Brompheniramine and Dextromethorphan in a Patient with Hypertension and Asthma
Brompheniramine is contraindicated in this patient due to her asthma, and the combination with dextromethorphan should be avoided as it may worsen her respiratory condition and potentially affect her blood pressure control. 1
Medication Concerns
Brompheniramine
- Brompheniramine is explicitly contraindicated in patients with asthma according to the FDA drug label 1
- Studies have shown that brompheniramine can cause significant decreases in pulmonary function in a subset of asthmatic patients 2
- First-generation antihistamines like brompheniramine have anticholinergic properties that can worsen asthma symptoms and potentially cause bronchospasm
Dextromethorphan
- While dextromethorphan is generally considered safe as an antitussive agent 3, the combination with brompheniramine creates additional risks
- Dextromethorphan should not be used in patients receiving monoamine oxidase inhibitors (MAOIs) 1
- Dextromethorphan is effective for cough suppression but should be used with caution in patients with hypertension 4
Hypertension Considerations
- First-generation antihistamines like brompheniramine may interact with antihypertensive medications, potentially reducing their effectiveness 5
- The FDA label specifically warns about using brompheniramine with caution in patients with hypertension 1
- The 2017 ACC/AHA guidelines emphasize careful medication selection in patients with hypertension and comorbidities 5
Alternative Recommendations
For this 47-year-old female with hypertension and asthma who needs cough treatment:
Ipratropium bromide nasal spray is recommended for upper airway cough syndrome and is safe in patients with asthma 5
Non-sedating antihistamines (such as bilastine, loratadine, or cetirizine) combined with dextromethorphan would be safer than brompheniramine for this patient 6
Dextromethorphan alone without the antihistamine component could be considered if the cough is not associated with significant upper airway symptoms 5
Monitoring and Precautions
If any cough medication is prescribed for this patient:
- Monitor blood pressure regularly during treatment
- Watch for signs of worsening asthma symptoms
- Consider shorter duration of therapy to minimize risks
- Ensure the patient is not taking any medications that could interact with the prescribed treatment
Conclusion
The combination of brompheniramine and dextromethorphan is not appropriate for this patient with hypertension and asthma. A safer alternative would be ipratropium bromide nasal spray or a non-sedating antihistamine if an antihistamine is needed, with careful monitoring of both blood pressure and respiratory status.