What is the use of Bromhexine (Mucolytic agent)?

From the Guidelines

Bromhexine should be considered for use in patients with bronchiectasis, as it has been shown to improve sputum production and difficulty in expectoration, although its impact on FEV1 is minimal 1. The medication works by stimulating secretory cells in the respiratory tract to produce thinner, less viscous mucus by breaking down mucopolysaccharide fibers. Some key points to consider when using bromhexine include:

• The typical adult dosage is not specified in the provided evidence, but it is generally recommended to be 8-16 mg three times daily.
• Bromhexine is available as tablets, oral solution, or syrup, and should be taken with food to minimize stomach upset.
• Treatment duration usually ranges from 7-14 days, depending on symptom improvement.
• Patients should drink plenty of fluids while taking bromhexine to help thin mucus further.
• Side effects are generally mild and may include temporary nausea, rash, or stomach discomfort. It's worth noting that bromhexine is not widely available in the UK and is not listed in the BNF, but it is commonly used in many European and Asian countries. Additionally, other mucolytic agents such as N-acetylcysteine, ambroxol, and carbocisteine have been studied in the context of COPD exacerbations, and may also be considered for use in certain patients 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Bromhexine Overview

• Bromhexine is a derivative of the Adhatoda vasica plant, used in some countries for the treatment of various respiratory diseases 2.
• It has been found to enhance the secretion of various mucus components, increasing mucociliary clearance and reducing cough 2.

Clinical Efficacy

• Principal clinical research studies have demonstrated the efficacy of bromhexine in improving respiratory symptoms, particularly in patients with chronic bronchitis and other respiratory diseases 2.
• Co-administration of antibiotics with bromhexine has been shown to amplify the actions of the antibiotic 2.
• Clinical trials have also shown that bromhexine, along with other mucoactive agents, has a place in the relief of cough symptoms by easing the elimination of mucus 3.

Specific Studies

• A study in 1986 found that ambroxol, a metabolite of bromhexine, had a symptomatic effect in patients with simple chronic bronchitis, particularly in improving expectoration 4.
• However, a study in 1978 found no significant improvement in the rate of recovery of patients with acute severe asthma treated with bromhexine 5.
• Another study in 1989 investigated the effect of bromhexine on nasal mucus clearance in patients with chronic maxillary sinusitis, but the results are not specified in the provided text 6.

Safety and Efficacy

• Mucoactive agents, including bromhexine, have been shown to have a good safety profile, although some precautions should be taken when using certain agents 3.
• The available evidence suggests that these products are useful in the therapy of upper respiratory airways infections, including bronchitis, sinusitis, and rhinosinusitis 3.