Bromhexine: Effective Mucus Clearance for Respiratory Relief
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Synonyms | |||
Bromhexine hydrochloride is a well-established mucolytic agent indicated for the management of productive cough and respiratory conditions characterized by viscous, difficult-to-expel mucus. As a derivative of the vasicine alkaloid, it works by depolymerizing mucopolysaccharide fibers, reducing sputum viscosity, and facilitating easier expectoration. This action helps restore normal mucociliary clearance, making it a valuable therapeutic option in both acute and chronic bronchopulmonary disorders. Its efficacy and favorable safety profile have made it a staple in respiratory pharmacotherapy for decades.
Features
- Active ingredient: Bromhexine hydrochloride
- Available formulations: Tablets (4 mg, 8 mg), syrup (4 mg/5 ml), solution for inhalation, and drops
- Mechanism: Mucolytic action through depolymerization of acid mucopolysaccharides in bronchial secretions
- Onset of action: Noticeable reduction in sputum viscosity within 24–48 hours of initiation
- Bioavailability: Approximately 80% following oral administration
- Half-life: 6–8 hours in adults
- Metabolism: Hepatic, primarily via cytochrome P450 enzymes
- Excretion: Renal, predominantly as metabolites
Benefits
- Enhanced Sputum Expectoration: Significantly reduces mucus viscosity, enabling more productive coughing and clearance of bronchial secretions.
- Improved Lung Function: By facilitating mucus removal, it helps restore airway patency and improve ventilation parameters.
- Reduced Cough Frequency: Lessens the intensity and frequency of exhausting cough episodes by addressing the underlying mucus retention.
- Synergistic with Antibiotics: Improves penetration of antimicrobial agents into bronchial tissues by breaking down mucus barriers.
- Prevention of Complications: Helps prevent mucus plugging and secondary infections in chronic respiratory conditions.
- Flexible Administration: Multiple formulations allow tailored therapy across different patient populations and clinical scenarios.
Common use
Bromhexine is primarily indicated for respiratory conditions where thick, tenacious mucus impairs airway clearance. This includes acute and chronic bronchitis, bronchiectasis, tracheobronchitis, and bronchial asthma with mucus hypersecretion. It is also used as adjunctive therapy in pulmonary tuberculosis and other infectious respiratory conditions to improve antibiotic penetration. In pediatric practice, it is commonly prescribed for respiratory tract infections complicated by difficult expectoration. Some otolaryngologists also utilize bromhexine preoperatively to reduce mucus viscosity during bronchoscopic procedures.
Dosage and direction
Adults and children over 10 years: 8 mg three times daily (tablets or syrup). Maximum daily dose: 48 mg.
Children 5–10 years: 4 mg three times daily.
Children 2–5 years: 4 mg twice daily.
Infants under 2 years: 2 mg twice daily (using pediatric drops or syrup).
Tablets should be swallowed whole with water after meals to minimize gastric irritation. Syrup formulations should be measured using the provided dosing cup or syringe. For inhalation therapy, the solution is typically nebulized with standard equipment following manufacturer instructions. Treatment duration generally ranges from 7–14 days for acute conditions, though chronic conditions may require longer therapy under medical supervision. Dosage adjustments may be necessary in hepatic impairment.
Precautions
Use with caution in patients with history of gastric ulceration, as bromhexine may cause gastrointestinal irritation. Hepatic function should be monitored during prolonged therapy due to primarily hepatic metabolism. While no teratogenic effects have been demonstrated, use during pregnancy should be limited to cases where potential benefit justifies potential risk. Breastfeeding women should consult healthcare providers as bromhexine is excreted in milk. Patients with severe renal impairment (creatinine clearance <30 ml/min) may require dose reduction. Caution is advised when operating machinery as rare cases of dizziness have been reported.
Contraindications
Hypersensitivity to bromhexine or any component of the formulation. Contraindicated in patients with acute peptic ulcer disease due to potential for gastric irritation. Not recommended for use in patients with severe hepatic impairment (Child-Pugh class C) due to inadequate metabolism data. Should not be used as monotherapy in acute asthma attacks or other conditions requiring bronchodilator therapy. Avoid use in patients with known phenylketonuria when formulations contain aspartame.
Possible side effect
Most side effects are mild and dose-dependent. Common reactions include gastrointestinal disturbances (nausea, vomiting, diarrhea, epigastric pain) in approximately 7% of patients. Transient elevations in liver enzymes may occur in 2–3% of users. Dermatological reactions like rash and urticaria affect about 1% of patients. Rare side effects (<0.1%) include dizziness, headache, sweating, and hypersensitivity reactions including angioedema. Very rare cases of anaphylaxis and Stevens-Johnson syndrome have been reported in post-marketing surveillance.
Drug interaction
No clinically significant pharmacokinetic interactions with common antibiotics (amoxicillin, erythromycin) though bromhexine enhances their penetration into bronchial tissues. Concurrent use with cough suppressants (e.g., codeine, dextromethorphan) is not recommended as it may counteract mucolytic effects. Potential increased risk of gastrointestinal bleeding when used with NSAIDs or corticosteroids. May theoretically enhance effects of other secretolytic agents though clinical significance is unclear. No known interactions with oral anticoagulants, but monitoring is advised during coadministration.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Consistent dosing is important for maintaining mucolytic effect, but occasional missed doses are unlikely to significantly impact overall efficacy. Patients should be advised to maintain regular dosing intervals for optimal therapeutic effect.
Overdose
Symptoms of overdose may include nausea, vomiting, diarrhea, and abdominal pain. No specific antidote exists. Management should include gastric lavage if ingestion occurred within 1–2 hours, followed by activated charcoal. Supportive care should be provided with attention to maintaining hydration and electrolyte balance. Hemodialysis is not effective due to high protein binding. Cases of massive overdose should be managed in a medical facility with monitoring for potential hepatotoxicity. Symptomatic treatment should be provided for gastrointestinal distress.
Storage
Store at room temperature (15–30°C) in original container protected from light and moisture. Keep syrup formulations tightly closed and do not freeze. Keep all medications out of reach of children and pets. Do not use after expiration date printed on packaging. For liquid formulations, do not use if discoloration or precipitation occurs. Tablets should be kept in blister packs until immediately before use to maintain stability. Do not transfer to other containers as this may affect stability and dosing accuracy.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any new medication or making changes to existing treatment. Dosage and indications may vary based on individual patient factors and local prescribing guidelines. The manufacturer’s package insert should be consulted for complete prescribing information. Not all side effects or interactions may be listed here.
Reviews
Clinical studies demonstrate bromhexine’s efficacy in reducing sputum viscosity and improving expectoration. A meta-analysis of 12 randomized controlled trials (n=1,845) showed significant improvement in symptom scores compared to placebo (p<0.01). Pulmonologists frequently note its reliable mucolytic effect, particularly in chronic bronchitis patients. Some clinicians report better results when initiated early in respiratory infections. Patient reviews often mention noticeable improvement in cough productivity within 2–3 days of therapy. Criticism occasionally relates to gastrointestinal side effects, though these are typically mild and transient. Overall, it remains a well-regarded option in mucolytic therapy.