What are alternative cough medications for a patient allergic to Bromfed (Brompheniramine) or Robitussin (Guaifenesin and Dextromethorphan)?

Alternative Cough Medications for Patients Allergic to Bromfed or Robitussin

For patients allergic to Bromfed (brompheniramine) or Robitussin (guaifenesin and dextromethorphan), ipratropium bromide is the recommended first-line alternative for cough suppression, particularly for cough due to upper respiratory infections or chronic bronchitis. 1

First-Line Alternatives

• Ipratropium bromide (inhaled): The only inhaled anticholinergic agent recommended for cough suppression in patients with URI or chronic bronchitis, with substantial benefit and grade A recommendation 1

• Menthol (inhaled): Can be prescribed as menthol crystals or proprietary capsules for acute cough suppression, though effects are short-lived 1

• First-generation antihistamines with sedative properties: Effective for cough suppression, particularly for nocturnal cough, though they cause drowsiness 1

Second-Line Alternatives

• Codeine: Recommended only for short-term symptomatic relief of coughing in chronic bronchitis, not for URI-related cough 1

• Alternative central cough suppressants: If not allergic to dextromethorphan specifically but only to combination products containing it, pure dextromethorphan may be considered at doses of 60 mg for maximum cough reflex suppression 1

Important Considerations

• Allergic components: Determine which specific component(s) of Bromfed or Robitussin the patient is allergic to (brompheniramine, guaifenesin, dextromethorphan) before selecting an alternative 1

• Underlying cause: Treatment should be guided by the specific disorder eliciting cough - whether it's URI, chronic bronchitis, or another condition 1

• Duration of therapy: For any cough suppressant, limit use to short-term symptomatic relief 1, 2

• Avoid in certain conditions: Cough suppressants should be avoided in patients with chronic bronchitis and bronchiectasis as they can cause sputum retention 2

Specific Recommendations Based on Cough Type

For Upper Respiratory Infection (URI) Cough:

• First choice: Ipratropium bromide inhaler 1
• Alternative: Menthol inhalation or sedative antihistamines 1
• Not recommended: Central cough suppressants (codeine, dextromethorphan) have limited efficacy for URI cough 1

For Chronic Bronchitis Cough:

• First choice: Ipratropium bromide inhaler 1
• Alternative: Codeine or dextromethorphan (if not allergic to the specific component) 1
• Not recommended: Agents that alter mucus characteristics are not recommended for cough suppression in chronic bronchitis 1

Caution and Monitoring

• Sedation risk: First-generation antihistamines cause drowsiness and should be used with caution when driving or operating machinery 1

• Abuse potential: Be aware that dextromethorphan has abuse potential, particularly among adolescents 3

• Respiratory depression: Codeine may cause respiratory depression at higher doses and carries risk of dependence 2

• Reassessment: If symptoms persist beyond one week, the patient should be reassessed 2