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BPM MAL PHENYLEPH HCL DM HBR
phenylephrine hydrochloride and
dextromethorphan hydrobromide liquid
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----------BPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL
DESCRIPTIONBPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL is an antihistamine, decongestant, and antitussive available for oral administration as a clear liquid. Each 5 mL (1 teaspoonful) of bubble gum flavored liquid contains:
Brompheniramine Maleate .............................4 mg
Phenylephrine Hydrochloride .......................10 mg
Dextromethorphan Hydrobromide................20 mg
Inactive Ingredients: Glycerin, Propylene Glycol, Sorbitol, Citric Acid, Sodium Citrate, Sodium Saccharin, Bubble Gum Flavor, Purified Water.
Brompheniramine Maleate is an antihistamine having the chemical name, 2-Pyridinepropanamine,g -(4-bromophenyl)-N, N-dimethyl-, (±)-,(Z)-2-butenedioate (1:1).
Phenylephrine Hydrochloride is a sympathomimetic amine decongestant which occurs as white or practically white, odorless crystals, having a bitter taste. It is freely soluble in water and in alcohol. The chemical name is: (–)-m-Hydroxy-a-[(methylamino)methyl] benzyl alcohol hydrochloride.
Dextromethorphan Hydrobromide is chemically named as 3-Methoxy-17-methyl-9a, 13a, 14a-morphinan hydrobromide which naturally occurs as white crystals and is sparingly soluble in water and freely soluble in alcohol.
CLINICAL PHARMACOLOGYAntihistamine, decongestant, and antitussive actions.
Brompheniramine Maleate is a histamine antagonist, specifically a H1-receptor-blocking agent belonging to the alkylamine class of antihistamines. Antihistamines appear to compete with histamine for receptor sites on effector cells. Brompheniramine Maleate also has anticholinergic (drying) and sedative effects. Among the antihistaminic effects, it antagonizes the allergic response (vasodilation, increased vascular permeability, increased mucus secretion) of nasal tissue.
Phenylephrine Hydrochloride is a sympathomimetic that acts predominantly on alpha receptors and has little action on beta receptors. Phenylephrine Hydrochloride causes constriction of blood vessels, which shrinks swollen mucous membranes, reduces tissue hyperemia, edema, nasal congestion and increases nasal airway patency. It, therefore, functions as an oral nasal decongestant while causing minimal central nervous system stimulation.
Dextromethorphan Hydrobromide is a nonnarcotic antitussive with effectiveness equal to codeine. It acts in the medulla oblongata to elevate the cough threshold. Dextromethorphan Hydrobromide does not produce analgesia or induce tolerance, and has minimal potential for addiction. The onset of antitussive action occurs in 15 to 30 minutes after administration and is of long duration.
At usual doses, it will not depress respiration nor inhibit ciliary activity. Dextromethorphan Hydrobromide is rapidly metabolized with trace amounts of the parent compound in blood and urine. About one-half of the administered dose is excreted in the urine as conjugated metabolites.
INDICATIONS AND USAGEBPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL is indicated for symptomatic relief of coughs and upper respiratory symptoms, including nasal congestion, associated with allergy or the common cold.
CONTRAINDICATIONSPatients with hypersensitivity or idiosyncrasy to any of its ingredients. Do not use in newborn infants, premature infants, in nursing mothers, in patients with severe hypertension, severe coronary artery disease, ischemic heart disease, or in those receiving monoamine oxidase (MAO) inhibitors. Antihistamines are contraindicated in patients with narrow-angle glaucoma, urinary retention, peptic ulcer, and during an asthma attack. Antihistamines should not be used to treat lower respiratory tract conditions including asthma.
WARNINGSDo not exceed the recommended dosage. Patients with persistent cough such as occur with smoking, asthma, emphysema, or where cough is accompanied by excessive secretions should not take this product. A persistent cough may be a sign of a serious condition. If the cough persists for more than 1 week, tends to recur, or is accompanied by fever, rash, or persistent headache, consult a doctor. Use caution when giving to children or patients with chronic pulmonary disease, shortness of breath, difficulty in breathing, asthma, emphysema, high blood pressure, heart disease, diabetes, thyroid disease, or difficulty in urination due to enlargement of the prostate gland unless directed by a physician. Antihistamines may impair mental and physical abilities required for the performance of potentially hazardous tasks, such as driving a car or operating machinery, and may impair mental alertness in children. Antihistamines may cause hyperexcitability, especially in children. At doses higher than the recommended dose, nervousness, dizziness, or sleeplessness may occur. Especially in infants and small children, antihistamines in overdosage may cause hallucinations, convulsions, and death. If nervousness, dizziness, or sleeplessness occurs, discontinue use and consult a doctor. Administration of Dextromethorphan Hydrobromide may be accompanied by histamine release and should be used with caution in atopic children.
If a hypertensive crisis occurs, these drugs should be discontinued immediately and therapy to lower blood pressure should be instituted immediately. Fever should be managed by means of external cooling.
Before prescribing medication to suppress or modify cough, it is important to ascertain that the underlying cause of cough is identified, that modification of cough does not increase the risk of clinical or physiologic complications, and that appropriate therapy for the primary disease is provided. Because of its antihistamine component, BPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL should be used with caution in patients with a history of bronchial asthma, narrow-angle glaucoma, gastrointestinal obstruction, or urinary bladder-neck obstruction. Because of its sympathomimetic component, BPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL should be used with caution in patients with diabetes, hypertension, heart disease, or thyroid disease.
Information for Patients
Patients should be warned about engaging in activities requiring mental alertness and motor coordination, such as driving a car or operating machinery. Patients should be cautioned to get up slowly from a lying or sitting position and to lie down if nausea occurs. Alcohol or other sedative drugs may enhance the drowsiness caused by antihistamines.
MAO inhibitors prolong and intensify the anticholinergic effects of antihistamines. Antihistamines may have additive effects with alcohol and other CNS depressants, e.g., hypnotics, sedatives, tranquilizers, antianxiety agents.
Carcinogenesis, Mutagenesis, Impairment of Fertility
Animal studies of BPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL to assess the carcinogenic and mutagenic potential to the effect on fertility have not been performed.
Teratogenic Effects – Pregnancy Category C
Animal reproduction studies have not been conducted with BPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL. It is also not known whether BPM Mal/ Phenyleph HCl/DM HBr 4/10/20mg/5 mL can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. BPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL should be given to a pregnant woman only if clearly needed.
Because of the higher risk of intolerance of antihistamines in small infants generally, and in newborns and prematures in particular, BPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL is contraindicated in nursing mothers.
Consult a physician for use in children under 2 years of age.
The elderly (60 years of age or older) are more likely to exhibit adverse reactions. Caution should be taken when prescribing this drug to the elderly.
ADVERSE REACTIONSThe most frequent adverse reactions to BPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL include sedation; dryness of mouth, nose, and throat; thickening of bronchial secretions; dizziness. Other adverse reactions may include:
General: urinary, drug rash, anaphylactic shock, photosensitivity, excessive perspiration, chills, dryness of mouth, nose, and throat.
Cardiovascular System: hypotension, headache, palpitations, tachycardia, extra systoles.
Dermatologic: urticaria, drug rash, photosensitivity, and pruritus.
Central Nervous System: sedation, sleepiness, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, irritability, insomnia, euphoria, paresthesias, blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis, hysteria, neuritis, convulsions.
Gastrointestinal: epigastric distress, anorexia, nausea, vomiting, diarrhea, constipation.
Genitourinary: urinary frequency, difficult urination, urinary retention, early mensea.
Respiratory: thickening of bronchial secretions, tightness of chest and wheezing, nasal stuffiness.
Hematologic System: hemolytic anemia, thrombocytopenia, agranulocytosis.
OVERDOSAGESigns and Symptoms
Overdosage of Phenylephrine Hydrochloride may be associated with central nervous system stimulation, tachycardia, hypertension, and cardiac arrhythmias. Dextromethorphan Hydrobromide in toxic doses will cause drowsiness, ataxia, nystagmus, opisthotonos and convulsive seizures. Central nervous system effects from overdosage of Brompheniramine Maleate may vary from depression to stimulation, especially in children. Anticholinergic effects may also occur.
Treatment: Induce emesis if patient is alert and is seen prior to 6 hours following ingestion. Precautions against aspiration must be taken, especially in infants and small children. Gastric lavage may be carried out, although in some instances tracheotomy may be necessary prior to lavage. Naloxone 0.005 mg/kg intravenously may be of value in reversing CNS depression that may occur from an overdose of Dextromethorphan Hydrobromide. CNS stimulants may counter CNS depression. Should CNS hyperactivity or convulsive seizures occur, intravenous short-acting barbiturates may be indicated. Hypertensive responses and/or tachycardia should be treated appropriately. Oxygen, intravenous fluids, and other supportive measures should be employed as indicated.
DOSAGE AND ADMINISTRATION*
Adults and children over 12 years of age:
BPM Mal/Phenyleph HCl/DM HBr 4/10/20mg/5 mL is an alcohol free, clear, bubble gum flavored liquid available in 16 fl oz (473 mL) bottles, NDC 68032-459-16.
Tamper evident by foil seal under cap. Do not use if foil seal is broken or missing.
Revised: 12/2010 River's Edge Pharmaceuticals, LLC
Reproduced with permission of U.S. National Library of Medicine
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