Version July 2025
Asthma, mild intermittent symptoms: Note: Although included as an FDA-approved use in the manufacturer's prescribing information for the temporary relief of mild symptoms of intermittent asthma, nonselective beta agonists or oral beta-2 agonists (including oral ephedrine/guaifenesin) are not recommended due to their potential for excessive cardiac stimulation, especially in high doses (Ref). All products (ie, Bronkaid, Primatene Asthma) have been discontinued in the United States >1 year.
Ephedrine 12.5 mg/guaifenesin 200 mg: Oral: 1 to 2 tablets every 4 hours as needed; maximum dose: 12 tablets (ephedrine 150 mg/guaifenesin 2.4 g) per 24 hours.
Ephedrine 25 mg/guaifenesin 400 mg: Oral: 1 tablet every 4 hours as needed; maximum dose: 6 tablets (ephedrine 150 mg/guaifenesin 2.4 g) per 24 hours.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustment provided in the manufacturer's labeling.
There are no dosage adjustment provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. 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
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.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet, Oral:
Bronkaid: Ephedrine sulfate 25 mg and guaifenesin 400 mg [DSC]
Primatene Asthma: Ephedrine sulfate 12.5 mg and guaifenesin 200 mg [DSC]
No
Tablets (Bronkaid Oral)
25-400 mg (per each): $0.18
Tablets (Primatene Asthma Oral)
12.5-200 mg (per each): $0.18
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Administer without regard to food.
Asthma, mild intermittent symptoms: Although included as an FDA-approved use in the manufacturer's prescribing information for the temporary relief of mild symptoms of intermittent asthma, nonselective beta agonists or oral beta-2 agonists (including oral ephedrine/guaifenesin) are not recommended due to their potential for excessive cardiac stimulation, especially in high doses (GINA 2024; NAEPP 2007).
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Alpha1-Blockers: May decrease therapeutic effects of Alpha-/Beta-Agonists. Risk C: Monitor
Atomoxetine: May increase hypertensive effects of Sympathomimetics. Atomoxetine may increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Atropine (Systemic): May increase therapeutic effects of EPHEDrine (Systemic). Risk C: Monitor
Benzylpenicilloyl Polylysine: Coadministration of Alpha-/Beta-Agonists and Benzylpenicilloyl Polylysine may alter diagnostic results. 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. Risk D: Consider Therapy Modification
Beta-Blockers: May decrease therapeutic effects of EPHEDrine (Systemic). Risk C: Monitor
Bornaprine: Sympathomimetics may increase anticholinergic effects of Bornaprine. Risk C: Monitor
Bretylium: May increase therapeutic effects of Alpha-/Beta-Agonists (Direct-Acting). Risk C: Monitor
Bromocriptine: May increase hypertensive effects of Alpha-/Beta-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider Therapy Modification
Cannabinoid-Containing Products: May increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Cardiac Glycosides: EPHEDrine (Systemic) may increase arrhythmogenic effects of Cardiac Glycosides. Risk C: Monitor
Chloroprocaine (Systemic): May increase hypertensive effects of Alpha-/Beta-Agonists. Risk C: Monitor
CloNIDine: May increase therapeutic effects of EPHEDrine (Systemic). Risk C: Monitor
CloZAPine: May decrease therapeutic effects of Alpha-/Beta-Agonists. Risk C: Monitor
Cocaine (Topical): May increase hypertensive effects 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. Risk D: Consider Therapy Modification
DexAMETHasone (Systemic): EPHEDrine (Systemic) may decrease serum concentration of DexAMETHasone (Systemic). Risk C: Monitor
Dihydralazine: Sympathomimetics may decrease therapeutic effects of Dihydralazine. Risk C: Monitor
Disulfiram: May increase adverse/toxic effects of Products Containing Ethanol. Management: Do not use disulfiram with dosage forms that contain ethanol. Risk X: Avoid
Doxofylline: Sympathomimetics may increase adverse/toxic effects of Doxofylline. Risk C: Monitor
Droxidopa: EPHEDrine (Systemic) may increase hypertensive effects of Droxidopa. Risk C: Monitor
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May increase vasoconstricting effects of Alpha-/Beta-Agonists. Risk X: Avoid
Esketamine (Injection): May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for elevated heart rate, hypertension, and arrhythmias may be increased. Risk C: Monitor
FentaNYL: Decongestants may decrease serum concentration of FentaNYL. Risk C: Monitor
Guanethidine: May increase hypertensive effects of Sympathomimetics. Guanethidine may increase arrhythmogenic effects of Sympathomimetics. Risk C: Monitor
Hexoprenaline: May increase adverse/toxic effects of Alpha-/Beta-Agonists. Risk X: Avoid
Hyaluronidase: May increase vasoconstricting effects of Alpha-/Beta-Agonists. Management: Do not use hyaluronidase to enhance the 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. Risk D: Consider Therapy Modification
Iobenguane Radiopharmaceutical Products: Alpha-/Beta-Agonists (Indirect-Acting) may decrease therapeutic effects of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose. Risk X: Avoid
Kratom: May increase adverse/toxic effects of Sympathomimetics. Risk X: Avoid
Levothyroxine: May increase therapeutic effects of Sympathomimetics. Sympathomimetics may increase therapeutic effects of Levothyroxine. Levothyroxine may increase adverse/toxic effects of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Risk C: Monitor
Linezolid: May increase hypertensive effects of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider Therapy Modification
Lisuride: May increase hypertensive effects of Alpha-/Beta-Agonists. Risk X: Avoid
Metergoline: May increase adverse/toxic effects of Alpha-/Beta-Agonists (Indirect-Acting). Risk C: Monitor
Methotrimeprazine: May increase CNS depressant effects of Products Containing Ethanol. Management: Avoid products containing alcohol in patients treated with methotrimeprazine. Risk X: Avoid
MetroNIDAZOLE (Systemic): May increase adverse/toxic effects of Products Containing Ethanol. A disulfiram-like reaction may occur. Risk X: Avoid
MetroNIDAZOLE (Topical): May increase adverse/toxic effects of Products Containing Ethanol. A disulfiram-like reaction may occur. Risk C: Monitor
Monoamine Oxidase Inhibitors: May increase hypertensive effects 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. Risk X: Avoid
Oxytocin: May increase hypertensive effects of EPHEDrine (Systemic). Risk C: Monitor
Pergolide: May increase hypertensive effects of Alpha-/Beta-Agonists. Risk C: Monitor
Propofol: May increase therapeutic effects of EPHEDrine (Systemic). Risk C: Monitor
QuiNIDine: May decrease therapeutic effects of EPHEDrine (Systemic). EPHEDrine (Systemic) may decrease therapeutic effects of QuiNIDine. Risk C: Monitor
Reserpine: May decrease therapeutic effects of Alpha-/Beta-Agonists (Indirect-Acting). Risk C: Monitor
Rocuronium: EPHEDrine (Systemic) may increase therapeutic effects of Rocuronium. Risk C: Monitor
Secnidazole: Products Containing Ethanol may increase adverse/toxic effects of Secnidazole. Risk X: Avoid
Serotonin/Norepinephrine Reuptake Inhibitor: May increase tachycardic effects of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitor may increase vasopressor effects of Alpha-/Beta-Agonists. Management: If possible, avoid coadministration of direct-acting alpha-/beta-agonists and serotonin/norepinephrine reuptake inhibitors. If coadministered, monitor for increased sympathomimetic effects (eg, increased blood pressure, chest pain, headache). Risk D: Consider Therapy Modification
Solriamfetol: Sympathomimetics may increase hypertensive effects of Solriamfetol. Sympathomimetics may increase tachycardic effects of Solriamfetol. Risk C: Monitor
Spironolactone: May decrease vasoconstricting effects of Alpha-/Beta-Agonists. Risk C: Monitor
Sympathomimetics: May increase adverse/toxic effects of Sympathomimetics. Risk C: Monitor
Tedizolid: May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for increased blood pressure and heart rate may be increased. Risk C: Monitor
Theophylline: May increase stimulatory effects of EPHEDrine (Systemic). Risk C: Monitor
Tranylcypromine: May increase hypertensive effects of Alpha-/Beta-Agonists (Indirect-Acting). Risk X: Avoid
Tricyclic Antidepressants: May increase vasopressor effects of Alpha-/Beta-Agonists. Management: Avoid, if possible, the use of 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. Risk D: Consider Therapy Modification
Vasopressin: Alpha-/Beta-Agonists (Direct-Acting) may increase hypertensive effects of Vasopressin. The effect of other hemodynamic parameters may also be enhanced. Risk C: Monitor
Refer to individual monographs.
Refer to individual monographs.
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
