Usage
Ambroxol + Levosalbutamol is prescribed for the symptomatic relief of cough associated with mucus, especially in conditions like:
- Bronchial asthma
- Chronic bronchitis
- Chronic obstructive pulmonary disease (COPD)
- Lower respiratory tract infections (LRTIs) such as acute bronchitis, pneumonia, and tuberculosis.
Pharmacological Classification:
- Ambroxol: Mucolytic expectorant
- Levosalbutamol: Bronchodilator (β2-adrenergic agonist)
Mechanism of Action:
Ambroxol works by thinning and loosening phlegm (mucus) in the lungs, windpipe, and nose, making it easier to cough out. Levosalbutamol relaxes the muscles in the airways, widening them and improving airflow to the lungs.
Alternate Names
This combination is often referred to simply as Ambroxol/Levosalbutamol. There are numerous brand names under which this combination is marketed, varying by region and manufacturer. Some examples include Ascoril LS, Soventus-LS, and EASCOF-LS.
How It Works
Pharmacodynamics:
- Ambroxol: Stimulates surfactant production, reduces mucus viscosity, and enhances mucociliary clearance.
- Levosalbutamol: Relaxes bronchial smooth muscle by stimulating β2-adrenergic receptors, leading to bronchodilation.
Pharmacokinetics:
- Ambroxol: Well absorbed orally. Metabolized in the liver and excreted primarily in the urine.
- Levosalbutamol: Administered orally or by inhalation. Metabolized in the liver and excreted primarily in the urine.
Mode of Action:
- Ambroxol: Modifies the structure of glycoproteins in mucus, reducing its viscosity.
- Levosalbutamol: Binds to β2-adrenergic receptors on bronchial smooth muscle cells, activating adenylate cyclase and increasing intracellular cAMP, leading to smooth muscle relaxation.
Receptor binding, enzyme inhibition, or neurotransmitter modulation:
- Levosalbutamol: β2-adrenergic receptor agonist.
Elimination pathways:
- Both drugs are primarily eliminated through renal excretion, with some hepatic metabolism.
Dosage
Standard Dosage
Adults:
Syrup: 10 ml three times daily.
Children:
- 2-6 years: 2.5 ml three times daily.
- 6-12 years: 5 ml three times daily.
Special Cases:
- Elderly Patients: Start with the lower end of the adult dose and adjust as needed based on renal and hepatic function.
- Patients with Renal Impairment: Dose adjustment is necessary in severe renal impairment.
- Patients with Hepatic Dysfunction: Use with caution.
- Patients with Comorbid Conditions: Use with caution in patients with cardiovascular disease, hypertension, hyperthyroidism, diabetes, and seizure disorders. Close monitoring is advised.
Clinical Use Cases
Dosage in specific clinical settings should be determined by the attending physician based on individual patient needs and response.
- Intubation: Not typically indicated.
- Surgical Procedures: Not typically indicated.
- Mechanical Ventilation: Not typically indicated.
- Intensive Care Unit (ICU) Use: Not typically indicated.
- Emergency Situations: Not typically indicated.
Dosage Adjustments
Dose adjustments may be required in patients with renal or hepatic impairment and in the elderly. Close monitoring of patient response and potential adverse effects is essential.
Side Effects
Common Side Effects:
- Nausea, vomiting, diarrhea
- Tremor, dizziness, headache
- Sleeplessness, nervousness
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling)
- Tachycardia, palpitations
- Hypokalemia
- Worsening of underlying cardiovascular disease
Long-Term Effects:
Chronic complications from prolonged use are not well established, but regular monitoring is advisable.
Adverse Drug Reactions (ADR):
Severe allergic reactions, paradoxical bronchospasm, and significant cardiovascular effects require immediate medical attention.
Contraindications
- Hypersensitivity to any of the components.
- Severe cardiovascular disease, including ischemic heart disease.
- Thyrotoxicosis.
Drug Interactions
- Beta-blockers can antagonize the bronchodilating effects of levosalbutamol.
- Other sympathomimetic drugs can have additive cardiovascular effects.
- Xanthine derivatives, corticosteroids, and diuretics can potentiate hypokalemia.
- MAO inhibitors and tricyclic antidepressants can potentiate the cardiovascular effects of levosalbutamol.
Pregnancy and Breastfeeding
Use with caution during pregnancy and breastfeeding. Safety has not been fully established. Consult a physician before use.
Drug Profile Summary
- Mechanism of Action: Ambroxol: Mucolytic; Levosalbutamol: β2-agonist bronchodilator.
- Side Effects: Nausea, vomiting, tremor, dizziness, headache.
- Contraindications: Hypersensitivity, severe cardiovascular disease, thyrotoxicosis.
- Drug Interactions: Beta-blockers, sympathomimetics, xanthines, corticosteroids, diuretics, MAO inhibitors, tricyclic antidepressants.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: Adult: 10 ml TID; Pediatric: dose adjusted by age.
- Monitoring Parameters: Respiratory function, heart rate, blood pressure, potassium levels.
Popular Combinations
This combination itself is a popular formulation. Sometimes guaiphenesin is added.
Precautions
- Monitor for allergic reactions and cardiovascular effects.
- Caution in patients with diabetes, hypertension, thyroid disorders, and seizure disorders.
- Avoid alcohol.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ambroxol + Levosalbutamol?
A: Adults: 10ml TID. Children: 2.5 ml (2-6 yrs), 5ml (6-12yrs) TID. Adjustments are necessary for specific populations.
Q2: How does this combination relieve cough?
A: Ambroxol thins and loosens mucus, while levosalbutamol opens up the airways, facilitating easier expectoration.
Q3: Can this be used in asthmatic patients?
A: Yes, it’s indicated for bronchial asthma and can help relieve bronchospasm and improve airflow.
Q4: Are there any cardiovascular risks?
A: Levosalbutamol can cause tachycardia and palpitations, especially in patients with pre-existing cardiovascular disease. Careful monitoring is essential.
Q5: Can pregnant women take this medicine?
A: It should be used with caution during pregnancy and breastfeeding, only under the guidance of a physician.
Q6: What are the common side effects?
A: Nausea, vomiting, tremor, dizziness, headache, and sleeplessness are commonly reported side effects.
Q7: Does it interact with other medications?
A: Yes, it can interact with beta-blockers, other sympathomimetics, and certain other medications. A detailed drug history is essential.
Q8: How should it be administered?
A: It is available as a syrup and should be taken orally, usually three times a day. Shake the bottle well before each use.
Q9: What should I do if a dose is missed?
A: Take the missed dose as soon as you remember. However, if it’s almost time for the next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Q10: Can it be used for dry cough?
A: It’s primarily indicated for productive cough associated with mucus. Its effectiveness for dry cough is limited. Consult with a doctor for appropriate medication for dry cough.
