Usage
- This combination drug is prescribed for the relief of bronchospasm (wheezing, chest tightness, and shortness of breath) associated with respiratory diseases like asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). It helps loosen and clear mucus from the airways while also widening the airways to improve breathing.
- Pharmacological classification: This is a combination of a mucolytic, expectorant, and bronchodilator. Bromhexine is a mucolytic and expectorant, while etofylline and salbutamol are bronchodilators.
- Mechanism of Action: Bromhexine breaks down the thick mucus secretions in the airways, making them easier to cough out. Etofylline and Salbutamol relax the muscles surrounding the airways, which causes the airways to widen and allows for improved airflow.
Alternate Names
- No commonly used alternative names for this specific combination exist. The individual components are sometimes referred to as ambroxol (a metabolite of bromhexine) and albuterol (the US name for salbutamol).
- Brand Names: Brand names vary depending on the region and manufacturer. Some examples include Albutamol Plus, Asthalin B, and Ventolin Expectorant.
How It Works
- Pharmacodynamics: Salbutamol acts as a short-acting beta2-adrenergic agonist, stimulating beta2 receptors in the lungs, leading to bronchodilation. Etofylline, a xanthine derivative, acts as a bronchodilator and may also have some anti-inflammatory properties. Bromhexine reduces the viscosity of mucus by breaking down mucopolysaccharide fibers, making it easier to expectorate.
- Pharmacokinetics: All three drugs are readily absorbed from the gastrointestinal tract. Salbutamol has a plasma half-life of 4-6 hours, while etofylline is metabolized in the liver. Bromhexine is also metabolized and excreted primarily in the urine.
- Mode of Action: Salbutamol binds to beta2-adrenergic receptors, leading to increased intracellular cAMP, which in turn relaxes bronchial smooth muscle. Etofylline inhibits phosphodiesterase enzymes, increasing cAMP levels and producing bronchodilation. Bromhexine directly breaks down mucus polymers.
- Elimination Pathways: Salbutamol is primarily eliminated via the kidneys, while etofylline and bromhexine undergo hepatic metabolism before renal excretion.
Dosage
Standard Dosage
Adults: One tablet (or 10ml syrup containing standard concentrations of the three drugs) three to four times daily. Dosages can be adjusted by the physician based on individual patient needs and response to therapy.
Children: Pediatric dosing varies depending on age and weight and requires careful assessment. It is generally not recommended for children under 2 years old. Typical dosing for older children (6 years and above) is 2.5 to 5ml of syrup three times a day. Specific dosing instructions for children should be consulted with a pediatrician.
Special Cases: Dosage adjustments may be necessary for patients with renal or hepatic impairment, elderly patients, or those with co-morbid conditions. Medical advice is crucial in such cases.
Clinical Use Cases
- Intubation/Surgical Procedures/Mechanical Ventilation/ICU Use/Emergency Situations: The combination of Bromhexine, Etofylline, and Salbutamol is typically not the preferred choice in these acute settings. Nebulized salbutamol alone or in combination with ipratropium bromide, or intravenous bronchodilators like terbutaline may be more appropriate.
Dosage Adjustments: Dose modification is needed for renal/hepatic impairment and other conditions as advised by a physician on a case-by-case basis.
Side Effects
Common Side Effects: Nausea, vomiting, diarrhea, headache, dizziness, tremors, palpitations, increased heart rate, muscle cramps, skin rash, and sweating.
Rare but Serious Side Effects: Allergic reactions (e.g., difficulty breathing, swelling), paradoxical bronchospasm, irregular heartbeat, hypokalemia, and hypersensitivity reactions.
Long-Term Effects: Tolerance to the bronchodilator effects of salbutamol may develop with prolonged use. Monitoring for long-term effects is crucial.
Contraindications
- Hypersensitivity to any component of the drug, severe heart disease, hyperthyroidism, uncontrolled diabetes.
- Use with caution in patients with hypertension, glaucoma, prostatic hypertrophy, or seizure disorders.
Drug Interactions
- Beta-blockers, theophylline, diuretics, MAO inhibitors, tricyclic antidepressants, some antibiotics (e.g., erythromycin), and cimetidine can interact with this combination.
- Alcohol can exacerbate side effects like dizziness and drowsiness.
Pregnancy and Breastfeeding
- Pregnancy: Use with caution during pregnancy only if clearly needed and the benefits outweigh the risks.
- Breastfeeding: Not generally recommended during breastfeeding due to potential transfer of the drug to the infant through breast milk.
Drug Profile Summary
- Mechanism of Action: Mucolytic, expectorant, and bronchodilator.
- Side Effects: Nausea, vomiting, headache, tremors, palpitations, increased heart rate.
- Contraindications: Hypersensitivity, severe heart disease, uncontrolled diabetes, hyperthyroidism.
- Drug Interactions: Beta-blockers, theophylline, diuretics.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks in pregnancy. Not recommended while breastfeeding.
- Dosage: Adults: One tablet/10ml syrup three to four times daily. Pediatric: Dosage based on age and weight and usually avoided in children under 2 years.
- Monitoring Parameters: Respiratory rate, oxygen saturation, heart rate, blood pressure, potassium levels.
Popular Combinations
- In some cases, this combination may be prescribed alongside inhaled corticosteroids for better management of asthma and COPD.
Precautions
- Pre-existing heart, liver, kidney diseases, thyroid disorders, and diabetes warrant careful consideration.
- Alcohol should be avoided.
- Caution with driving or operating machinery due to potential dizziness and drowsiness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Etofylline + Salbutamol?
A: Adults: One tablet/10ml syrup three to four times daily. Pediatric doses are adjusted based on age and weight and should be determined by a pediatrician.
Q2: What are the common side effects?
A: Nausea, vomiting, headache, dizziness, tremor, palpitations, and increased heart rate are common.
Q3: Is it safe during pregnancy?
A: Use only if clearly needed and benefits outweigh risks. Consult a doctor before use.
Q4: Can I take this while breastfeeding?
A: Not generally recommended during breastfeeding.
Q5: What are the major contraindications?
A: Hypersensitivity, severe heart disease, uncontrolled diabetes, hyperthyroidism.
Q6: Does it interact with other medications?
A: Yes, it can interact with beta-blockers, theophylline, diuretics, certain antibiotics, and other drugs.
Q7: What should I monitor while on this medication?
A: Respiratory rate, oxygen saturation, heart rate, blood pressure, potassium levels.
Q8: Can I take it with alcohol?
A: Alcohol is not advised as it may worsen side effects.
Q9: What if I have kidney or liver problems?
A: Dosage adjustment is necessary. Consult with a physician.
Q10: Are there any long-term side effects?
A: Tolerance to salbutamol may develop with chronic use. Regular monitoring is recommended.
