What is the recommended dosage and usage of Brompheniramine for allergic symptoms?

Brompheniramine Dosage and Usage for Allergic Symptoms

For allergic symptoms, brompheniramine should be dosed at 4 mg every 4-6 hours for adults, not exceeding 24 mg daily, while children 6-12 years should receive 2 mg every 4-6 hours, not exceeding 12 mg daily. Brompheniramine is a first-generation antihistamine effective for managing allergic rhinitis symptoms, particularly rhinorrhea.

Adult Dosing

• Standard oral dosage: 4 mg every 4-6 hours
• Extended-release formulation: 8-12 mg twice daily 1
• Maximum daily dose: 24 mg
• Elderly (>65 years): Reduced dosage recommended due to increased risk of anticholinergic effects

Pediatric Dosing

• Children 6-12 years: 2 mg every 4-6 hours (maximum 12 mg/day)
• Children 2-6 years: 1 mg every 4-6 hours (maximum 6 mg/day)
• Not recommended for children under 2 years of age 2

Clinical Efficacy

Brompheniramine is particularly effective for:

• Rhinorrhea (runny nose)
• Sneezing
• Nasal itching

Research shows brompheniramine significantly reduces nasal secretion weights, rhinorrhea scores, and sneeze counts compared to placebo 3. Extended-release formulations of brompheniramine (12 mg twice daily) have demonstrated superior efficacy compared to terfenadine (60 mg twice daily) for reducing total nasal symptom severity 1.

Important Considerations and Precautions

Side Effects

• Sedation/somnolence (24% incidence) 4
• Anticholinergic effects (dry mouth, urinary retention, constipation)
• Potential cognitive impairment that can affect school performance and driving ability 4
• Performance impairment can occur without subjective awareness of sedation

Special Warnings

1. First-generation antihistamines like brompheniramine can cause significant sedation and performance impairment that persists even when dosed at bedtime due to their prolonged half-life (24.9 ± 9.3 hours) 5, 4

2. Concomitant use with alcohol or other CNS depressants can enhance performance impairment 4

3. Use with caution in patients with:

   • Narrow-angle glaucoma
   • Prostatic hypertrophy
   • Asthma (a subset of asthmatic children may experience worsening pulmonary function) 6
   • Elderly patients (increased risk of anticholinergic effects)

4. Not recommended for children under 6 years according to American Academy of Pediatrics and FDA guidelines due to potential toxicity and lack of proven efficacy 2

Alternative Treatments

For patients experiencing significant sedation with brompheniramine, consider:

• Second-generation antihistamines (cetirizine, loratadine, fexofenadine)
• Intranasal corticosteroids for more comprehensive symptom control
• For isolated rhinorrhea, especially in nonallergic rhinitis, intranasal anticholinergics like ipratropium bromide may be effective 4

Duration of Treatment

For seasonal allergic rhinitis, treatment should continue throughout the relevant pollen season. For perennial allergic rhinitis, treatment may be ongoing but should be periodically reassessed to determine continued need.

Remember that while brompheniramine is effective for symptom control, it does not modify the underlying allergic disease process. For patients with persistent or severe symptoms, referral to an allergist for consideration of immunotherapy may be appropriate.