A fixed-dose combination (FDC) syrup for symptomatic relief of productive and non-productive cough associated with upper respiratory tract infections. It combines an expectorant (Guaifenesin), a mucolytic (Bromhexine), an antihistamine (Diphenhydramine), an expectorant/acidifier (Ammonium Chloride), and a soothing agent (Menthol). This combination is widely used in the Indian market for its multi-modal action on cough reflex, mucus viscosity, and airway irritation.
Adult: 10 ml (2 teaspoonfuls) three to four times a day. Maximum: 40 ml per day.
Note: Take orally. Use the measuring cup/spoon provided. Can be taken with or without food. Taking with a full glass of water may enhance the expectorant effect of Guaifenesin and Ammonium Chloride. Do not drive or operate machinery for 6-8 hours after a dose.
This combination works synergistically. Guaifenesin increases respiratory tract fluid secretions and reduces mucus viscosity. Bromhexine depolymerizes mucopolysaccharide fibers in sputum, decreasing viscosity and aiding expectoration. Diphenhydramine acts centrally on the medullary cough center to suppress the cough reflex and peripherally as an H1-antagonist to reduce post-nasal drip. Ammonium Chloride acts as an expectorant by irritating the gastric mucosa, leading to a reflex increase in bronchial secretions; it also acidifies urine. Menthol provides a cooling sensation and mild local anesthetic effect on the throat, soothing irritation.
Pregnancy: Category B (US FDA) for Guaifenesin; Category C for Diphenhydramine and Bromhexine. Safety not established. Use only if potential benefit justifies potential risk to the fetus, especially in the third trimester (Diphenhydramine may cause neonatal withdrawal or anticholinergic effects). Avoid in first trimester unless absolutely necessary.
Driving: STRONGLY DISCOURAGED. Causes significant drowsiness and impaired alertness. Do not drive or operate heavy machinery for at least 6-8 hours after a dose.
| Alcohol, Benzodiazepines, Opioids, other CNS Depressants | Additive CNS depression, sedation, and impaired psychomotor performance. | Major |
| MAO Inhibitors (e.g., Phenelzine, Selegiline) | Increased anticholinergic effects (dry mouth, blurred vision, urinary retention, hyperpyrexia). | Major |
| Anticholinergic drugs (e.g., Atropine, Tricyclic Antidepressants, Antipsychotics) | Additive anticholinergic side effects. | Moderate |
| Drugs metabolized by CYP2D6 (e.g., Codeine, Metoprolol, Venlafaxine) | Diphenhydramine is a CYP2D6 inhibitor; may increase levels of these drugs. | Moderate |
| Urinary Alkalinizers (e.g., Sodium Bicarbonate, Acetazolamide) | Decrease renal excretion of Diphenhydramine, increasing its levels and effects. | Moderate |
| Sympathomimetics (e.g., Ephedrine, Pseudoephedrine) | Diphenhydramine may potentiate pressor effects. | Moderate |