What is Bromhexine?

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1. What is Bromhexine? What is Bromhexine used for?

1.1. Pharmacodynamics of the drug Bromhexine Bromhexine hydrochloride is a drug with expectorant effect. The reason is due to the ability to activate synthesis of sialomucin and break down mucopolysaccharide acid fibers, so the drug has the effect of making sputum more loose and less viscous. From there, sputum from the bronchi easily escapes effectively. The active ingredient Bromhexine inhibits the human transmembrane serine receptor 2 (TMPRSS2). TMPRSS2 activation plays an important role in viral respiratory diseases such as influenza A and Middle East Respiratory Syndrome (MERS).
Inhibition of viral entry and receptor activation by Bromhexine may be effective in the prevention and treatment of various respiratory diseases, including COVID-19 disease.
When taking Bromhexine, it usually takes 2-3 days for patients to have clinical effects, but if injected, it only takes about 15 minutes.
1.2. Pharmacokinetics of the drug Bromhexine Absorption: Bromhexine is rapidly absorbed from the gastrointestinal tract, due to its very strong first-pass metabolism in the liver, bioavailability when taken orally is only 20%. Food increases the bioavailability of Bromhexine. The drug concentration peaks in plasma after oral administration, from 1/2 hour to 1 hour.
Distribution: Bromhexine is very widely distributed into body tissues. The drug has very strong binding ability (95-99%) to plasma proteins. When administered intravenously, the volume of distribution of the drug is about 7 liters/kg. The active substance Bromhexine crosses the blood-brain barrier and a small amount of the drug can cross the placenta.
Metabolism: Bromhexine is metabolized mainly in the liver. Ambroxol is a metabolite of the active substance Bromhexine and is metabolized in plasma. Elimination: Approximately 85-90% of the dose is excreted in the urine, mainly as metabolites, in the form of sulfo or glucuro conjugates, and a small amount is excreted unchanged. Bromhexine is excreted in the feces very little, with less than 4%. The mean terminal half-life is 13-40 hours depending on the individual.

2. Indications of the drug Bromhexine

Bromhexine is used in the following cases:
Bronchial secretion disorders, especially in acute exacerbations of acute and chronic bronchitis. Bromhexine is often used as an adjunct to antibiotics, when severe respiratory infections are present. Bromhexine has also been used orally and topically in the treatment of dry eye syndromes associated with abnormal mucus production.

3. How to use and dose of Bromhexine

3.1. Therapeutic dose of Bromhexine For adults Tablet form, oral: 8-16 mg/time, 3 times a day. The duration of treatment should not exceed 8-10 days unless prescribed by the treating doctor.
Oral solution: 10mg/time, 3 times a day. The duration of treatment should not exceed 8-10 days unless directed by the treating doctor.
Injections: Used for severe cases or complications after surgery.
Injectable dose: inject 8-16 mg/day, divided into 2 times daily.
For children Tablet form, oral: If children over 10 years old: 8 - 16 mg/time, 3 times a day. The duration of treatment should not exceed 8-10 days unless prescribed by the treating doctor.
Oral solution: Children over 10 years old: 10mg/time, 3 times a day. Children under 10 years old: 0.5 mg/kg/day divided into 2-4 doses. Children 5 - 10 years old: 4mg / time (1 teaspoon of elixir) 4 times a day. Children from 2 years old to under 5 years old: 4mg / time (1/2 teaspoon of elixir) 2 times a day. Children under 2 years old: 1mg/time (1/4 teaspoon of elixir) 3 times a day. The duration of treatment should not exceed 8-10 days unless directed by a pediatrician.
Injections: Used for severe cases or complications after surgery.
3.2. How to use Bromhexine Take Bromhexine tablets with 1 cup of water. Oral solution must not be used for nebulization. Injection solution: Bromhexine injection solution can be injected intramuscularly or intravenously slowly in 2-3 minutes. The solution for injection may also be infused intravenously with 5% glucose solution (up to 20 mg/500 ml), or 0.9% sodium chloride injection solution (up to 40 mg/500 ml). Absolutely, do not mix with lye solution because the drug will create a precipitate.

4. Undesirable effects of the drug Bromhexine

Bromhexine is well tolerated. However, when using Bromhexine you may experience unwanted effects including:
Headache, dizziness; Sweating; Rash, redness with itching on the surface of the skin; Cough or bronchospasm. Undesirable effects in the gastrointestinal tract such as:
Feeling of bloating and flatulence; Digestive disorders such as diarrhea, indigestion; Nausea, vomiting. Not everyone experiences these side effects. You may experience other health side effects not mentioned. If you have any questions about side effects, consult your treating doctor or other qualified healthcare professional.

5. Bromhexine drug interactions

Using Bromhexine with antibiotics such as amoxicillin, cefuroxime, erythromycin, doxycycline can lead to an increase in antibiotic concentration in lung parenchyma.
In addition, clinical adverse interactions with other drugs have not been specifically reported.

6. Some notes when using Bromhexine drug

6.1. General notes when using Bromhexine While using Bromhexine, it is necessary to avoid combining with other cough medicines, because there is a risk of causing sputum stagnation in the respiratory tract. Bromhexine, due to its mucolytic effect, can damage the gastric mucosal barrier. Therefore, when used for people with a history of peptic ulcer disease, they must be very careful. Caution should be exercised when used in people with asthma, because Bromhexine can cause bronchospasm in some susceptible individuals. The clearance of Bromhexine and other metabolites may be reduced in patients with severe hepatic or renal impairment, so caution and monitoring is required. Bromhexine should be used with caution in the elderly or debilitated, especially children under 2 years of age, because children are not able to effectively expectorate sputum, thus increasing sputum stasis. . 6.2. Precautions for use in pregnant women The risk of teratogenic effects of Bromhexine in animals has not been studied. There are no adequate and well-controlled studies on the treatment of bromhexine in pregnant women, therefore, the use or treatment of bromhexine in pregnant women is not recommended.
6.3. Caution when using with lactating women There have not been studies whether Bromhexine is excreted in breast milk. Therefore, the use of Bromhexine in nursing women is not recommended. If necessary, do not breast-feed or consult a doctor.
6.4. Caution when using with drivers and operating machines Bromhexine has little or no effect when operating machinery or driving a vehicle.
Bromhexine is a medicine that is usually made in many different forms such as tablets, sugar coated tablets, injection solution. The drug is mainly used to treat cough with phlegm. To ensure the effectiveness of treatment and avoid side effects, patients need to take medicine according to prescription or consult a doctor, professional pharmacist.
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