Usage
Bromhexine + Guaifenesin is prescribed for respiratory conditions characterized by excessive mucus production and difficulty expectorating, such as acute and chronic bronchitis, bronchial asthma, bronchiectasis, emphysema, and other bronchopulmonary disorders. It is also used for the symptomatic treatment of productive cough associated with upper respiratory tract infections.
It’s pharmacological classification includes:
- Mucolytic (Bromhexine)
- Expectorant (Guaifenesin)
Mechanism of Action: Bromhexine breaks down the structure of mucus, reducing its viscosity, while Guaifenesin increases respiratory tract secretions, making the mucus thinner and easier to cough up. This combined action promotes mucociliary clearance and relieves cough.
Alternate Names
There are no widely recognized alternate generic names for this specific combination. However, each component has other names:
- Bromhexine: Bisolvon
- Guaifenesin: Guaiphenesin, Glyceryl guaiacolate
Brand names for the combination vary regionally and internationally and include Ascoril, Bro-Zedex, Broncorex, Pecof, Salbux Plus, and TusQ-X.
How It Works
Pharmacodynamics: Bromhexine reduces mucus viscosity by breaking down mucopolysaccharide fibers. Guaifenesin increases respiratory tract fluid secretions, further thinning the mucus. This combined action improves mucociliary clearance.
Pharmacokinetics:
- Bromhexine: Well-absorbed orally. Metabolized in the liver. Excreted primarily in the urine.
- Guaifenesin: Readily absorbed from the gastrointestinal tract. Metabolized in the liver and excreted in the urine.
Mode of Action:
- Bromhexine depolymerizes mucopolysaccharide fibers in mucus.
- Guaifenesin stimulates receptors in the gastric mucosa, increasing respiratory tract fluid output, leading to thinner mucus.
Bromhexine and Guaifenesin do not directly bind to receptors, inhibit enzymes, or modulate neurotransmitters in the way that some other drugs do. Their primary mechanism is through their physicochemical effects on mucus. Elimination is primarily through hepatic metabolism and renal excretion.
Dosage
Standard Dosage
Adults:
10 ml (containing a specific strength of Bromhexine and Guaifenesin) three times a day. Dosages may vary according to the specific product.
Children:
- 2-6 years: 2.5 ml three times a day (consult a doctor).
- 6-12 years: 5-10 ml three times a day.
- >12 years: Adult dose.
Special Cases:
- Elderly Patients: Dosage adjustments may be needed based on renal and hepatic function.
- Patients with Renal Impairment: Dose reduction may be necessary.
- Patients with Hepatic Dysfunction: Dosage adjustments are advised.
- Patients with Comorbid Conditions: Caution is advised in patients with diabetes, cardiovascular disease, hyperthyroidism, peptic ulcer disease, and hypertension. Dose adjustments may be needed.
Clinical Use Cases
Dosage in these settings is similar to the standard dosage but should be individualized based on patient needs and closely monitored.
- Intubation: May be used to help clear secretions.
- Surgical Procedures: May be used pre- or post-operatively to manage secretions.
- Mechanical Ventilation: Helps loosen and remove secretions.
- Intensive Care Unit (ICU) Use: May be beneficial in managing airway secretions.
- Emergency Situations: Not typically used in acute emergency situations like status epilepticus or cardiac arrest.
Dosage Adjustments
Dose adjustments should be based on renal and hepatic function, patient response, and coexisting medical conditions.
Side Effects
Common Side Effects
Nausea, vomiting, diarrhea, headache, dizziness, skin rash, stomach upset.
Rare but Serious Side Effects
Allergic reactions (including anaphylaxis, angioedema, bronchospasm), Stevens-Johnson syndrome, toxic epidermal necrolysis.
Long-Term Effects
No significant long-term effects are typically associated with the combination, but prolonged use should be monitored.
Adverse Drug Reactions (ADR)
Clinically significant ADRs include severe allergic reactions and severe skin reactions.
Contraindications
- Hypersensitivity to Bromhexine or Guaifenesin.
- Pregnancy (especially the first trimester).
- Severe hepatic or renal impairment.
- Patients with a history of gastric or duodenal ulcers.
Drug Interactions
- Antibiotics: Bromhexine may increase the concentration of certain antibiotics in bronchial secretions.
- Antitussives: Concomitant use with cough suppressants is not recommended, as it can interfere with the expectoration of loosened mucus.
Pregnancy and Breastfeeding
Use with caution during pregnancy, especially the first trimester. Safety during breastfeeding is not fully established. Consult a physician before use.
Drug Profile Summary
- Mechanism of Action: Bromhexine reduces mucus viscosity, Guaifenesin increases respiratory secretions, facilitating expectoration.
- Side Effects: Nausea, vomiting, diarrhea, headache, dizziness, skin rash, allergic reactions.
- Contraindications: Hypersensitivity, pregnancy (1st trimester), severe hepatic/renal impairment, gastric/duodenal ulcers.
- Drug Interactions: Antibiotics, antitussives.
- Pregnancy & Breastfeeding: Use with caution. Consult a physician.
- Dosage: Varies by age and condition. See dosage section.
- Monitoring Parameters: Respiratory status, cough frequency and productivity, side effects.
Popular Combinations
Bromhexine and Guaifenesin are often combined with bronchodilators like Salbutamol or Terbutaline for enhanced relief of bronchospasm and mucus clearance.
Precautions
Assess for allergies and pre-existing conditions. Caution in patients with renal/hepatic impairment, diabetes, cardiovascular disease, and peptic ulcer disease. Avoid alcohol.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Guaifenesin?
A: See dosage section.
Q2: How does Bromhexine + Guaifenesin work?
A: Bromhexine thins mucus, and Guaifenesin helps loosen and expel it.
Q3: What are the common side effects?
A: Nausea, vomiting, diarrhea, dizziness, headache, skin rash.
Q4: Who should not take this medication?
A: Individuals with hypersensitivity, pregnant women (especially 1st trimester), severe hepatic/renal impairment, and history of gastric ulcers.
Q5: Can I take this medication with other cough medicines?
A: Avoid concomitant use with cough suppressants. Consult a physician about other medications.
Q6: What should I do if I experience side effects?
A: Contact your physician if side effects are severe or persistent.
Q7: Is it safe to take during pregnancy or breastfeeding?
A: Use with caution. Consult a physician.
Q8: How long should I take this medication?
A: Do not use for more than 4-5 days without consulting a physician.
Q9: Are there any dietary restrictions while taking this medication?
A: No specific dietary restrictions, but avoid alcohol.
