What is the recommended dosage of Bromphen-Pseudoeph-DM (Brompheniramine, Pseudoephedrine, Dextromethorphan) 2-30-10 MG/5ML oral syrup for an adult or child with symptoms such as cough, congestion, or allergies?

Bromphen-Pseudoeph-DM Dosing for Adults and Children

For adults and children over 12 years, take 5 mL by mouth every 4 hours as needed, with a maximum of 20 mL (4 doses) in 24 hours, which provides appropriate therapeutic levels of all three active ingredients while minimizing adverse effects. 1

Dosing by Age Group

Adults and children ≥12 years:

• 5 mL every 4 hours as needed
• Maximum: 20 mL (4 doses) in 24 hours
• This delivers per dose: brompheniramine 2 mg, pseudoephedrine 30 mg, dextromethorphan 10 mg 1

Children 6-12 years:

• Reduced dosing (typically 2.5 mL every 4 hours) should be used with physician consultation
• The combination formulation requires careful weight-based consideration 1, 2

Children under 6 years:

• This combination is generally not recommended due to safety concerns with pseudoephedrine and the sedating antihistamine in young children 3

Component-Specific Considerations

Brompheniramine (antihistamine):

• Provides 12-24 hour duration of action with peak effect at 3 hours after administration
• Produces significant histamine blockade (52% wheal suppression, 72% flare suppression) lasting up to 30 hours from a single 4 mg dose in children 2
• The 2 mg dose per 5 mL is appropriate for symptom control while minimizing sedation 2

Pseudoephedrine (decongestant):

• The 30 mg dose per 5 mL provides effective nasal decongestion for 4-6 hours
• Objective measurements show significant reduction in nasal airway resistance compared to placebo (p < 0.001) 4
• Causes modest cardiovascular effects: increases heart rate by approximately 2-4 beats per minute and systolic blood pressure by ~1 mmHg 5, 4

Dextromethorphan (cough suppressant):

• The 10 mg dose per 5 mL (0.5 mg/kg for a 20 kg child) falls within the therapeutic range
• Evidence suggests doses of 0.5 mg/kg balance symptomatic relief with adverse event avoidance 6
• Meta-analysis supports dextromethorphan's efficacy for acute cough suppression, though maximum effect occurs at 60 mg doses 7

Critical Safety Warnings

Contraindications and high-risk populations:

• Avoid in patients with: uncontrolled hypertension, cardiovascular disease, cerebrovascular disease, hyperthyroidism, closed-angle glaucoma, bladder neck obstruction, or prostatic hypertrophy 1, 5
• Migraine patients: Use only if no cardiovascular comorbidities exist; limit to twice weekly to prevent medication-overuse headaches 5
• Never crush, chew, or break capsules if switching to benzonatate as an alternative (though this is a liquid formulation) 8

Common adverse effects to monitor:

• Sedation and drowsiness (from brompheniramine) 1, 2
• Insomnia, irritability, palpitations (from pseudoephedrine) 5, 4
• In overdose situations: hyperirritability, psychosis, and ataxia have been reported with pseudoephedrine/dextromethorphan combinations 3

Practical Clinical Algorithm

Step 1: Verify no contraindications (cardiovascular disease, hypertension, glaucoma, urinary retention) 1, 5

Step 2: Confirm appropriate age (≥12 years for full adult dosing) 1

Step 3: Instruct patient on proper dosing:

• Take 5 mL every 4 hours only when symptoms present
• Do not exceed 20 mL in 24 hours
• Avoid concurrent use with caffeine or other stimulants 1

Step 4: Set expectations:

• Symptom relief should occur within 1-3 hours 4, 2
• If cough persists beyond 2-3 weeks, reassess for underlying causes rather than continuing symptomatic treatment 8

Step 5: Consider alternatives if:

• Sedation is problematic: switch to non-sedating antihistamine combination 9
• Cardiovascular concerns exist: consider topical oxymetazoline for short-term nasal congestion 5
• Simple viral cough without significant symptoms: honey and lemon may be equally effective 7, 8

Duration of Treatment

Limit use to acute symptoms only:

• Acute viral cough typically resolves within 3 weeks 7
• For persistent productive cough, this combination is less appropriate than evaluation for underlying causes 7
• First-generation antihistamines like brompheniramine are preferred for cold symptoms due to anticholinergic drying effects, but should not be used chronically 1