Cough drops

Cough drops of various compositions are pharmacological agents that are used in the treatment of cough - either to thin phlegm and facilitate its removal from the bronchi (with a wet, i.e. productive cough), or to suppress the cough center - if the cough is dry.

Indications for use of cough drops: acute respiratory infections and acute respiratory viral infections, pharyngitis, tracheitis, laryngotracheitis, acute and chronic bronchitis of various etiologies, tracheobronchitis, pneumonia, bronchopneumonia, whooping cough.

Names of cough drops prescribed for better expectoration of sputum in productive cough: ammonia-anise drops, chest cough drops, Bronchipret, Bronchosan, Gedelix. ATX code R05C A10.

Names of cough drops recommended for use with dry (unproductive) cough: Sinekod, Stoptussin. ATX code R05D B13.

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Pharmacodynamics

The expectorant effect of ammonia-anise drops is provided by the active substances - essential oil from anise seeds and ammonia solution (aqueous solution of ammonia). Anise oil contains phenolic compounds with antiseptic properties - aromatic ether anethole (1-methoxy-4-propenylbenzene) and its isomer para-allylanisole, as well as organic carboxylic acids (propionic and butyric). And the ammonia solution acts not only on the ciliated epithelium of the respiratory tract, but also on the nerve endings, reflexively stimulating the respiratory center and expectoration of sputum.

Pharmacodynamics of Chest Cough Drops (identical to Chest Elixir) is provided by the same anise oil and ammonia solution, stimulating the secretory function of the mucous membrane of the upper respiratory tract, as well as licorice root extract (naked licorice root), which contains saponins and glycyrrhizic acid, which help soften cough and expectorate. In addition, the licorice flavonoid glabridin relieves inflammation of the upper respiratory tract.

The combined expectorant Bronchipret facilitates the discharge of sputum due to the combined action of the active substances of the drug: thyme herb extract (terpenes, phenols and flavonoids of essential oil) and ivy leaf tincture (containing saponins and organic acids).

The mechanism of pharmacological action of Bronchosan cough drops is based on the components of the drug - bromhexine and essential oils of anise, fennel, oregano, eucalyptus and peppermint. Bromhexine provides the drug with an expectorant effect and a mucolytic (reducing the viscosity of bronchial secretions) effect. And essential oils - in addition to analgesic and antispasmodic effects - help to facilitate breathing, reduce the intensity of cough and reduce inflammation of the bronchial mucosa caused by staphylococcal infection.

The pharmacodynamics of Gedelix drops is due to hederin, saponins and organic acids of ivy leaf extract (Hedera helix L.), which promote the separation, formation and removal of mucus from the respiratory tract of the bronchi and lungs.

Sinekod drops affect the cough center of the medulla oblongata and suppress the cough reflex; the active substance of the drug butamirate - 2-(2-(diethylamino)ethoxy)ethyl 2-phenylbutyrate dihydrogen - also expands the lumen of the bronchi, facilitating breathing and the removal of accumulated mucus.

Stoptussin cough drops are classified as complex agents by their pharmacological action, since they contain, in addition to the cough suppressant butamirate, guaifenesin, a glycerol ether of 2-methoxyphenol (glycerol guaiacolate) that reduces the viscosity of sputum. Guaifenesin is quickly absorbed into the bronchial mucosa, destroys acidic mucopolysaccharides of mucus, which leads to an increase in the volume of sputum. And its excretion is accelerated due to irritation of the ciliated epithelium of the bronchi by phenolic compounds of guaiacolate.

Pharmacokinetics

It should be noted that the pharmacokinetics of many drops used to treat cough are not provided by drug manufacturers.

The pharmacokinetics of Bronchosan, according to the official instructions, is described only on the basis of absorption and transformation of bromhexine, which is quickly absorbed into the blood from the gastrointestinal tract, reaching the highest concentration in the blood plasma 60 minutes after administration. Splitting occurs in the liver with the formation of the active metabolite ambroxol, which has an expectorant effect. Excretion is through the intestines.

Butamirate in Sinekod and Stopussin drops is absorbed in the gastrointestinal tract, enters the blood and binds to proteins. Biotransformation of butamirate begins in the blood plasma - with the formation of pharmacologically active metabolites similar in their effect on the body. Metabolites are excreted in the urine within 12 hours.

Guaifenesin in Stopussin drops is metabolized in the liver, the products of biotransformation are excreted in the urine by the kidneys, and also in the sputum through the lungs.

Method of administration and dosage

Cough drops are taken orally. The recommended dosage of ammonia-anise drops: for adults - 3-4 times a day, 10-15 drops (dissolved in 50 ml of water); for children - one drop for each year of life (for children under 1 year - one drop) - three times a day.

Dosage of Chest Cough Drops: 20 to 40 drops per dose 3-4 times a day (dilute in a small amount of water, take half an hour before or an hour after meals).

The standard single dose of Gedelix is 30 drops (after meals) - for adults and children over 10 years old (three doses per day), for children 4-10 years old - 20 drops, 2-4 years old - 15 drops.

Adults should take Bronchipret up to four times a day (after meals) - 35-40 drops per dose; a single dose for children aged 7-11 is 10-15 drops, 12-17 years - 20-25 drops. Drops are diluted in 100 ml of water.

Recommended doses of Bronchosan: adults and children over 6 years old - 20 drops four times a day, children 2-6 years old - 10 drops (diluted, 25-30 minutes before meals).

Sinekod and Stoptussin drops should also be dissolved in water and taken: adults and children over two years old - 20-25 drops (four times a day).

Overdose of Chest Cough Drops may increase the manifestations of side effects; with prolonged use in high doses, potassium deficiency in the body may occur.

Exceeding the recommended doses of Bronchipret and Gedelix may cause vomiting and intestinal dysfunction; an overdose of Bronchosan - increased side effects; drops of Stoptussin and Sinekod - dizziness, decreased blood pressure, nausea, vomiting and diarrhea.

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Using Cough Drops During Pregnancy

In the treatment of cough in pregnant women, it is prohibited to use ammonia-anise drops, chest drops for cough, drops Gedelix. It is not recommended to take drops Bronchipret during pregnancy.

The use of Bronchosan, Stoptussin and Sinekod drops in the first trimester of pregnancy and during lactation is contraindicated; the decision on the advisability of taking this drug at a later stage is made by a doctor - according to indications, but taking into account the fact that the active substances of these drugs penetrate the BBB and can affect the development of the fetus.

Contraindications for use

The main contraindications for the use of cough drops:

• ammonia-anise drops - increased acidity of gastric juice, gastric ulcer, age up to three years;
• Chest cough drops - high blood pressure, liver and kidney dysfunction, hypokalemia, severe obesity, age under 12 years;
• Bronchipret - age up to 6 years;
• Bronchosan - severe renal or hepatic insufficiency, gastric ulcer and duodenal ulcer, liver cirrhosis, alcoholism, age under three years;
• Gedelix – bronchial asthma, children under two years of age;
• Sinekod - pulmonary hemorrhage, age up to two years;
• Stoptussin – cardiac arrhythmia, myocarditis, high blood pressure, exacerbation of gastric ulcer, hyperthyroidism, diabetes mellitus, glaucoma.

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Side effects of cough drops

The official instructions note the following most likely side effects of cough drops:

• ammonia-anise drops can lead to a decrease in heart rate, irritation of the gastric mucosa and vomiting;
• Chest cough drops provoke allergic reactions, bronchospasm, nausea and vomiting, and can cause swelling and increased blood pressure;
• Bronchipret drops cause skin allergic reactions in the form of rash and itching, and cause bouts of nausea;
• Bronchosan - in addition to itchy skin and allergic rhinitis, there may be nausea, vomiting and activation of liver enzymes;
• When using Gedelix drops, nausea, vomiting, diarrhea may occur, and abdominal pain cannot be ruled out;
• Sinekod and Stoptussin drops can cause allergic skin rashes, headaches and dizziness, nausea and diarrhea. In addition, long-term use of Stoptussin often causes epigastric pain.

Interactions with other drugs

Manufacturers of these drugs pay attention to interactions with other drugs.

Chest cough drops enhance the effect of some diuretics and laxatives, which can cause electrolyte imbalance; these cough drops should not be taken simultaneously with antibiotics and nitrofurans.

Bronchipret and Bronchosan drops, when taken in parallel with antibiotics or sulfonamides, increase their concentration in the respiratory tract and bronchial tissue.

Stoptussin cough drops enhance the effect of acetylsalicylic acid and all medications containing it, and also potentiate the effect of muscle relaxants, sleeping pills and alcohol.

Storage conditions for cough drops: in a dark place, at room temperature (not higher than +25-27°C).

Shelf life: ammonia-anise drops, chest cough drops - 3 years; Bronchipret, Bronchosan - 2 years; Geleliks - 2 years (an opened bottle can be stored for no longer than 6 months); Sinekod and Stoptussin - 5 years.