How bromhexine works
Bromhexine is an expectorant, i.e. it promotes the expectoration of bronchial secretions: it makes the secretions thinner (secretolytic effect) and causes the cilia of the lung mucosa to beat faster (secretomotor effect).
Increased secretions are produced in the lungs, particularly in the case of respiratory tract infections. It is intended both to fight the invading pathogens and to ensure their removal towards the mouth and nose.
Secretions in the body are produced by glands. These can be roughly divided into serous glands (with watery, protein-containing secretions) and mucous glands (with viscous secretions). The former can contain antibodies, whereas mucous glands with their viscous mucus mechanically prevent the invading bacteria from advancing.
If the balance of serous and mucous secretions is shifted too far in the direction of mucus production, such viscous mucus is produced that it can hardly or no longer be coughed up.
Secretolytic agents such as bromhexine increase the release of serous secretions and thus make the mucus thinner. Bromhexine also stimulates the movement of the cilia on the surface of the lung mucosa. This allows the mucus to be removed more efficiently.
Absorption, breakdown and excretion
Shortly after ingestion, four-fifths of the active ingredient is converted in the liver into metabolites such as ambroxol, which are also effective against thick mucus. The degradation products are excreted in the urine via the kidneys.
When is bromhexine used?
Bromhexine is approved for the treatment of acute and chronic lung and bronchial diseases in which the formation and transportation of mucus is impaired.
In Switzerland, bromhexine is used for the excessive formation of mucus in cold coughs and, on medical prescription, also for chronic respiratory diseases with the formation of thick secretions and impaired secretion transport.
The active ingredient can therefore be used for colds as well as for more serious illnesses such as asthma, COPD (chronic obstructive pulmonary disease) and cystic fibrosis.
Depending on the indication, bromhexine is used on a short-term or long-term basis. In the latter case, liver function should be checked regularly.
How bromhexine is used
The cough suppressant is taken in tablet form or as a liquid (bromhexine drops, juice). Adults and adolescents aged 14 years and over should take 8 to 16 milligrams of bromhexine three times a day, whereby the total daily dose should not exceed 48 milligrams.
Children under the age of 14 are given a lower dosage.
Infants and small children under two years of age can also be treated with liquid bromhexine preparations if prescribed by a doctor. However, the medicine must not contain mint oil, as this can lead to laryngeal spasms and choking in small children.
What side effects does Bromhexine have?
Bromhexine generally has a good spectrum of side effects. It occasionally triggers fever, nausea, abdominal pain, vomiting, diarrhea and allergic reactions (such as rash, itching, shortness of breath). Rarely, bronchospasm occurs – a spasm of the bronchial tubes that manifests itself like an asthma attack.
If allergic reactions occur, you should stop taking the medicine and consult a doctor.
What should I bear in mind when taking Bromhexine?
Contraindications
Bromhexine must not be taken in cases of known hypersensitivity to the active substance or any of the other ingredients of the medicine.
Interactions
No antitussive agents (such as dextromethorphan/DXM, codeine) should be taken during treatment with Bromhexin, as this can lead to a build-up of secretions in the lungs with shortness of breath and even suffocation. However, taking cough suppressants exclusively at night to ensure a peaceful night’s sleep may be advisable after consulting a doctor.
Age restriction
Pregnancy and breastfeeding
The manufacturer recommends not taking bromhexine during pregnancy for safety reasons due to a lack of data – unless the risk-benefit assessment by the doctor speaks in favor of treatment. According to the experts at the Pharmacovigilance and Advisory Center for Embryonal Toxicology at Charité – Universitätsmedizin Berlin, the active ingredient can also be used during pregnancy if inhalation treatments and sufficient liquid intake are insufficiently effective.
As bromhexine passes into breast milk in animal studies, its use during breastfeeding is not recommended according to the instructions for use. However, clinical experience to date has not shown any incompatibilities. Bromhexine is therefore one of the expectorants of choice during breastfeeding if hydration and inhalation therapy are not sufficiently effective.
How to obtain medication with bromhexine
All preparations containing the cough expectorant bromhexine are pharmacy-only in Germany, Austria and Switzerland, but do not require a prescription. They can therefore be purchased over the counter in any pharmacy.
How long has Bromhexine been known?
Medicines containing the active ingredient bromhexine were first approved in Europe in 1966.
