Bromohexine Dosing for Adult Productive Cough
Recommended Dose
The standard adult dose of bromohexine for productive cough is 8 mg taken orally three times daily. 1
This dosing regimen has been validated in clinical trials for the management of productive cough in adults with acute bronchitis and lower respiratory tract infections. 2, 1
Clinical Context and Efficacy
Bromohexine is a mucolytic agent that reduces sputum viscosity and facilitates expectoration in patients with productive cough. 2
When combined with antibiotics in bacterial lower respiratory tract infections, bromhexine 8 mg four times daily demonstrated significantly greater symptom improvement compared to antibiotic alone, particularly for cough frequency, ease of expectoration, and sputum volume reduction by day 3 of treatment. 2
In acute bronchitis with productive cough, fixed-dose combinations containing bromhexine (with salbutamol and guaifenesin) showed efficacy in reducing cough severity and improving sputum characteristics. 3
Duration of Treatment
Treatment courses typically range from 5-7 days for acute lower respiratory tract infections. 2
For COVID-19 patients, bromhexine 8 mg three times daily was administered throughout hospitalization with significant reductions in ICU admission, intubation, and mortality. 1
Important Contraindications and Precautions
Bromhexine should not be used for dry, non-productive cough where mucolytic therapy provides no benefit and cough suppression is the appropriate goal. 4, 5
When NOT to Use Bromhexine:
Dry cough: For non-productive cough, dextromethorphan 30-60 mg is the preferred agent with superior safety profile. 4, 5
Acute viral bronchitis without bacterial infection: Antibiotics (and likely mucolytics) provide minimal benefit, and simple remedies like honey and lemon are first-line. 6
Cough requiring suppression rather than expectoration: When airway clearance is not needed, central antitussives are more appropriate. 4
Alternative and Complementary Therapies
For Productive Cough:
Guaifenesin-based combinations: Fixed-dose combinations of salbutamol + bromhexine + guaifenesin showed superior efficacy (44.4% excellent response) compared to dual-agent combinations. 3
Ambroxol combinations: Ambroxol + guaifenesin + levosalbutamol demonstrated superiority over bromhexine-containing combinations in acute bronchitis with productive cough. 7
For Non-Productive Cough (Alternative Approach):
First-line: Honey and lemon mixture as simple, effective, non-pharmacological treatment. 4, 5
Pharmacological: Dextromethorphan 30-60 mg (maximum 120 mg daily) is the preferred antitussive with optimal cough suppression at 60 mg doses. 4, 5
Nocturnal cough: First-generation sedating antihistamines (NOT promethazine) or dextromethorphan 15-30 mg at bedtime. 4, 5
Critical Clinical Algorithm
Determine cough type: Productive (wet) versus non-productive (dry). 4
For productive cough with difficult expectoration: Bromhexine 8 mg three times daily for 5-7 days. 2, 1
For dry cough: Use dextromethorphan 30-60 mg, NOT bromhexine. 4, 5
Exclude serious pathology first: Rule out pneumonia (fever, tachypnea, abnormal chest exam), hemoptysis, or foreign body before initiating symptomatic treatment. 4
Common Pitfalls to Avoid
Using bromhexine for dry cough: This provides no therapeutic benefit as there is no sputum to mobilize. 4
Expecting rapid symptom resolution: Significant improvement in cough frequency and sputum characteristics typically occurs by day 3, but complete resolution may take 5-7 days. 2
Combining multiple mucolytic agents without rationale: Fixed-dose combinations are more effective than single agents, but avoid redundant therapy. 3
Suppressing productive cough when clearance is beneficial: In conditions like pneumonia or bronchiectasis, sputum expectoration serves a protective function and should not be suppressed. 4