Bromhexine

Bromhexine hydrochloride is a well-established mucolytic agent indicated for the symptomatic treatment of productive cough and respiratory conditions characterized by viscous, difficult-to-expel mucus. As a derivative of the vasicine alkaloid, it works by depolymerizing mucopolysaccharide fibers, reducing sputum viscosity, and facilitating expectoration. This action supports airway clearance, improves lung function, and enhances the efficacy of concomitant respiratory therapies. Its long-standing clinical use and favorable safety profile make it a cornerstone in the management of acute and chronic bronchopulmonary disorders.

Features

• Active ingredient: Bromhexine hydrochloride
• Available forms: Tablets (4 mg, 8 mg), syrup (4 mg/5 mL), solution for inhalation, and drops
• Mechanism: Mucolytic and secretolytic action through depolymerization of acid mucopolysaccharides in bronchial secretions
• Onset of action: Noticeable effect within 2–4 days of initiation
• Half-life: Approximately 1.5 hours, with metabolites exhibiting prolonged activity
• Administration: Oral (tablets, syrup) or inhalation (nebulized solution)

Benefits

• Reduces sputum viscosity, enabling easier expectoration and decreased coughing effort
• Improves mucociliary clearance by stimulating ciliary activity and hydrating bronchial secretions
• Enhances penetration of antibiotics into bronchial secretions, potentially increasing their efficacy in respiratory infections
• Alleviates chest congestion and shortness of breath associated with excessive mucus production
• Supports lung function parameters in chronic obstructive pulmonary disease (COPD) and bronchiectasis
• May reduce frequency and severity of exacerbations in chronic bronchitis

Common use

Bromhexine is commonly prescribed for acute and chronic respiratory conditions where thick, tenacious mucus impedes airway clearance. These include acute bronchitis, chronic bronchitis, COPD exacerbations, bronchiectasis, bronchial asthma with mucus hypersecretion, and tracheobronchitis. It is also used as adjunctive therapy in respiratory infections—such as pneumonia or sinusitis—to improve mucus drainage and antibiotic delivery. In pediatric practice, it is sometimes used for symptomatic relief in conditions like cystic fibrosis or post-operative atelectasis prevention, though dosing must be carefully adjusted.

Dosage and direction

Adults and adolescents (12 years and older):

• Tablets: 8 mg three times daily; in severe cases, initial dose may be increased to 16 mg twice daily under medical supervision
• Syrup: 10 mL (8 mg) three times daily
• Inhalation solution: 2 mL (8 mg) administered via nebulizer twice daily

Children (6–12 years):

• Tablets: 4 mg three times daily
• Syrup: 5 mL (4 mg) three times daily

Children (2–6 years):

• Syrup: 2.5 mL (2 mg) three times daily

Dosage should be taken after meals to minimize gastric irritation. Duration of treatment depends on clinical response but typically ranges from 7 to 14 days in acute conditions. For chronic disorders, long-term use may be indicated under periodic medical review. Inhalation therapy should be performed using a jet nebulizer; ultrasonic nebulizers are not recommended.

Precautions

• Use with caution in patients with a history of gastric ulceration, as bromhexine may cause gastrointestinal irritation.
• Hepatic or renal impairment requires dosage adjustment; monitor liver enzymes in long-term use.
• Not recommended during the first trimester of pregnancy unless clearly needed; use in later trimesters only under medical supervision.
• Avoid in patients with known hypersensitivity to bromhexine or related compounds.
• Caution advised when administering to patients with compromised cough reflex (e.g., post-operative, neurological impairment) due to risk of aspiration.
• Syrup formulation contains sucrose; consider in patients with diabetes mellitus.

Contraindications

• Hypersensitivity to bromhexine hydrochloride or any excipients in the formulation.
• Severe hepatic impairment (Child-Pugh Class C).
• Peptic ulcer disease in active phase.
• Use in children under 2 years of age due to insufficient safety data.
• Concomitant use with antitussives that suppress cough reflex (e.g., codeine, pholcodine).

Possible side effect

Most adverse reactions are mild and transient. Common side effects include:

• Gastrointestinal: Nausea, epigastric discomfort, diarrhea (usually dose-related)
• Dermatological: Rash, urticaria, pruritus
• Neurological: Dizziness, headache
• Other: Transient elevation of liver transaminases, sweating

Rare but serious side effects:

• Severe cutaneous reactions (e.g., Stevens-Johnson syndrome)
• Anaphylactoid reactions
• Acute bronchospasm (particularly with inhalation route)

Drug interaction

• Bromhexine may increase bronchial penetration and tissue concentrations of antibiotics such as amoxicillin, erythromycin, and tetracyclines, potentially enhancing their efficacy in respiratory infections.
• No clinically significant interactions with common bronchodilators (e.g., salbutamol, ipratropium) or corticosteroids.
• Theoretical potential to increase gastric absorption of other medications due to mucolytic action on gastric mucus barrier; clinical significance uncertain.
• Avoid concomitant use with cough suppressants (e.g., dextromethorphan, codeine) due to opposing mechanisms of action.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Consistent dosing is important for maintaining mucolytic effect, but occasional missed doses are unlikely to significantly impact overall efficacy.

Overdose

No specific antidote exists for bromhexine overdose. Symptoms may include nausea, vomiting, diarrhea, and dizziness. Gastric lavage or activated charcoal may be considered if ingestion was recent and the patient is conscious. Supportive care should be provided, including hydration and symptomatic treatment. Hemodialysis is not effective due to high protein binding. Cases of significant toxicity are rare; most reported overdoses have been uneventful.

Storage

Store at room temperature (15–30°C), protected from light and moisture. Keep syrup tightly closed and avoid freezing. Do not use beyond the expiration date printed on the packaging. Keep all medications out of reach of children. Nebulizer solutions should be used immediately after opening; discard any unused portion.

Disclaimer

This information is intended for medical professionals and educated patients as a summary of bromhexine’s characteristics. It does not replace professional medical advice, diagnosis, or treatment. Always consult a physician or qualified healthcare provider for personalized recommendations. Dosage and suitability depend on individual patient factors, including age, comorbidities, and concomitant medications. The prescriber should verify local prescribing information and guidelines before initiation.

Reviews

Bromhexine has been extensively studied and used clinically since the 1960s. Meta-analyses and systematic reviews generally support its efficacy in reducing sputum viscosity and improving symptom scores in acute and chronic bronchitis. A 2013 Cochrane review noted moderate-quality evidence for its benefit in chronic bronchitis, though highlighted variability in outcome measures across studies. Pediatric studies show promising results in conditions like bronchiolitis and pneumonia, particularly in settings where chest physiotherapy is limited. Criticisms occasionally note the modest effect size compared to placebo, but its favorable safety profile and low cost maintain its position in formularies worldwide. Long-term users with chronic respiratory conditions often report subjective improvement in breathing comfort and reduced exacerbation frequency.