Can a pediatric patient under 12 take DayQuil (dextromethorphan) or NyQuil (acetaminophen and dextromethorphan) with bromfed (brompheniramine)

Can Pediatric Patients Under 12 Take DayQuil/NyQuil with Bromfed?

No, pediatric patients under 12 years old should not take DayQuil (dextromethorphan) or NyQuil (acetaminophen and dextromethorphan) with bromfed (brompheniramine), as this combination provides no additional therapeutic benefit and increases the risk of adverse effects including excessive sedation, respiratory depression, and anticholinergic toxicity.

Rationale for Avoiding This Combination

Lack of Efficacy for Combined Antihistamines

• Combining multiple antihistamines (brompheniramine in Bromfed with the antihistamine components often found in cold preparations) does not improve symptom control in pediatric patients 1
• Antihistamines show only limited short-term benefit (days 1-2) for overall cold symptoms in adults, with no clinically significant effect on nasal obstruction, rhinorrhea, or sneezing 1
• There is no evidence of effectiveness of antihistamines in children for common cold symptoms 1

Increased Risk of Adverse Effects

• The combination of multiple CNS-active agents (dextromethorphan plus brompheniramine) significantly increases sedation risk 2
• Dextromethorphan in megadoses (which can occur with accidental overdose in children) produces profound psychological and physiological effects 3
• First-generation antihistamines like brompheniramine are among the most commonly used medications in young children, with exposure rates of 7.6% in children under 2 years and 10.1% in children aged 2-5 years 4

Age-Specific Concerns for Pediatric Use

Children Under 12 Years

• Approximately 1 in 10 US children uses a cough and cold medication in a given week, with the highest prevalence among 2-5 year olds 4
• Decongestants that are part of some combined products are not approved for children under the age of 4 years 2
• The use of multiple-ingredient cold products accounts for 64.2% of all cough and cold medications used by children, increasing the risk of unintentional overdose 4

Risk of Toxicity in Young Children

• Children have variable metabolism of dextromethorphan, with approximately 5% of persons of European ethnicity lacking the ability to metabolize the drug normally, leading to rapid acute toxic levels 3
• Patients who have ingested more than 7.5 mg/kg of dextromethorphan should be referred to an emergency department for evaluation 5
• Sedation and respiratory depression are more common with sedating antihistamines, though differences are not always statistically significant 1

Safer Alternative Approaches

Monotherapy Recommendations

• If treatment is deemed necessary, use a single agent rather than combination therapy 2
• For nasal congestion, intranasal steroids are more effective than oral antihistamines in children with allergic rhinitis 2
• Oral antihistamines and oral decongestant combinations should only be considered if nasal sprays are disliked or not tolerated 2

Monitoring Requirements

• Any child receiving cough and cold medications should have poison center-initiated follow-up approximately every 2 hours for up to 4 hours after ingestion if doses approach 5-7.5 mg/kg 5
• Parents should be educated to carefully ascertain whether other drugs, such as acetaminophen, were involved to assess risk for toxicity or drug interactions 5

Critical Pitfalls to Avoid

• Never combine multiple antihistamine-containing products as this provides no additional benefit and increases sedation risk 1
• Do not assume over-the-counter medications are safe for young children simply because they are available without prescription 4
• Avoid using combination products when a single symptom predominates, as this exposes the child to unnecessary medications 2
• Do not induce emesis if overdose is suspected; refer to emergency department instead 5