Screen for absolute contraindications and high-risk conditions before recommending brompheniramine combination products.
Absolute contraindications include infants <6 months, breastfeeding mothers, severe hypertension or coronary disease, MAOI therapy, and hypersensitivity to any component. Relative cautions include asthma, cardiac arrhythmias, urinary retention, narrow-angle glaucoma, hyperthyroidism, and diabetes due to sympathomimetic effects.
Premature or newborn infants (risk of fatal respiratory depression)
Breastfeeding mothers—drug passes into milk and may cause infant sedation
Hypersensitivity to brompheniramine, pseudoephedrine, dextromethorphan, or formulation excipients
Severe hypertension or significant coronary artery disease
Use of monoamine oxidase inhibitors within 14 days
Lower respiratory disease including asthma or COPD where thick secretions may worsen
Children 2–5 years (requires clinician oversight and precise dosing)
Cardiovascular disease, arrhythmias, or uncontrolled hypertension
Hyperthyroidism or diabetes mellitus
Narrow-angle glaucoma
Urinary retention or bladder neck obstruction
Concurrent sedatives, stimulants, or other anticholinergic antihistamines
Avoid during breastfeeding; the antihistamine can cause infant sedation or excitation. Use in pregnancy only if benefits outweigh risks.