Usage
This combination medication is prescribed for the symptomatic relief of productive cough associated with various respiratory disorders, including:
- Acute bronchitis (including tracheobronchitis)
- Acute exacerbations of chronic bronchitis (AECB)
- Bronchial asthma
- Emphysema
- Asthmatic bronchitis
- Pneumonia
- Other bronchopulmonary disorders where bronchospasm, mucus plugging, and difficulty with expectoration coexist.
Pharmacological Classification:
This is a combination product containing drugs from three different pharmacological classifications:
- Salbutamol: Bronchodilator (Beta-2 adrenergic agonist)
- Bromhexine: Mucolytic
- Guaifenesin: Expectorant
Mechanism of Action:
- Salbutamol: Relaxes the smooth muscles of the airways by stimulating beta-2 adrenergic receptors, leading to bronchodilation and improved airflow.
- Bromhexine: Breaks down the disulfide bonds in mucoproteins, reducing the viscosity of sputum and making it easier to expectorate.
- Guaifenesin: Increases respiratory tract fluid secretions, which helps to thin and loosen mucus, facilitating its removal by coughing.
Alternate Names
This combination does not have a universally recognized international nonproprietary name (INN). It’s often referred to by the names of its individual components.
Brand Names: Ascorex Expectorant, Salbux Plus Syrup, Pecof/Pecof SF, Shaltoux Expectorant, Eascof Expectorant, Caryl Cough Syrup, Vento Broncho M. Numerous other brand names may exist regionally.
How It Works
Pharmacodynamics: The combined effect of bronchodilation, mucus thinning, and expectoration improves airflow and reduces cough.
Pharmacokinetics:
- Salbutamol: Well-absorbed orally. Metabolized in the liver and excreted primarily in urine.
- Bromhexine: Readily absorbed orally. Metabolized in the liver and excreted in urine. Dose proportional pharmacokinetics.
- Guaifenesin: Readily absorbed from the gastrointestinal tract. Rapidly metabolized and excreted in the urine.
Mode of Action:
- Salbutamol: Binds to beta-2 adrenergic receptors, activating adenylate cyclase and increasing intracellular cAMP, leading to smooth muscle relaxation in the airways.
- Bromhexine: Depolymerizes mucopolysaccharide fibers in mucus.
- Guaifenesin: Stimulates receptors in the gastric mucosa, which reflexively increases respiratory tract secretions.
Elimination Pathways: Primarily renal excretion for all three components. Salbutamol and Bromhexine undergo hepatic metabolism before renal excretion.
Dosage
Standard Dosage
Adults: 10-20 ml thrice daily.
Children:
- 6-12 years: 5-10 ml thrice daily.
- 2-6 years: 5 ml thrice daily. (Use only on the advice of a doctor, pharmacist, or nurse practitioner, if potential benefits outweigh potential risk).
- Under 2 years: Not recommended.
Special Cases:
- Elderly Patients: Start with a lower dose (e.g., 5 ml thrice daily) and adjust as needed.
- Patients with Renal Impairment: Use with caution. Dose adjustment may be necessary.
- Patients with Hepatic Dysfunction: Use with caution. Dose adjustment may be necessary.
- Patients with Comorbid Conditions: Use with caution in patients with diabetes mellitus, serious cardiovascular disorders, hypertension, hyperthyroidism, and peptic ulcers. Monitor serum potassium levels.
Clinical Use Cases
Dosage in specific clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations should be determined on a case-by-case basis considering the patient’s condition and other medications being administered. There is no standard dosing regimen for these situations in the given information.
Dosage Adjustments
Adjustments may be needed based on patient response and tolerance. Monitor for adverse effects.
Side Effects
Common Side Effects:
- Headache
- Nausea
- Vomiting
- Dizziness
- Diarrhea
- Indigestion
- Tremors
- Palpitations
Rare but Serious Side Effects:
- Hypersensitivity reactions (angioedema, urticaria, bronchospasm, hypotension, collapse)
- Hypokalemia
- Hyperactivity
- Tachycardia
- Severe skin reactions (erythema multiforme, Stevens-Johnson syndrome)
Long-Term Effects:
No specific long-term effects are mentioned in the sources provided, but prolonged use of any medication may have potential long-term implications.
Adverse Drug Reactions (ADR): Any serious or unexpected adverse effects should be reported.
Contraindications
- Hypersensitivity to any of the active ingredients or excipients.
- Pregnancy (first and second trimester)
- Pre-existing cardiac tachyarrhythmias.
- Thyrotoxicosis
Drug Interactions
- Beta-blockers: May reduce the effect of salbutamol.
- Sympathomimetic agents: Concomitant use with other oral sympathomimetic agents is not recommended.
- Monoamine oxidase inhibitors: Salbutamol should be administered with extreme caution.
- Diuretics: May interact and should be used with caution.
- Theophylline: May increase the risk of hypokalemia.
- Digoxin: May decrease serum digoxin levels.
Pregnancy and Breastfeeding
This combination is not recommended during pregnancy, particularly during the first and second trimesters. It is unknown whether the components are secreted in breast milk. Use only if clearly needed and the potential benefits outweigh the risks.
Drug Profile Summary
- Mechanism of Action: See above.
- Side Effects: See above.
- Contraindications: See above.
- Drug Interactions: See above.
- Pregnancy & Breastfeeding: Not recommended.
- Dosage: See above.
- Monitoring Parameters: Pulmonary function, blood pressure, heart rate, serum potassium levels, blood glucose levels (in diabetics).
Popular Combinations
This combination itself is a popular one. There is no information provided in the sources about other combinations frequently used with this one.
Precautions
- Pre-existing medical conditions (diabetes, cardiovascular disease, hypertension, hyperthyroidism, peptic ulcer).
- Renal/hepatic impairment.
- History of seizures.
- Hypokalemia.
- Pregnancy/breastfeeding.
- Avoid alcohol as it may potentiate dizziness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Guaifenesin + Salbutamol?
A: See Dosage section above.
Q2: What are the common side effects?
A: Common side effects include headache, nausea, vomiting, dizziness, diarrhea, indigestion, tremor, and palpitations.
Q3: Can this combination be used during pregnancy?
A: It is generally not recommended during pregnancy, especially the first two trimesters.
Q4: What are the contraindications for this medication?
A: Contraindications include hypersensitivity to any component, pregnancy (first and second trimester), pre-existing tachyarrhythmias, and thyrotoxicosis.
Q5: How does Bromhexine + Guaifenesin + Salbutamol work?
A: Salbutamol bronchodilates, bromhexine thins mucus, and guaifenesin helps expel mucus.
Q6: Are there any drug interactions I should be aware of?
A: Yes, this combination can interact with beta-blockers, sympathomimetics, MAO inhibitors, diuretics, theophylline, and digoxin.
Q7: Can this medication be used in children?
A: It can be used in children over 2 years of age, with appropriate dose adjustments. It is not recommended for children under 2.
Q8: What should I monitor in patients taking this medication?
A: Monitor for efficacy, side effects, and potential drug interactions. Monitor pulmonary function, blood pressure, heart rate, and serum potassium levels. Monitor blood glucose in diabetic patients.
Q9: Should this medication be taken with food?
A: Information regarding administration with food varies. Some sources indicate it should be taken with food. Consult the specific product information.
