Is Bromfed (brompheniramine and pseudoephedrine) effective for treating Covid-19 symptoms?

Bromfed is Not Recommended for COVID-19 Treatment

Bromfed (brompheniramine and pseudoephedrine) is not recommended for treating COVID-19 symptoms, as it is not included in any evidence-based treatment guidelines for COVID-19 management.

Evidence-Based COVID-19 Symptom Management

Respiratory Symptoms

• For distressing cough in COVID-19, guidelines recommend:

  • Encouraging patients to avoid lying on their back 1
  • Using short-term codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution for severe cough 1, 2
  • Implementing controlled breathing techniques, including proper positioning and pursed-lip breathing 1, 2

• For breathlessness management:

  • Position adjustment, relaxation techniques, and breathing exercises are recommended 1, 2
  • For end-of-life patients with moderate to severe breathlessness, morphine sulfate may be considered 2

Fever and General Symptoms

• Paracetamol is recommended for fever management 2
• Adequate hydration with up to 2 liters of fluid per day is advised 2

Antibiotic Use in COVID-19

• Antibiotics should be used restrictively in COVID-19 patients, especially upon admission 1
• Maximum efforts should be made to obtain sputum and blood culture samples as well as pneumococcal urinary antigen testing before starting antibiotics 1
• Antibiotics should be stopped if cultures and urinary antigen tests show no signs of bacterial pathogens after 48 hours 1
• Some experts suggest that oral antibiotics could be considered if secondary bacterial infection is suspected, particularly in patients who might have severe radiologic features despite mild symptoms 1

Recommended Pharmacological Interventions

• Remdesivir is recommended for treatment of hospitalized COVID-19 patients or non-hospitalized patients with mild-to-moderate COVID-19 at high risk for progression to severe disease 2, 3
• Dexamethasone is recommended in critically ill COVID-19 patients 3
• Tocilizumab may be considered in hospitalized severe/critical COVID-19 patients with elevated markers of systemic inflammation 3

Not Recommended Treatments

• Lopinavir/ritonavir 3
• Hydroxychloroquine/chloroquine 3
• Azithromycin 3
• Convalescent plasma therapy 3
• Intravenous immunoglobulin 3
• Bromfed (brompheniramine and pseudoephedrine) is not mentioned in any COVID-19 treatment guidelines 1, 2

Potential Role of Bromhexine (Not Bromfed)

• Bromhexine (not to be confused with Bromfed) has been studied as a potential COVID-19 treatment due to its ability to inhibit TMPRSS2, which plays a role in viral entry into host cells 4
• While some clinical trials have shown potential benefits of bromhexine in COVID-19, it is not yet included in major treatment guidelines and should not be confused with Bromfed 4

Treatment Planning Considerations

• Treatment escalation plans should be put in place for COVID-19 patients as they may deteriorate rapidly 1, 2
• Risks, benefits, and likely outcomes of treatment options should be discussed with patients and their families 1
• For patients with pre-existing advanced comorbidities, advance care plans should be identified 1

Common Pitfalls to Avoid

• Using medications not supported by evidence or guidelines, such as Bromfed 2
• Delaying treatment escalation for patients showing signs of deterioration 2
• Routine administration of corticosteroids for mild cases without specific indications 2
• Overuse of antibiotics without confirmed bacterial infection 1

Bromfed, a combination of brompheniramine (an antihistamine) and pseudoephedrine (a decongestant), is primarily indicated for allergic rhinitis and nasal congestion but has no established role in COVID-19 management according to current guidelines and evidence.