BROMPHENIRAMINE MALEATE
(brome-fen-ir'a-meen)
Codimal-A, Conjec-B, Cophene-B, Dehist, Dimetane, Nasahist B, Sinusol-B
Classifications: antihistamine; (h₁-receptor antagonist)
Prototype: Diphenhydramine
Pregnancy Category: C

Availability

10 mg/mL injection; ingredient in many oral combination products containing a decongestant, expectorant, and/or analgesic

Actions

Antihistamine similar to diphenhydramine; shares properties of other antihistamines. Has less sedative effect than diphenhydramine. Competes with histamine for H₁-receptor sites on effector cells, thus blocking histamine-mediated responses.

Therapeutic Effects

Effective against upper respiratory symptoms and allergic manifestations.

Uses

Symptomatic treatment of allergic manifestations. Also used in various cough mixtures and antihistamine-decongestant cold formulations.

Contraindications

Hypersensitivity to antihistamines; acute asthma; pregnancy (category C), lactation; newborns.

Cautious Use

Older adults; prostatic hypertrophy; narrow-angle glaucoma; cardiovascular or renal disease; hyperthyroidism.

Route & Dosage

Allergy
Adult: PO 4–8 mg t.i.d. or q.i.d. or 8–12 mg of sustained release b.i.d. or t.i.d. SC/IM/IV 5–20 mg q6–12h (max: 40 mg/24 h)
Geriatric: PO 4 mg 1–2 times/d
Child: PO >6 y, 2–4 mg t.i.d. or q.i.d. or 8–12 mg of sustained release b.i.d. (max: 12 mg/24 h); <6 y, 0.5 mg/kg in 3–4 divided doses

Administration

Oral

Give with meals or a snack to prevent gastric irritation.

Subcutaneous/Intramuscular

Give without further dilution or diluted to a 1:10 ratio with NS.

Intravenous

PREPARE: Direct: Give undiluted or diluted with 10 mL D5W or NS.

ADMINISTER: Direct: Give IV push slowly over 1 min to a recumbent patient.

INCOMPATIBILITIES Solution/additive: Radio-contrast media (diatrizoate, iothalamate).

Store in tightly covered container at 15°–30° C (59°–86° F) unless otherwise directed. Elixir and parenteral form should be protected from light. Avoid freezing.

Adverse Effects (1%)

Body as a Whole: Hypersensitivity reaction (urticaria, increased sweating, agranulocytosis). CNS: Sedation, drowsiness, dizziness, headache, disturbed coordination. GI: Dry mouth, throat, and nose, stomach upset, constipation. Special Senses: Ringing or buzzing in ears. Skin: Rash, photosensitivity.

Diagnostic Test Interference

May cause false-negative allergy skin tests.

Interactions

Drug: Alcohol and other cns depressants add to sedation.

Pharmacokinetics

Peak: 3–9 h. Duration: Up to 48 h. Distribution: Crosses placenta. Elimination: 40% excreted in urine within 72 h; 2% in feces. Half-Life: 12–34 h.

Nursing Implications

Assessment & Drug Effects

Drowsiness, sweating, transient hypotension, and syncope may follow IV administration; reaction to drug should be evaluated. Keep physician informed.
Note: Older adults tend to be particularly susceptible to drug's sedative effect, dizziness, and hypotension. Most symptoms respond to reduction in dosage.
Lab tests: Periodic CBC in patients receiving long-term therapy.

Patient & Family Education

Acute hypersensitivity reaction can occur within minutes to hours after drug ingestion. Reaction is manifested by high fever, chills, and possible development of ulcerations of mouth and throat, pneumonia, and prostration. Patient should seek medical attention immediately.
Follow diligent mouth care. Sugarless gum, lemon drops, or frequent rinses with warm water may relieve dry mouth.
Do not drive a car or other potentially hazardous activities until response to drug is known.
Do not take alcoholic beverages or other CNS depressants (e.g., tranquilizers, sedatives, pain or sleeping medicines) without consulting physician.
Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug