Ambroxol

Ambroxol (ambroxol hydrochloride) is a mucolytic agent used to improve sputum expectoration in bronchial and pulmonary diseases. This active substance is used in the treatment of acute and chronic respiratory diseases in which there is a problem of sputum secretion.

Ambroxol stimulates serous cells of the glands of the bronchial epithelium, increasing the secretion of mucous secretion. This helps to reduce the viscosity of sputum and facilitates its discharge. Ambroxol also activates the production of lipid compounds (surfactants) on the surface of the airways, which improves their protective functions and helps stabilize breathing.

Indications Ambroxol

1. Acute and chronic bronchitis.
2. Tracheobronchitis.
3. Bronchial asthma.
4. Diseases of the respiratory tract, accompanied by the formation of thick and viscous sputum.

Release form

1. Tablets and lozenges:

   • Tablets usually contain 30 mg of active ingredient.
   • The chewable tablets are convenient for those who have difficulty swallowing regular pills.

2. Syrup:

   • Ambroxol syrup is often used to treat children because it is easier to take and has a pleasant taste. The concentration of the active ingredient in the syrup may vary, but the standard dose is 15 mg/5 ml.

3. Solution for inhalation:

   • The solution for inhalation is applied using a nebulizer and allows you to deliver the drug directly into the respiratory tract, which is effective in the treatment of bronchial and pulmonary pathology.

4. Solution for oral administration and injection:

   • This form is suitable for both intravenous and oral administration. The solution may be particularly useful in hospital settings for rapid relief of symptoms.

5. Extended-release capsules:

   • Capsules containing microgranules for prolonged release of the active substance provide a longer therapeutic effect.

6. Pastilles:

   • Lozenges are convenient for eliminating coughs and making swallowing easier, especially for upper respiratory diseases.

Pharmacodynamics

The main pharmacodynamics of ambroxol is related to its ability to increase mucus secretion in the respiratory tract and improve its properties. Ambroxol stimulates the production of surfactant, which is an important component of mucus in the lungs and helps to maintain their elasticity and functional activity. This promotes more effective expectoration and removal of mucus from the respiratory tract.

In addition, ambroxol has a weak mucokinetic effect, improving the activity of mucociliary transport. This means that it can increase the movement of cilia on the surface of the respiratory tract, which also promotes the removal of mucus.

Pharmacokinetics

1. Absorption: Ambroxol is rapidly and completely absorbed from the gastrointestinal tract after oral administration.
2. Distribution: It is well distributed throughout the body and penetrates into the respiratory tract where it exerts its effect.
3. Metabolism: Ambroxol is metabolized in the liver to form several metabolites.
4. Excretion: Mainly excreted through the kidneys in the form of metabolites, and also in insignificant amounts - with bile.
5. Half-excretion: The half-excretion of ambroxol from the body is about 7-12 hours, which allows it to be taken relatively infrequently.

Dosing and administration

1. Tablets and lozenges

• Adults and children over 12 years of age:

  • The usual starting dose is 30 mg three times a day (90 mg per day) for the first 2-3 days, after which the dose may be reduced to 30 mg twice a day (60 mg per day).

• Children 6 to 12 years old:

  • Usually 15 mg (half a 30 mg tablet) three times a day (45 mg daily).

2. Syrup

• Adults and children over 12 years of age:

  • 10 ml syrup (30 mg ambroxol) three times a day for the first 2-3 days, then 10 ml syrup twice a day.

• Children 2 to 5 years old:

  • 2.5 ml syrup (7.5 mg ambroxol) two or three times a day.

• Children 6 to 12 years old:

  • 5 ml syrup (15 mg ambroxol) two to three times a day.

3. Solution for inhalation and oral administration

• Adults and children over 5 years of age:

  • 2-3 ml of solution (15-22.5 mg of ambroxol) twice a day for inhalation.
  • 4 ml solution (30 mg ambroxol) three times a day for oral administration for the first 2-3 days, then 4 ml twice a day.

• Children under 2 years of age (only under a doctor's supervision):

  • 1 ml solution (7.5 mg ambroxol) twice daily for inhalation.

4. Extended-release capsules

• Adults and children over 12 years of age:
  • One capsule (usually 75 mg) once daily.

Use Ambroxol during pregnancy

Data on the safety of ambroxol during pregnancy are limited. There are currently insufficient studies to draw definitive conclusions about its effect on fetal development. However, since ambroxol is used mainly for the treatment of respiratory diseases, it is usually prescribed to pregnant women only if clearly needed and after careful discussion with a doctor.

Contraindications

1. Hypersensitivity: People with known hypersensitivity to ambroxol or any of its components should not use the drug.
2. Gastric and duodenal ulcer: The use of ambroxol may lead to irritation of gastric and intestinal mucosa, therefore it is contraindicated in gastric and duodenal ulcers.
3. Diabetes mellitus: When using ambroxol in syrup or other sugar-containing forms, blood glucose levels should be carefully considered in patients with diabetes mellitus.
4. Pregnancy and breastfeeding: There is insufficient data on the safety of ambroxol use during pregnancy and breastfeeding, therefore it should be used only when prescribed by a physician and under strict control.
5. Children: Ambroxol may be used in children only with caution and under medical supervision, especially in infants and young children.
6. Hepatic insufficiency: In the presence of severe hepatic insufficiency the use of ambroxol may be contraindicated due to the risk of increased side effects.
7. Renal insufficiency: In the presence of severe renal insufficiency also ambroxol should be used with caution and under medical supervision.

Side effects Ambroxol

1. Systemic reactions: Rarely, allergic reactions such as urticaria, itching, swelling or even anaphylaxis may occur.
2. Gastrointestinal disorders: May include diarrhea, nausea, vomiting, dry mouth, and dyspepsia.
3. Nervous systemic disorders: In rare cases, headache, drowsiness, fatigue and dizziness may occur.
4. Other rare side effects: R are cases of taste disturbance and rhinitis may occur.

Overdose

1. Hypersalivation (excessive salivation).
2. Tachycardia (accelerated heart rate).
3. Dizziness and weakness.
4. Increased secretion of mucus in the airways, which can lead to difficulty breathing.

Interactions with other drugs

1. Drugs that slow down intestinal motility: Ambroxol may reduce the absorption rate of other drugs when taken together with drugs that slow down intestinal motility, such as antacids or drugs containing aluminum, magnesium or calcium.
2. Mucolytics and expectorants: The use of ambroxol with other mucolytic agents or expectorants may enhance their effect, resulting in more effective liquefaction and removal of sputum from the respiratory tract.
3. Drugs that increase the risk of bleeding: Ambroxol may increase the risk of bleeding when co-administered with drugs that also increase this risk, such as anticoagulants or antiaggregants.
4. Drugs metabolized in the liver: Interaction of ambroxol with drugs metabolized in the liver with participation of the same enzymes may affect their metabolism and concentration in blood.
5. Drugs affecting renal function: Administration of ambroxol with drugs affecting renal function may change the rate of its excretion from the body and affect its concentration in blood.