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Ephedrine and Guaifenesin

Pronunciation

(e FED rin & gwye FEN e sin)

Index Terms

  • Guaifenesin and Ephedrine

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Bronkaid: Ephedrine sulfate 25 mg and guaifenesin 400 mg

Primatene Asthma: Ephedrine sulfate 12.5 mg and guaifenesin 200 mg [scored]

Brand Names: U.S.

  • Bronkaid [OTC]
  • Primatene Asthma [OTC]

Pharmacologic Category

  • Expectorant/Decongestant

Pharmacology

Ephedrine: Releases tissue stores of norepinephrine and thereby produces an alpha- and beta-adrenergic stimulation; longer-acting and less potent than epinephrine

Guaifenesin: Thought to act as an expectorant by irritating the gastric mucosa and stimulating respiratory tract secretions, thereby increasing respiratory fluid volumes and decreasing mucous viscosity

Use: Labeled Indications

Asthma: Temporary relief of mild symptoms of intermittent asthma (wheezing, tightness of chest, shortness of breath) and to loosen phlegm (mucus), thick bronchial secretions, drain bronchial tubes, and make coughs more productive.

Note: Use of ephedrine-containing products are not included as a recommended treatment for asthma by current clinical practice guidelines (eg, GINA, NAEPP).

Contraindications

OTC labeling: When used for self-medication, do not use if asthma is not confirmed by a health care provider; coadministration with a monoamine oxidase inhibitor (MAOI) or 2 weeks after discontinuing an MAOI; hypersensitivity to ephedrine, guaifenesin, or any component of the formulation; children <12 years (Bronkaid only).

Dosing: Adult

Asthma: Oral: Ephedrine 12.5 to 25 mg/guaifenesin 200 to 400 mg every 4 hours as needed. Maximum: Ephedrine 150 mg/guaifenesin 2400 mg per 24 hours.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Asthma: Children ≥12 years and Adolescents: Oral: Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling.

Administration

Administer without regard to food.

Storage

Store at 20° to 25°C (68° to 77°F).

Drug Interactions

Alkalinizing Agents: May increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy

Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists may antagonize Alpha1-Blocker vasodilation. Monitor therapy

AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Atropine (Systemic): May enhance the therapeutic effect of EPHEDrine (Systemic). Monitor therapy

Benzylpenicilloyl Polylysine: Alpha-/Beta-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. Consider therapy modification

Beta-Blockers: May enhance the vasopressor effect of Alpha-/Beta-Agonists (Direct-Acting). Epinephrine used as a local anesthetic for dental procedures will not likely cause clinically relevant problems. Some beta-adrenoceptor mediated effects of Alpha-/Beta-Agonists (Direct-Acting), including anti-anaphylactic effects of epinephrine, may be diminished by Beta-Blockers. Management: Cardioselective beta-blockers and lower doses of epinephrine may confer a more limited risk. Patients who may require acute subcutaneous epinephrine (e.g., bee sting kits) should probably avoid beta blockers. Consider therapy modification

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol. Monitor therapy

Carbonic Anhydrase Inhibitors: May increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy

Cardiac Glycosides: EPHEDrine (Systemic) may enhance the arrhythmogenic effect of Cardiac Glycosides. Monitor therapy

CloNIDine: May enhance the therapeutic effect of EPHEDrine (Systemic). Monitor therapy

Cocaine: May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Consider therapy modification

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Monitor therapy

Droxidopa: EPHEDrine (Systemic) may enhance the hypertensive effect of Droxidopa. Monitor therapy

Ergot Derivatives: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Exceptions: Ergoloid Mesylates; Nicergoline. Avoid combination

FentaNYL: Alpha-/Beta-Agonists (Indirect-Acting) may decrease the serum concentration of FentaNYL. Specifically, fentanyl nasal spray serum concentrations may decrease and onset of effect may be delayed. Monitor therapy

Hyaluronidase: May enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Management: Avoid the use of hyaluronidase to enhance dispersion or absorption of alpha-/beta-agonists. Use of hyaluronidase for other purposes in patients receiving alpha-/beta-agonists may be considered as clinically indicated. Consider therapy modification

Inhalational Anesthetics: EPHEDrine (Systemic) may enhance the arrhythmogenic effect of Inhalational Anesthetics. Avoid combination

Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Avoid combination

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Consider therapy modification

MAO Inhibitors: May enhance the hypertensive effect of Alpha-/Beta-Agonists (Indirect-Acting). While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Exceptions: Linezolid; Tedizolid. Avoid combination

Oxytocin: May enhance the hypertensive effect of EPHEDrine (Systemic). Monitor therapy

Propofol: May enhance the therapeutic effect of EPHEDrine (Systemic). Monitor therapy

Rocuronium: EPHEDrine (Systemic) may enhance the therapeutic effect of Rocuronium. Monitor therapy

Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the tachycardic effect of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitors may enhance the vasopressor effect of Alpha-/Beta-Agonists. Consider therapy modification

Spironolactone: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Tricyclic Antidepressants: May enhance the vasopressor effect of Alpha-/Beta-Agonists (Direct-Acting). Management: Avoid, if possible, the use of direct-acting alpha-/beta-agonists in patients receiving tricyclic antidepressants. If combined, monitor for evidence of increased pressor effects and consider reductions in initial dosages of the alpha-/beta-agonist. Consider therapy modification

Urinary Acidifying Agents: May decrease the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy

Adverse Reactions

Frequency not defined.

Cardiovascular: Hypertension, tachycardia

Central nervous system: Emotional disturbance, headache, insomnia, nervousness, seizure

Hypersensitivity: Hypersensitivity reaction

Neuromuscular & skeletal: Tremor

Respiratory: Cough, exacerbation of asthma, productive cough

Warnings/Precautions

Concerns related to adverse effects:

• Cardiovascular effect: May cause hypertension or tachycardia, increasing the risk of myocardial infarction (MI) and/or stroke. Serious cardiovascular events (eg, MI, stroke, arrhythmias), including deaths, have been previously reported with use of dietary supplements containing ephedra alkaloids (Haller, 2000).

Disease-related concerns:

• Asthma: Only use with a diagnosis of asthma; notify health care provider if asthma becomes worse during use. Inhaled bronchodilators provide more rapid symptomatic relief of asthma than ephedrine/guaifenesin.

• Cardiovascular disease: Use with caution in patients with heart disease and/or hypertension.

• Diabetes: Use with caution in patients with diabetes mellitus.

• Glaucoma: Use with caution in patients with narrow angle glaucoma.

• Prostatic hyperplasia/urinary stricture: Use with caution in patients with prostatic hyperplasia and/or urinary stricture.

• Psychiatric conditions: Use with caution in patients with psychiatric or emotional conditions.

• Seizures: Use with caution in patients with a history of seizure disorder.

• Thyroid disease: Use with caution in patients with thyroid disease.

Special populations:

• Pediatric: Not for OTC use in children <12 years.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience insomnia or tremors. Have patient report immediately to prescriber tachycardia, seizures, or severe anxiety (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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