A fixed-dose combination (FDC) cough syrup/tablet designed for the symptomatic management of productive and non-productive cough associated with upper respiratory tract infections (URTIs) and allergic conditions. It provides a multi-modal approach: Guaifenesin and Bromhexine act as mucolytics/expectorants to loosen and clear mucus, Dextromethorphan suppresses the cough reflex centrally, and Chlorpheniramine provides antihistaminic action to reduce allergic symptoms and rhinorrhea. This combination is widely used in the Indian OTC and prescription market for acute cough and cold.
Adult: 10 ml (2 teaspoonfuls) or 1 tablet, three to four times daily. Maximum: 4 doses in 24 hours.
Note: Take orally with or without food. If gastrointestinal upset occurs, take with food. For syrup: Use the measuring cup/spoon provided. Shake the bottle well before use. Drink a full glass of water after each dose to help loosen mucus. Do not drive or operate machinery after taking the dose due to drowsiness.
The combination works synergistically on different pathways of the cough reflex and mucus production. Guaifenesin increases the volume and reduces the viscosity of respiratory tract secretions by stimulating vagal receptors in the gastric mucosa, leading to reflex increased respiratory tract fluid. Bromhexine depolymerizes and lyses acid mucopolysaccharide fibers in bronchial secretions, making sputum less viscous. It also stimulates surfactant production. Dextromethorphan acts centrally on the cough center in the medulla oblongata, raising the threshold for cough reflex. Chlorpheniramine competitively antagonizes histamine at H1 receptors, reducing symptoms of allergic rhinitis like sneezing and rhinorrhea, and has mild anticholinergic effects which may help dry secretions.
Pregnancy: Category C (US FDA). Safety not established. Avoid, especially in first trimester. Use only if potential benefit justifies potential risk to the fetus. Chlorpheniramine has been associated with rare cases of retrolental fibroplasia in premature infants when used near delivery.
Driving: NOT ADVISABLE. The combination, particularly Chlorpheniramine and Dextromethorphan, can cause significant drowsiness, dizziness, and blurred vision, impairing the ability to drive or operate machinery.
| Monoamine Oxidase Inhibitors (MAOIs) e.g., Phenelzine, Selegiline, Linezolid | Risk of severe serotonin syndrome, hyperpyrexia, rigidity, myoclonus, autonomic instability. Can be fatal. | Contraindicated |
| Selective Serotonin Reuptake Inhibitors (SSRIs) e.g., Fluoxetine, Paroxetine | Increased risk of serotonin syndrome due to CYP2D6 inhibition and additive serotonergic effects. | Major |
| Other CNS Depressants (Alcohol, Benzodiazepines, Opioids, Sedative Antipsychotics) | Additive CNS depression, profound sedation, impaired psychomotor performance, respiratory depression. | Major |
| Anticholinergic Drugs (Tricyclic Antidepressants, Atropine, Oxybutynin, First-gen antipsychotics) | Additive anticholinergic side effects: urinary retention, constipation, dry mouth, blurred vision, confusion. | Moderate |
| Potent CYP2D6 Inhibitors (Quinidine, Cinacalcet, Terbinafine) | Markedly increased Dextromethorphan and Chlorpheniramine levels, leading to toxicity (CNS effects, serotonin syndrome). | Major |
| Antihypertensives | Chlorpheniramine may reduce the effect of some antihypertensives and cause tachycardia. | Moderate |
Same composition (Guaifenesin (100mg) + Bromhexine (8mg) + Chlorpheniramine Maleate (2mg) + Dextromethorphan Hydrobromide (10mg)), different brands: