Bromfed DM Dosing for Adults
For adults with cough and cold symptoms, Bromfed DM (containing brompheniramine, pseudoephedrine, and dextromethorphan) should be dosed according to the dextromethorphan component at 10-15 mg three to four times daily (maximum 120 mg/day), with pseudoephedrine 60 mg every 4-6 hours as needed for nasal congestion. 1
Dextromethorphan Component Dosing
Standard dosing is 10-15 mg three to four times daily, with a maximum daily dose of 120 mg for effective cough suppression. 1
For maximum cough reflex suppression, a single 60 mg dose can be used, though this is higher than typical over-the-counter recommendations. 1, 2
Standard over-the-counter dosing is often subtherapeutic; maximum cough suppression occurs at 60 mg and demonstrates a clear dose-response relationship. 1, 2
Critical caution: When using higher doses of dextromethorphan in combination products like Bromfed DM, carefully check for other ingredients to avoid excessive amounts of antihistamines or decongestants. 1
Pseudoephedrine Component Dosing
Pseudoephedrine 60 mg is the standard dose taken every 4-6 hours for nasal congestion associated with upper respiratory infections. 3
This dose has been demonstrated to significantly reduce nasal airway resistance compared to placebo after both single and multiple doses. 3
Heart rate may increase by 2-4 beats per minute with pseudoephedrine use. 3
Brompheniramine Component Considerations
Brompheniramine is a first-generation sedating antihistamine that can suppress cough and is particularly useful for nocturnal symptoms due to its sedative effects. 1, 2
The sedative properties make this combination especially suitable when cough disrupts sleep. 1, 2
Chlorphenamine (a related antihistamine) demonstrates efficacy in alleviating rhinorrhea and other cold symptoms, with a more favorable benefit/risk profile than vasoconstrictors alone. 4
Duration and Treatment Approach
Use Bromfed DM for short-term symptomatic relief only. 1
If cough persists beyond 3 weeks, discontinue antitussive therapy and pursue full diagnostic workup for alternative diagnoses. 1
Consider non-pharmacological approaches first, such as honey and lemon mixtures, which may be as effective as pharmacological treatments for benign viral cough. 1, 2
Important Safety Considerations
Do not use in productive cough where clearance of secretions is beneficial. 1
Avoid in patients requiring assessment for pneumonia (tachycardia, tachypnea, fever, abnormal chest examination). 2
The combination of antihistamine and decongestant may cause drowsiness, particularly affecting activities requiring alertness. 1, 2
Pseudoephedrine may induce less common but potentially life-threatening cardiovascular adverse effects compared to antihistamines alone. 4
Common Prescribing Pitfalls to Avoid
Using subtherapeutic doses of the dextromethorphan component (less than 30 mg per dose) may provide inadequate relief. 1, 2
Failing to account for all active ingredients when calculating total daily doses in combination products. 1
Continuing treatment beyond 2-3 weeks without reassessing for underlying causes of persistent cough. 1, 5