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 excessive, viscous mucus. As a derivative of the vasicine alkaloid, it works by depolymerizing mucopolysaccharide fibers, thereby reducing sputum viscosity and facilitating expectoration. This pharmacological profile makes it a valuable therapeutic option in both acute and chronic bronchopulmonary disorders. Its efficacy and safety have been demonstrated through decades of clinical use and numerous studies, positioning it as a fundamental agent in respiratory pharmacotherapy.
Features
- Active ingredient: Bromhexine hydrochloride
- Pharmacological class: Mucolytic expectorant
- Mechanism: Depolymerizes acid mucopolysaccharides in bronchial secretions
- Administration forms: Tablets, syrup, solution for inhalation, injectable form
- Onset of action: Oral administration shows effects within 2-4 hours
- Half-life: Approximately 1.5 hours with hepatic metabolism
- Excretion: Primarily renal as metabolites
Benefits
- Significantly reduces sputum viscosity, enabling easier expectoration
- Improves mucociliary clearance by stimulating ciliary activity
- Enhances antibiotic penetration into bronchial secretions during concurrent therapy
- Reduces coughing effort and frequency in productive cough
- May decrease exacerbation frequency in chronic bronchitis
- Supports overall respiratory function improvement
Common use
Bromhexine is primarily indicated for respiratory conditions where thick, tenacious mucus impairs airway clearance. This includes acute and chronic bronchitis, bronchiectasis, tracheobronchitis, bronchial asthma with mucus hypersecretion, and chronic obstructive pulmonary disease (COPD). It is also used pre- and post-operatively to prevent respiratory complications and in conditions such as pulmonary tuberculosis where mucus clearance is therapeutic. Pediatric use is established for respiratory infections with difficult expectoration.
Dosage and direction
Adults: 8-16 mg three times daily (tablets) or 10 mL of syrup (8 mg/5 mL) three times daily. Maximum daily dose: 48 mg.
Children 5-12 years: 4-8 mg three times daily.
Children 2-5 years: 4 mg twice daily.
Inhalation solution: 2 mL (containing 2 mg/mL) diluted with sterile saline, administered 2-3 times daily.
Duration of treatment typically ranges from 4 to 14 days depending on condition severity. Administration after meals may reduce gastrointestinal discomfort. For optimal hydration effects, adequate fluid intake should be maintained.
Precautions
Use with caution in patients with gastric ulceration due to potential gastrointestinal irritation. Hepatic impairment requires dosage adjustment as bromhexine is metabolized in the liver. Renal impairment may necessitate reduced dosage. Not recommended during first trimester pregnancy unless clearly needed. Use in nursing mothers requires risk-benefit assessment as bromhexine is excreted in breast milk. Monitor for signs of bronchospasm in asthmatic patients, though this is rare.
Contraindications
Hypersensitivity to bromhexine or any component of the formulation. Severe hepatic impairment with Child-Pugh class C. Acute peptic ulcer disease. Concurrent use with antitussives that suppress cough reflex (counteracts therapeutic effect). Not recommended in phenylketonuria patients (some formulations contain aspartame).
Possible side effect
Generally well-tolerated. Most common: gastrointestinal disturbances (nausea, vomiting, diarrhea, epigastric pain) in 2-5% of patients. Less frequent: dizziness, headache, sweating, transient elevations in liver transaminases. Rare: allergic reactions including rash, urticaria, angioedema. Very rare: anaphylactic reactions, severe cutaneous adverse reactions. Inhalation form may cause local irritation or bronchospasm in susceptible individuals.
Drug interaction
No clinically significant pharmacokinetic interactions documented. Pharmacodynamic interactions: enhanced penetration of antibiotics (particularly amoxicillin, erythromycin, tetracyclines) into bronchial secretions. Theoretical interaction with cough suppressants (reduced efficacy). No known interactions with CYP450 enzymes. Caution with drugs causing gastric irritation (NSAIDs, corticosteroids).
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for the missed one. Maintain regular dosing schedule to ensure consistent mucolytic effect. The therapeutic effect is cumulative rather than immediate per dose.
Overdose
No specific antidote. Symptoms may include nausea, vomiting, diarrhea, and dizziness. Gastric lavage may be considered if ingestion recent. Supportive care including hydration and symptomatic treatment. Hemodialysis not effective due to high protein binding. Maximum documented non-toxic dose: 300 mg in adults. Contact poison control center for management guidance.
Storage
Store at room temperature (15-30°C). Protect from light and moisture. Keep container tightly closed. Do not freeze liquid formulations. Keep out of reach of children. Discard any unused solution for inhalation 24 hours after opening. Check expiration date before use.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult a healthcare professional before starting any medication. Dosage and treatment duration should be determined by a physician based on individual patient characteristics. Not all possible uses, interactions, or adverse effects are listed here.
Reviews
Clinical studies demonstrate bromhexine’s efficacy in reducing sputum viscosity by 30-50% compared to placebo. Meta-analyses show significant improvement in symptom scores in acute bronchitis. Long-term studies in chronic bronchitis indicate reduced exacerbation frequency. Patient-reported outcomes consistently show improved ease of expectoration and reduced coughing effort. Safety profile remains favorable across age groups, with most adverse effects being mild and self-limiting.