximately 21.6 hours, while pseudoephedrine has a shorter half-life of about 8.0 hours.
Clinical Considerations
Precautions and Contraindications:
- Cardiovascular disease: Use with caution due to pseudoephedrine's sympathomimetic effects
- Hypertension: May exacerbate high blood pressure
- Diabetes: May affect blood glucose control
- Glaucoma: May increase intraocular pressure
- Prostatic hypertrophy: May cause urinary retention
- Thyroid disorders: Use with caution
Adverse Effects:
- Common: Drowsiness, dizziness, dry mouth, blurred vision, urinary retention
- Cardiovascular: Tachycardia, palpitations, increased blood pressure
- Central nervous system: Nervousness, insomnia, headache
Special Populations
Elderly:
- Start with lower doses due to increased sensitivity to anticholinergic effects and potential for adverse reactions
- Consider starting with half the adult dose and titrate based on response
Renal/Hepatic Impairment:
- Dose reduction recommended
- Consider extending dosing interval in patients with significant renal impairment
Monitoring
- Monitor for signs of excessive anticholinergic effects (dry mouth, blurred vision, urinary retention)
- Watch for cardiovascular effects, particularly in patients with pre-existing cardiovascular disease
- Assess for CNS effects including sedation, which may affect ability to drive or operate machinery
Clinical Pearls
- Bromfed should be taken with food to minimize GI upset
- The sustained-release formulation should not be crushed or chewed
- Avoid concurrent use with MAO inhibitors and within 14 days of discontinuing an MAO inhibitor
- Avoid alcohol consumption while taking this medication as it may enhance CNS depression
Remember that antihistamine-decongestant combinations like Bromfed should be used for the shortest duration necessary to control symptoms, as prolonged use of decongestants can lead to rebound congestion.