Mucosan®, Mucoangin®, Mucosolvan®, Lindoxyl®, mucolytic, secretolytic, ambroxol hydrochloride, expectorant, local anestheticAmbroxol is an active ingredient used in medicines primarily as a cough expectorant. It has a mucolytic effect on the lungs and bronchial tubes and has a slightly anaesthetic effect on the throat area. Ambroxol is therefore often used for colds with particularly stubborn mucus and for acute or chronic respiratory diseases.
Two important effects of the drug can be highlighted: the expectorant and the pain-relieving effect. First, the first effect: with each breath, oxygen is absorbed with the air and carbon dioxide is released, thus keeping the body’s oxygen supply constant. Breathing air reaches the alveolar system of the lungs via the upper and lower airways, where the actual exchange of oxygen takes place.
The upper airways include the nasal cavity and the paranasal sinuses, the oral cavity and the throat. They are lined with a mucous membrane rich in glands and vessels, which is covered with respiratory epithelium (ciliated epithelium) that extends into the bronchi. The glands form a layer of mucus that covers the epithelium like a sticky film.
This layer moistens the incoming air and inhaled dirt and dust particles and pathogens remain attached to it. So-called cilia on the epithelium transport the mucus together with the particles to the throat, where they are swallowed and thus eliminated. Colds disturb this cleansing mechanism of the body.
The mucous membranes swell and very viscous mucus is formed, which sticks together the cilia and thus prevents pollutants from being transported towards the throat. Instead, the irritation of the respiratory tract triggers a cough reflex via sensory cells of the mucous membrane and the viscous mucus is coughed up in pain. Ambroxol unfolds its effect by making viscous mucus more fluid again, thus preventing the cilia from sticking together.
In addition, it mobilizes the hairs in addition to the accelerated removal of mucus towards the vestibule and stimulates the formation of surfactant, a surface-active substance that reduces the surface tension of the sticky mucus and thus makes it easier to cough up. The second pain-relieving effect is mainly used for severe sore throats. Ambroxol inhibits the formation and transmission of excitation of pain fibers localized in the mucosal cells.
Ambroxol is available in many different dosage forms. The active ingredient is often used in cough syrup or in drop form in dosages of 3; 6; 7.5 and 15 mg per ml. Ambroxol is also available as a film or effervescent tablet (30 or 60 mg), as a lozenge (15 or 20 mg), as a sustained-release preparation in a 75 mg dose, as well as in suppository form (15 mg) and as an inhaler solution (7.5 mg/ml).
Besides these mono-preparations, Ambroxol is also available as a combined preparation. Clenbuterol, theophylline or doxycycline are used as secondary substances. The attending physician decides on the appropriate method of application and dosage of the drug depending on the patient’s course of disease.
Ambroxol is to be taken as a cough syrup (15 mg/5 ml solution) no longer than 4-5 days. The dose varies in children and adults and is to be measured with an enclosed measuring cup: Ambroxol in drop form (7.5 mg/ml): In tablet form (30 mg), ambroxol is an effervescent tablet (60 mg) due to its high active ingredient content: Lozenges (20 mg) are available for children from 12 years of age and adults, up to 6 tablets should be taken throughout the day as required, the individual dose should not exceed one lozenge. The duration of the treatment should not exceed 3 days.
Retard preparations (75 mg) are only given to children from 12 years of age and adults, in this case only one capsule per day is taken unchewed together with plenty of liquid. Ambroxol suppositories (15 mg) are suitable for children; the inhalation solution (15 mg/2 ml) is only suitable to a limited extent for children under 6 years of age, juice and drops should be used. Children from 6 years of age and adults receive 2-3 ml 1-2 times daily for inhalation.
All common inhalers that do not use the steam boiler principle are suitable for this. The solution should initially be warmed to body temperature. It can be mixed 1:1 with physiological saline solution for best possible humidification.
When inhaling, normal breathing should be ensured. – Children under the age of 2 years receive 1⁄2 measuring beaker with 2.5 solution twice a day for ingestion;
- Children aged 2-5 years receive 1⁄2 measuring cup with 2.5 ml oral solution three times a day. – For children aged 6-12 years, the dose is increased to 1 measuring cup with 5 ml of oral solution 2-3 times a day.
- Adults and children over 12 years of age usually receive 2 measuring cups with 5 ml solution 3 times a day for the first few days, then the dose is reduced to 2 measuring cups with 5 ml solution twice a day. – Children under 2 years of age should only be administered under medical supervision. – For children aged 2-5 years, a dose of 20 drops 3 times a day (equivalent to 3 times 1 ml of solution) is recommended.
- Children from 6-12 years receive 40 drops 2-3 times daily (corresponds to 2-3 times 2ml solution) and
- Adults or children over 12 years of age receive 80 drops 3 times a day for the first few days (corresponds to 3 times 4ml solution), after which the amount is reduced to 2 times 80 drops a day. – Not suitable for children under 6 years. – Children from 6- 12 years receive half a tablet 2-3 times a day.
- Adults and children over 12 years of age receive 1 tablet 3 times a day for the first few days, then the amount is reduced to 1 tablet twice a day. The tablet should always be taken unchewed with a sufficient amount of liquid. – are not suitable for children under 12 years of age;
- Adults and children over 12 years of age receive 1⁄2 effervescent tablet 3 times a day for the first few days, later the amount is reduced to 1⁄2 effervescent tablet twice a day.
This should be taken after meals dissolved in a glass of water. – However, children under 2 years of age should only be treated under medical supervision. – For children aged 2-5 years, the daily dose is 2 times 1 suppository,
- Children from 6-12 years receive 1 suppository 2-3 times a day.
If possible, this suppository should be inserted deep anally after bowel movements. A frequently used dosage form of Ambroxol is cough syrup. The active ingredient can act in the throat area immediately after ingestion, loosening the mucus and relieving pain.
The mucolytic effect can be further improved by a simultaneous intake of fluid. Compared to tablets, the cough syrup has a faster onset of action. Ambroxol cough syrup is available in different dosages (between 3 and 15 mg active ingredient per ml solution).
The dosage most frequently used in cough syrup is 15 mg per 5 ml solution. In this dosage, it is not recommended to take it without medical advice for longer than 4 to 5 days. If the symptoms do not improve, a doctor should be consulted and the further procedure should be discussed.
The exact daily dosage and frequency of use depends on the patient’s age. It is also possible to take it in children under 2 years of age. Adults and children over 12 years of age usually receive 2 measuring cups with 5 ml solution three times a day.
Another frequently used dosage form of Ambroxol is tablets. However, the effect is delayed, as the active ingredient is first absorbed in the intestines and reaches the site of the sore throat via the bloodstream, where it dissolves mucus and relieves pain. The tablets of Ambroxol usually contain 30 milligrams of the active ingredient.
Compared to the other dosage forms, this is a relatively high dosage of Ambroxol. For this reason, Ambroxol tablets are not suitable for children under 6 years of age. Children between 6 and 12 years of age should take half a tablet two to three times a day.
Children over 12 years of age and adults usually take one Ambroxol tablet three times a day. It is recommended to take it with a sufficient amount of liquid. Ambroxol tablets should not be taken for more than 4 to 5 days without medical advice.
If the symptoms do not improve, a doctor should be consulted and the further procedure should be discussed. Drops are another form of Ambroxol. This also has a direct mucolytic and pain-relieving effect in the neck area.
Ambroxol drops contain approximately 7.5 milligrams per milliliter of the solution. The exact dosage also depends on the age of the patient. Use in children under 2 years of age is recommended only under medical supervision.
Children between 2 and 6 years of age should take 20 drops three times a day, children between 6 and 12 years of age receive 40 drops three times a day and children over 12 years of age and adults receive 80 drops three times a day. Ambroxol drops should not be taken for more than 4 to 5 days without medical advice. If the symptoms do not improve, a doctor should be consulted and the further procedure should be discussed.
Lozenges are another form of Ambroxol. The dissolution in the oral cavity and the neck allows a quick onset of action. One lozenge contains approximately 20 milligrams of the active ingredient.
As the dosage is high compared to cough syrup and Ambroxol drops, it is not allowed to be taken by children under 12 years of age. Children over 12 years of age and adults can take up to 6 lozenges spread over the day. The intake of Ambroxol lozenges should not exceed a period of 3 days.
If the symptoms do not improve, a doctor should be consulted and the further procedure should be discussed. The active ingredient Ambroxol is also available in the form of an ointment. However, this is usually a combination preparation with dimethyl sulfoxide, which also has analgesic and anti-inflammatory properties.
Compared to the other forms of ambroxol, the ointment is not used to dissolve mucus in respiratory diseases. Instead, Ambroxol ointment is used to treat neuropathic pain caused by local damage to nerve fibres. Due to a local anaesthetic effect of the ointment, pain in the affected skin area can be reduced after only 5 to 30 minutes.
It is not possible to use Ambroxol during pregnancy and lactation. Especially during the first third of the pregnancy, Ambroxol must not be taken in any case. The active substance can pass through the placenta and thus enter the baby’s bloodstream.
There are no sufficient study results available on the exact effects of Ambroxol in the baby’s body. Switching to other expectorant (sometimes also herbal) products is advisable during pregnancy and breastfeeding. The consumption of alcohol should be avoided while taking Ambroxol.
Ambroxol is metabolised and broken down in the liver after absorption in the intestine. If the liver is simultaneously stressed by the regular consumption of alcohol, damage to the liver tissue may occur. Conversely, the metabolism and degradation of ambroxol may be restricted if the liver is already damaged.
In this case an adjustment of the dosage of Ambroxol is necessary. An interaction of Ambroxol with the pill is not known. Studies and test results could not show any influence of Ambroxol on the effectiveness of the pill.
Some studies reported only a slight influence on the consistency of the lining of the uterus (increased permeability for sperm), but this has no relevant effect on the effectiveness of the pill. Ambroxol is not available in pharmacies on prescription. However, due to a wide range of side effects, a consultation with the treating doctor or a pharmacist is recommended.
In addition, there is a risk of interaction with other drugs due to the metabolism of the preparation in the liver. It is also necessary to adjust the dosage in case of kidney or liver dysfunction. If the symptoms of a respiratory disease do not improve after treatment with Ambroxol, a doctor should be consulted within a few days and the further procedure should be discussed.
There are numerous alternatives to Ambroxol for mucus dissolution and pain relief in acute and chronic respiratory diseases. One frequently used preparation is acetylcysteine (ACC). This is an expectorant drug that is often prescribed as part of the treatment of a chronic cough.
Acetylcysteine has a different mechanism of action from ambroxol. A combination of acetylcysteine with ambroxol is not recommended because of the many and sometimes severe side effects that can occur. Diarrhea is often observed after taking Ambroxol.
Occasionally nausea and vomiting accompanied by abdominal pain may occur. Fever and hypersensitivity reactions may also occur (swelling, itching, breathing difficulties and skin rash). In rare cases heartburn may occur.
Very rarely, hypersensitivity can turn into anaphylactic shock. Constipation, increased salivation, dehydration of the respiratory tract or strong nasal discharge and impaired urination can also occur as a very rare side effect. Ambroxol should not be used if a known allergy to ambroxol hydrochloride or any of the other ingredients of the drug is known.
Lozenges should not be taken if you are intolerant to fructose, as sorbitol is used as an additive. Caution is also advised in cases of galactose intolerance, glucose-galactose intolerance and lobule lactase deficiency. Mucous membrane ulcers should not be treated with Ambroxol lozenges.
In case of a known tendency to allergies or a sensitive bronchial system, inhalation of Ambroxol should be avoided, as the muscles of the respiratory tract could become cramped. If changes in the skin or mucous membranes are detected, a doctor should be consulted immediately, as the rare forms of Lyell or Stevens-Johnson syndrome may be present. Patients with severe kidney and liver dysfunction should use Ambroxol with great caution.
Renal insufficiency may cause the breakdown products of the drug to accumulate in the liver. Some rare bronchial diseases such as malignant cilia syndrome should not be treated with Ambroxol as there is a risk of secretion congestion. Retard preparations should not be used for longer periods in cases of histamine intolerance.
Pregnant women and nursing mothers should refrain from treatment if possible, as Ambroxol can cross the placental barrier and also pass into breast milk. With regard to treatment and possible side effects, no sufficient study results are available here. If Ambroxol is taken together with a cough-relieving medication (antitussive), a reduced cough reflex can lead to an accumulation of secretions that cannot be coughed up. The use of both drugs should always be accompanied by a doctor.
