Brompheniramine maleate (parabromdylamine maleate)

brompheniramine maleate (parabromdylamine maleate)

(brome fen ir' a meen)

Bidhist, BroveX, BroveX CT, Lodrane XR, LoHist 12 Hour, VaZol

Pregnancy Category C

Drug class

Antihistamine (alkylamine type)

Therapeutic actions

Competitively blocks the effects of histamine at H₁-receptor sites; has anticholinergic (atropine-like), antipruritic, and sedative effects.

Indications

·        Symptomatic relief of symptoms associated with perennial and seasonal allergic rhinitis—runny nose, sneezing, itching nose and throat, watery eyes

·         

Contraindications and cautions

·        Contraindicated with allergy to any antihistamines, allergy to tartrazine (BroveX CT), third trimester of pregnancy (newborn or premature infants may have severe reactions).

·        Use cautiously with lactation, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthma attack, bladder neck obstruction, pyloroduodenal obstruction. Use cautiously in the elderly (this population is extremely sensitive to anticholinergic side effects of this drug).

Available forms

Chewable tablets—12 mg; ER tablets—6 mg; ER capsules—12 mg; liquid—2 mg/5 mL; oral suspension—8 mg/5 mL, 12 mg/5 mL

Dosages

ADULTS AND PEDIATRIC PATIENTS > 12 YR

ER tablets: 6–12 mg PO q 12 hr. Chewable tablets: 12–24 mg PO q 12 hr, maximum 48 mg/day. ER capsules: 12–24 mg/day PO. Oral suspension (BroveX): 5–10 mL (12–24 mg) PO q 12 hr; maximum 48 mg/day. Oral liquid: 10 mL (4 mg) PO 4 times/day. Oral suspension (Lodrane XR): 5 mL PO q 12 hr; do not exceed 2 doses/day.

PEDIATRIC PATIENTS 6–12 YR

ER tablets: 6 mg PO q 12 hr. Chewable tablets: 6–12 mg PO q 12 hr, maximum 24 mg/day. ER capsules: 12 mg/day PO. Oral liquid: 5 mL (2 mg) PO 4 times/day. Oral suspension (BroveX): 5 mL (12 mg) PO q 12 hr; maximum 24 mg/day. Oral suspension (Lodrane XR): 2.5 mL PO q 12 hr; up to 5 mL/day.

PEDIATRIC PATIENTS 2–6 YR

Chewable tablets: 6 mg PO q 12 hr; maximum 12 mg/day. Oral liquid: 2.5 mL (1 mg) PO 4 times/day. Oral suspension (BroveX): 2.5 mL (6 mg) PO q 12 hr up to 12 mg/day. Oral suspension (Lodrane XR): 1.25 mL PO q 12 hr; maximum 2.5 mg/day.

PEDIATRIC PATIENTS 12 MO–6 YR

Oral suspension: 1.25 mL (3 mg) PO q 12 hr up to 2.5 mL (6 mg)/day. Oral liquid: Titrate dose based on 0.5 mg/kg/day PO in equally divided doses four times/day. 

GERIATRIC PATIENTS

More likely to cause dizziness, sedation, syncope, toxic confusional states, and hypotension in elderly patients; use with caution.

Pharmacokinetics

Route	Onset	Peak	Duration
Oral	15–30 min	1–2 hr	4–6 hr

Metabolism: Hepatic; T_1/2: 12–35 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

Adverse effects

·        CNS: Drowsiness, sedation, dizziness, faintness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, headache, blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis, hysteria, tingling, heaviness and weakness of the hands

·        CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles

·        GI: Epigastric distress, anorexia, increased appetite and weight gain, nausea, vomiting, diarrhea or constipation

·        GU: Urinary frequency, dysuria, urinary retention, early menses, decreased libido, impotence

·        Hematologic: Hemolytic anemia, hypoplastic anemia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia

·        Hypersensitivity: Urticaria, rash, anaphylactic shock, photosensitivity

·        Respiratory: Thickening of bronchial secretions, chest tightness, wheezing, nasal stuffiness, dry mouth, dry nose, dry throat, sore throat

Interactions

Drug-drug

·        Increased sedation with alcohol, other CNS depressants

·        Increased and prolonged anticholinergic (drying) effects with MAOIs

Nursing considerations

Assessment

·        History: Allergy to any antihistamines, tartrazine, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction, third trimester of pregnancy, lactation

·        Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examination; P, BP; R, adventitious sounds; bowel sounds; prostate palpation; CBC with differential

Interventions

·        Give orally with food if GI upset occurs.

Teaching points

·        Take as prescribed; avoid excessive dosage; take with food if GI upset occurs.

·        Avoid alcohol while on this drug; serious sedation could occur.

·        Oral liquid and oral suspensions differ in strength; do not use interchangeably.

·        You may experience these side effects: Dizziness, sedation, drowsiness (use caution if driving or performing tasks that require alertness); epigastric distress, diarrhea or constipation (take with meals); dry mouth (frequent mouth care, sucking sugarless lozenges may help); thickening of bronchial secretions, dryness of nasal mucosa (try a humidifier).

·        Report difficulty breathing, hallucinations, tremors, loss of coordination, unusual bleeding or bruising, visual disturbances, irregular heartbeat.

Adverse effects in Italic are most common; those in Bold are life-threatening.