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Cough and upper respiratory symptoms associated with common cold: Oral: Anaplex® DM: 5 mL every 4-6 hours (maximum: 4 doses/24 hours) Bromaline® DM: 20 mL every 4-6 hours (maximum: 4 doses/24 hours) Dosing: Pediatric

Cough and upper respiratory symptoms: Oral: 2-6 years (Anaplex® DM): 1.25 mL every 4-6 hours (maximum: 4 doses/24 hours) 6-12 years: Anaplex® DM: 2.5 mL every 4-6 hours (maximum: 4 doses/24 hours) Bromaline® DM: 10 mL every 4-6 hours (maximum: 4 doses/24 hours) ≥12 years: Refer to adult dosing. Dosing: Geriatric Refer to adult dosing. Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product Elixir, oral: Bromaline® DM: Brompheniramine maleate 1 mg, pseudoephedrine hydrochloride 15 mg, and dextromethorphan hydrobromide 5 mg per 5 mL (120 mL [DSC], 480 mL) [ethanol free; contains sodium benzoate; grape flavor] Liquid, oral: Bromphenex™ DM: Brompheniramine maleate 4 mg, pseudoephedrine hydrochloride 60 mg, and dextromethorphan hydrobromide 30 mg per 5 mL (480 mL) [contains propylene glycol; ethanol free, dye free, sugar free; raspberry flavor] Brotapp-DM: Brompheniramine maleate 1 mg, pseudoephedrine hydrochloride 15 mg, and dextromethorphan hydrobromide 5 mg per 5 mL (120 mL, 240 mL) [grape flavor] LoHist PSB DM: Brompheniramine maleate 4 mg, pseudoephedrine hydrochloride 20 mg, and dextromethorphan hydrobromide 20 mg per 5 mL (473 mL) [dye free, ethanol free, sugar free; cherry flavor] Q-Tapp Cold & Cough: Brompheniramine maleate 1 mg, pseudoephedrine hydrochloride 15 mg, and dextromethorphan hydrobromide 5 mg per 5 mL (118 mL) [ethanol free; contains propylene glycol, sodium 2 mg/5 mL, sodium benzoate; grape flavor] Solution, oral [drops]: PediaHist DM: Brompheniramine maleate 1 mg, pseudoephedrine hydrochloride 15 mg, and dextromethorphan hydrobromide 4 mg per 1 mL (30 mL) [grape flavor] Resperal-DM: Brompheniramine maleate 1 mg, pseudoephedrine hydrochloride 12 mg, and dextromethorphan hydrobromide 5 mg per 1 mL (30 mL) [dye free, ethanol free, gluten free; contains proplylene glycol; grape flavor] Syrup, oral: Brompheniramine maleate 4 mg, pseudoephedrine hydrochloride 60 mg, and dextromethorphan hydrobromide 30 mg per 5 mL (480 mL) Anaplex® DM: Brompheniramine maleate 4 mg, pseudoephedrine hydrochloride 60 mg, and dextromethorphan hydrobromide 30 mg per 5 mL (480 mL) [ethanol free, dye free, sugar free; fruit flavor]

Syrup, oral: Brompheniramine maleate 4 mg, pseudoephedrine hydrochloride 60 mg, and dextromethorphan hydrobromide 30 mg per 5 mL (480 mL) Anaplex® DM: Brompheniramine maleate 4 mg, pseudoephedrine hydrochloride 60 mg, and dextromethorphan hydrobromide 30 mg per 5 mL (480 mL) [ethanol free, dye free, sugar free; fruit flavor] Bromdex D: Brompheniramine maleate 3 mg, pseudoephedrine hydrochloride 50 mg, and dextromethorphan hydrobromide 30 mg per 5 mL (480 mL) [ethanol free, sugar free; contains sodium benzoate; berry-vanilla flavor] Bromfed® DM: Brompheniramine maleate 2 mg, pseudoephedrine hydrochloride 30 mg, and dextromethorphan hydrobromide 10 mg per 5 mL (473 mL) [contains ethanol 0.95%, propylene glycol, sodium benzoate; butterscotch flavor] Myphetane DX: Brompheniramine maleate 2 mg, pseudoephedrine hydrochloride 30 mg, and dextromethorphan hydrobromide 10 mg per 5 mL (480 mL) [contains ethanol <1%; butterscotch flavor] [DSC] Neo DM: Brompheniramine maleate 2 mg, pseudoephedrine hydrochloride 30 mg, and dextromethorphan hydrobromide 10 mg per 5 mL (473 mL) [contains propylene glycol; berry-vailla flavor] Sildec-DM: Brompheniramine maleate 4 mg, pseudoephedrine hydrochloride 45 mg, and dextromethorphan hydrobromide 15 mg per 5 mL (480 mL) [grape flavor] Generic Equivalent Available: U.S. Yes Use Relief of cough and upper respiratory symptoms (including nasal congestion) associated with allergy or the common cold Adverse Reactions Significant Frequency not defined. Cardiovascular: Arrhythmias, flushing, hypertension, pallor, palpitation, tachycardia Central nervous system: Convulsions, CNS stimulation, dizziness, drowsiness, excitability (children; rare), giddiness, hallucinations, headache, insomnia, irritability, lassitude, nervousness, sedation Dermatologic: Photosensitivity, pruritus, rash, urticaria Gastrointestinal: Anorexia, constipation, diarrhea, dyspepsia, GI upset, nausea, vomiting, xerostomia Hematologic: Agranulocytosis, hemolytic anemia, thrombocytopenia Neuromuscular skeletal: Tremors, weakness Ocular: Diplopia Renal: Dysuria, polyuria, urinary retention (with BPH) Respiratory: Respiratory difficulty

Dermatologic: Photosensitivity, pruritus, rash, urticaria Gastrointestinal: Anorexia, constipation, diarrhea, dyspepsia, GI upset, nausea, vomiting, xerostomia Hematologic: Agranulocytosis, hemolytic anemia, thrombocytopenia Neuromuscular skeletal: Tremors, weakness Ocular: Diplopia Renal: Dysuria, polyuria, urinary retention (with BPH) Respiratory: Respiratory difficulty Contraindications Hypersensitivity to brompheniramine, pseudoephedrine, dextromethorphan or any component of the formulation; severe hypertension or coronary artery disease; MAO inhibitor therapy; GI or GU obstruction; peptic ulcer disease; narrow-angle glaucoma; acute asthma attack Warnings/Precautions

Disease-related concerns: • Asthma: Use with caution in patients with a history of asthma. • Cardiovascular disease: Use with caution in patients with cardiovascular disease (including hypertension and ischemic heart disease); contraindicated with severe disease. • Diabetes: Use with caution in patients with diabetes mellitus. • Increased intraocular pressure: Use with caution in patients with increased intraocular pressure. • Prostatic hyperplasia/urinary obstruction: Use with caution in patients with prostatic hyperplasia and/or GU obstruction. • Thyroid dysfunction: Use with caution in patients with thyroid dysfunction.

Special populations: • Debilitated patients: Use with caution in sedated, debilitated patients confined to supine position. • Elderly: Use with caution in the elderly; may be more sensitive to adverse effects. • Pediatrics: Antihistamines may cause excitation in young children. Use with caution in atopic children. Metabolism/Transport Effects Refer to individual components. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) Abiraterone Acetate: May increase the serum concentration of CYP2D6 Substrates. Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity. Risk D: Consider therapy modification Acetylcholinesterase Inhibitors (Central): Anticholinergics may diminish the therapeutic effect of Acetylcholinesterase Inhibitors (Central). Acetylcholinesterase Inhibitors (Central) may diminish the therapeutic effect of Anticholinergics. If the anticholinergic action is a side effect of the agent, the result may be beneficial. Risk C: Monitor therapy Aclidinium: May enhance the anticholinergic effect of Anticholinergics. Risk X: Avoid combination Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy Alpha1-Blockers: May diminish the hypertensive effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists may antagonize hypotensive effects of Alpha1-Blockers. Alpha1-Blockers may diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists may antagonize Alpha1-Blocker vasodilation. Risk C: Monitor therapy Amphetamines: May diminish the sedative effect of Antihistamines. Risk C: Monitor therapy Antacids: May decrease the excretion of Alpha-/Beta-Agonists.

Exceptions: Levocabastine (Nasal). Risk C: Monitor therapy Antipsychotics: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Risk C: Monitor therapy AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Risk X: Avoid combination Benzylpenicilloyl Polylysine: Antihistamines may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Suspend systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing and delay testing until systemic antihistaminic effects have dissipated. A histamine skin test may be used to assess persistent antihistaminic effects. Risk D: Consider therapy modification Benzylpenicilloyl Polylysine: Alpha-/Beta-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. Risk D: Consider therapy modification Betahistine: Antihistamines may diminish the therapeutic effect of Betahistine. Risk C: Monitor therapy Bromocriptine: Alpha-/Beta-Agonists may enhance the adverse/toxic effect of Bromocriptine. Including increased blood pressure, ventricular arrhythmias, and seizure. Risk C: Monitor therapy Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of CNS depressants used in combination with buprenorphine. Consider avoiding other CNS depressants in patients thought to be at high risk of buprenorphine overuse or self-injection. Risk D: Consider therapy modification Cannabinoids: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy Carbonic Anhydrase Inhibitors: May decrease the excretion of Alpha-/Beta-Agonists.

Exceptions: Levocabastine (Nasal). Risk C: Monitor therapy CYP2D6 Inhibitors (Moderate): May decrease the metabolism of CYP2D6 Substrates. Risk C: Monitor therapy CYP2D6 Inhibitors (Strong): May decrease the metabolism of CYP2D6 Substrates. Risk D: Consider therapy modification Darunavir: May increase the serum concentration of CYP2D6 Substrates. Risk C: Monitor therapy Ergot Derivatives: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists.

Exceptions: Ergoloid Mesylates. Risk X: Avoid combination FentaNYL: Alpha-/Beta-Agonists (Indirect-Acting) may decrease the serum concentration of FentaNYL. Specifically, fentanyl nasal spray serum concentrations may decrease and onset of effect may be delayed. Risk C: Monitor therapy Hyaluronidase: Antihistamines may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving antihistamines (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Risk D: Consider therapy modification HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Risk X: Avoid combination Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergics. Risk X: Avoid combination Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy MAO Inhibitors: May enhance the serotonergic effect of Dextromethorphan. This may cause serotonin syndrome. Risk X: Avoid combination MAO Inhibitors: May enhance the hypertensive effect of Alpha-/Beta-Agonists (Indirect-Acting). Risk X: Avoid combination Metoclopramide: Serotonin Modulators may enhance the adverse/toxic effect of Metoclopramide. This may be manifest as symptoms consistent with serotonin syndrome or neuroleptic malignant syndrome. Risk C: Monitor therapy Metyrosine: CNS Depressants may enhance the sedative effect of Metyrosine. Risk C: Monitor therapy Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Risk X: Avoid combination Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Risk C: Monitor therapy Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Risk D: Consider therapy modification Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Risk D: Consider therapy modification Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy Pramlintide: May enhance the anticholinergic effect of Anticholinergics. These effects are specific to the GI tract. Risk D: Consider therapy modification QuiNIDine: May increase the serum concentration of Dextromethorphan. Management: Avoid concurrent use of these agents when possible, unless the increased psychoactive effects of dextromethorphan are desired. Since codeine activation is also inhibited by quinidine, codeine is unlikely to be suitable as an alternative antitussive. Risk D: Consider therapy modification ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Risk C: Monitor therapy Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Risk C: Monitor therapy Selective Serotonin Reuptake Inhibitors: May enhance the serotonergic effect of Dextromethorphan. Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Dextromethorphan. Management: Avoid the concurrent use of dextromethorphan and SSRIs, particularly fluoxetine and paroxetine, when possible. The risk for this interaction may persist for several weeks following discontinuation of fluoxetine or paroxetine.

Exceptions: FluvoxaMINE. Risk D: Consider therapy modification Serotonin Modulators: May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Risk D: Consider therapy modification Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the tachycardic effect of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitors may enhance the vasopressor effect of Alpha-/Beta-Agonists. Risk D: Consider therapy modification Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. Risk D: Consider therapy modification Spironolactone: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy Tiotropium: Anticholinergics may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider therapy modification Ethanol/Nutrition/Herb Interactions Ethanol: May increase CNS depression; monitor for increased effects with coadministration. Caution patients about effect. Mechanism of Action Brompheniramine maleate is an antihistamine with H 1 -receptor activity; pseudoephedrine, a sympathomimetic amine and isomer of ephedrine, acts as a decongestant in respiratory tract mucous membranes with less vasoconstrictor action than ephedrine in normotensive individuals; dextromethorphan, a non-narcotic antitussive, increases cough threshold by its activity on the medulla oblongata. Use of UpToDate is subject to the Subscription and License Agreement . Topic 8698 Version 45.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.6- C21.56 Licensed to: AsanBook Dig. Med. Lib. | Support Tag: [1102-222.190.118.195-58B3102C39-S244013.14]