Bromhexine

Bromhexine is a mucolytic agent used to facilitate sputum discharge in various respiratory diseases associated with increased viscosity of bronchial secretions. This drug improves the work of the ciliated epithelium of the respiratory tract, thus contributing to the effective cleansing of the bronchi from phlegm.

Bromhexine works by liquefying sputum and facilitating its passage through the respiratory tract. It turns the mucoid bronchial secretion into a less viscous and more liquid one, which eases coughing and promotes more effective lung cleansing.

Indications Bromhexine

1. Bronchitis: Bromhexine is used to treat acute and chronic forms of bronchitis, including obstructive and cough bronchitis. It helps to thin out sputum and improves its passage through the respiratory tract.
2. Diseases of the upper respiratory tract: Bromhexine may be recommended for the treatment of various diseases of the upper respiratory tract, such as rhinitis, sinusitis, pharyngitis and laryngitis.
3. ARVI and influenza: As part of complex therapy, bromhexine can be used to relieve symptoms of ARVI and influenza, such as cough with heavy sputum.
4. COPD (obstructive lung disease): Bromhexine can be included in COPD therapy to help clear sputum and improve respiratory function.
5. Cystic fibrosis: In patients with cystic fibrosis, which is characterized by the production of heavy, sticky mucus, bromhexine may help thin the mucus and make it easier to cough up.
6. Preparation for diagnostic procedures: Bromhexine may be used to prepare for certain diagnostic procedures, such as bronchoscopy, to help clear mucus.

Release form

1. Tablets: This is the most common form. Bromhexine tablets are usually taken orally with water.
2. Syrup: This form is convenient for children and adults who prefer a liquid form of medication. The syrup usually has a pleasant taste and is easily dosed using a special measuring cap.
3. Capsules: Bromhexine may also be available in capsule form, which are taken orally and usually washed down with water.
4. Injection solution: Bromhexine may sometimes be given as an injection solution, but this method of administration is less common and is more often used in hospital settings.

Pharmacodynamics

1. Dilution of secretions in the respiratory tract: The main mechanism of action of bromhexine is to stimulate the release of water and electrolytes into the respiratory tract, which leads to thinning of mucus and making it easier to expectorate. This is achieved by activating the channels of cell membranes and increasing the secretion of serous secretion by the glands of the bronchial mucosa.
2. Improving mucociliary clearance: Bromhexine also helps to improve mucociliary clearance - a mechanism for clearing mucus and contaminants from the airways due to the activity of cilia and mucus secretion.
3. Anti-inflammatory effects: Some studies have shown that bromhexine may have anti-inflammatory properties, helping to reduce inflammation in the airways. However, the exact mechanism of this action requires additional research.
4. Antioxidant Action: There is evidence that bromhexine may have antioxidant properties, helping to protect airway cells from damage caused by free radicals.
5. Exspectorant action: Bromhexine helps to increase the formation and removal of mucus from the respiratory tract, which helps relieve expectoration and relieve cough.

Pharmacokinetics

1. Absorption: Bromhexine is usually well absorbed from the gastrointestinal tract after oral administration. Maximum plasma concentrations are usually achieved 1-3 hours after administration.
2. Distribution: Bromhexine is distributed in body tissues, including the respiratory tract and mucous membranes of the lungs.
3. Metabolism: Bromhexine is metabolized in the liver to form active metabolites.
4. Excretion: The main route of elimination of bromhexine and its metabolites is through the kidneys. Small amounts may also be excreted in the urine.
5. Half-life: The half-life of bromhexine is usually about 6-12 hours.

Dosing and administration

1. Tablets:

   • Usually bromhexine tablets are taken orally, completely washed down with water.
   • The usual dosage for adults is 8-16 mg 2-3 times a day.
   • For children, the dosage depends on age and weight. Dosage recommendations should be provided by a physician.

2. Syrup:

   • Bromhexine syrup is usually taken orally, often after meals.
   • For adults, a dosage of 8-16 ml (corresponding to 8-16 mg of active substance) 2-3 times a day is usually recommended.
   • For children, the dosage depends on age and weight. Dosage recommendations should be provided by a physician.

3. Capsules:

   • Like tablets, bromhexine capsules are usually taken orally with water.
   • The dosage is similar to the dosage of tablets.

4. Solution for injection:

   • This type of use is usually reserved for cases where the use of oral forms is not possible or when rapid action is required.
   • The dosage and frequency of injections are determined by the doctor depending on the patient’s condition and the nature of the disease.

Use Bromhexine during pregnancy

Recommendations for use during pregnancy:

1. Safety information:

   • Scientific data on the effects of bromhexine on pregnant women is limited. Animal studies have shown no direct or indirect harmful effects on pregnancy, embryo/fetal development, childbirth or postnatal development. However, the absence of negative data from animal studies does not always guarantee safety in humans.

2. Use in the first trimester:

   • Due to the lack of sufficient data, the use of bromhexine in the first trimester of pregnancy is not recommended. This is the period of greatest risk for the development of intrauterine defects in the fetus.

3. Use in the second and third trimesters:

   • The use of bromhexine in the second and third trimesters is possible if the expected benefit to the mother outweighs the potential risk to the fetus. The physician may consider using bromhexine based on the patient's symptoms and needs.

4. Making treatment decisions:

   • Any decision to treat with bromhexine during pregnancy should be made in conjunction with a physician, who can evaluate the risks and benefits based on the individual clinical situation.

Alternatives:

• To relieve symptoms of cough and airway congestion during pregnancy, you may consider safer alternatives such as humidifying the air, drinking plenty of fluids, and using saline nasal sprays. These methods may help relieve symptoms without the use of drugs.

Contraindications

1. Individual intolerance or allergic reaction: People with a known individual intolerance to bromhexine or any other component of the drug should avoid its use.
2. Peptic ulcer of the stomach and duodenum: For peptic ulcer of the stomach and duodenum, the use of bromhexine can increase irritation of the mucous membrane and cause an exacerbation of the disease.
3. Pregnancy and breastfeeding: During pregnancy and breastfeeding, the use of bromhexine should be discussed with a doctor, since the safety of its use during this period has not been fully established.
4. Severe renal and liver dysfunction: If you have severe kidney or liver disease, dosage adjustments or complete discontinuation of the drug may be required.
5. Bronchial asthma: In some patients with bronchial asthma, the use of bromhexine may cause exacerbation of symptoms or allergic reactions, so it should be used with caution.
6. Children: The safety and effectiveness of bromhexine in children under 6 years of age has not been established.
7. Particular caution if there is a history of hemoptysis: Patients with a predisposition to hemoptysis should use bromhexine with caution and under medical supervision.

Side effects Bromhexine

1. Gastrointestinal disorders:

   • The most commonly reported symptoms are nausea, vomiting and diarrhea. Some patients may experience stomach pain or abdominal discomfort.

2. Allergic reactions:

   • Although it is rare, bromhexine may cause allergic skin reactions such as rash, itching, or hives. In very rare cases, more serious reactions may occur, including angioedema or anaphylactic shock.

3. Dermatological reactions:

   • In some cases, skin rashes may appear, which usually disappear after stopping the drug.

4. Respiratory disorders:

   • Bromhexine can sometimes cause bronchospasm, especially in patients with asthma or chronic obstructive pulmonary disease.

5. Other rare side effects:

   • Headache, dizziness, fatigue and excessive sweating may also occur, but these effects are quite rare.

Overdose

1. Усиление нежелательных эффектов: Это может включать в себя усиление таких симптомов, как головокружение, тошнота, рвота, диарея и др.
2. Нарушения ЦНС: При высоких дозах бромгексина могут возникнуть центральные нервные системные симптомы, такие как возбуждение, сонливость, головная боль, гиперактивность или депрессия дыхания.
3. Повышение вязкости мокроты: Возможно увеличение вязкости мокроты в дыхательных путях, что может затруднить её отхаркивание.
4. Other systemic effects: Overdose may cause various other systemic complications, including cardiovascular, gastrointestinal and respiratory problems.

Interactions with other drugs

1. Antibiotics: Bromhexine may enhance the penetration of antibiotics into the bronchial mucosa, which may improve their effectiveness.
2. Mucolytics and expectorants: The combination of bromhexine with other mucolytics and expectorants can enhance their effect, which contributes to the thinning of sputum and its removal.
3. Cough remedies: Bromhexine may be combined with cough medications such as codeine or dextromethorphan to relieve cough symptoms.
4. Drugs that depress the cough reflex center: Concomitant use of bromhexine with drugs that depress the cough reflex center, such as opiates or benzodiazepines, may reduce reflex cough.
5. Drugs affecting the liver: Bromhexine is metabolized in the liver, so use with other drugs affecting liver function may affect its metabolism.