Bromhexine Dosing in Adults
The standard adult dose of bromhexine is 8 mg three times daily (24 mg total daily dose), administered orally. 1, 2
Standard Dosing Regimen
- 8 mg orally three times per day is the established adult dose used across multiple clinical contexts 1, 2, 3
- This dosing schedule (8 mg TID) has been validated in clinical trials for respiratory conditions including chronic bronchitis, lower respiratory tract infections, and COVID-19 4, 5, 2, 3
Alternative Dosing Considerations
- 16 mg three times daily (48 mg total daily) has been studied in chronic bronchitis patients with irreversible airways obstruction, showing statistically significant reduction in phlegm stickiness 4
- The higher dose (16 mg TID) may be considered in severe cases with particularly thick, tenacious mucus, though this is less commonly used 4
Clinical Context and Limitations
- The European Respiratory Society guidelines recommend against routine use of bromhexine in children and adolescents with bronchiectasis due to potential adverse effects (OR 2.93 for adverse events compared to placebo) 6
- Despite this caution in pediatric bronchiectasis, the 8 mg three times daily dosing remains the standard when bromhexine is clinically indicated in adults for conditions with thick mucus 1
Duration of Treatment
- Treatment courses typically range from 5-7 days for acute lower respiratory tract infections 5
- Longer courses of 3 weeks have been studied in chronic bronchitis 4
- Extended prophylactic use of 8 weeks has been evaluated in specific contexts (COVID-19 prevention) 3
Important Caveats
- Bromhexine functions as a mucolytic by increasing serous mucus production and reducing viscosity, making it most appropriate when the primary goal is improving mucus clearance rather than cough suppression 1
- The medication is generally well-tolerated, though some patients report side effects including gastrointestinal symptoms 4
- No dose adjustments are specifically mentioned in the available evidence for renal or hepatic impairment, though clinical judgment should guide use in these populations