A fixed-dose combination (FDC) antitussive and mucolytic agent used for the symptomatic relief of productive and non-productive cough associated with respiratory tract conditions. Bromhexine is a mucolytic, Dextromethorphan is a centrally-acting antitussive, and Ammonium Chloride is an expectorant. This combination is widely prescribed in India for acute cough due to its triple-action mechanism.
Adult: 1-2 tablets (or 5-10 ml syrup) three to four times daily. Maximum: 8 tablets or 40 ml syrup in 24 hours.
Note: Take with a full glass of water. Can be taken with or without food. For syrup, use the measuring cup provided. Maintain adequate hydration.
The combination works synergistically: Bromhexine reduces mucus viscosity, Dextromethorphan suppresses the cough reflex in the medulla, and Ammonium Chloride increases bronchial secretions and promotes expulsion.
Pregnancy: Category C (US FDA). Bromhexine and dextromethorphan cross the placenta. Use only if potential benefit justifies potential risk. Avoid in first trimester. Indian context: Prescribe with extreme caution.
Driving: May cause dizziness/drowsiness. Patients should not drive or operate machinery until effect is known.
| MAO Inhibitors (Phenelzine, Selegiline) | Risk of serotonin syndrome, hyperpyrexia, death. | Contraindicated |
| SSRIs/SNRIs (Fluoxetine, Sertraline, Venlafaxine) | Increased risk of serotonin syndrome. | Major |
| CNS Depressants (Alcohol, Benzodiazepines, Opioids) | Additive sedation and respiratory depression. | Major |
| CYP2D6 Inhibitors (Quinidine, Paroxetine) | Increased dextromethorphan levels, increased toxicity risk. | Moderate |
| CYP3A4 Inducers (Rifampicin, Carbamazepine) | Decreased dextromethorphan efficacy. | Moderate |
| Urinary Alkalinizers (Sodium Bicarbonate, Acetazolamide) | Decreased renal excretion of dextromethorphan, increasing levels. | Moderate |
| Anticholinergics (Atropine, Oxybutynin) | Increased risk of constipation, urinary retention. | Moderate |