Bromhexine instructions for use tablets. What are bromhexine tablets from and how to take

Bromhexine is an expectorant that affects the viscosity of sputum, and also contributes to its rapid removal from the respiratory tract. The active ingredient of the drug is bromhexine hydrochloride. Bromhexine belongs to the pharmacological group of mucolytics with expectorant action.

The drug is available in the following dosage forms:

Bromhexine tablets: 1 tablet contains 4 or 8 mg of the active ingredient. In pharmacies, packages of 10, 20, 25, 50 tablets are available;
Bromhexine solution for oral administration: in 5 ml of the drug, the concentration of the substance is 4 mg. Bottles are available in volumes of 60, 100, 150 ml, each of them comes with a measuring spoon;
Bromhexine drops for oral administration: in 1 ml of the drug, the content of bromhexine hydrochloride is 8 mg. The medicine also contains anise (0.25 mg) and fennel (0.74 mg) oils. Each vial contains 20 ml of the drug;
Bromhexine syrup: 5 ml of syrup accounts for 4 mg of the active ingredient. The product is available in bottles of 60 and 100 ml, the kit includes a measuring spoon.

Also, this drug is part of the combined cough medicines, such as:

Joset syrup: 5 ml contains 1.205 mg of salbutamol, 0.5 mg of menthol, 2 mg of bromhexine, 50 mg of guaifenesin;
Ascoril expectorant in the form of a syrup: 2 mg salbutamol, 4 mg bromhexine, 100 mg guaifenesin, 1 mg menthol;
Ascoril expectorant in the form of tablets: 8 mg of bromhexine, 100 mg of guaifenesin, 2 mg of salbutamol;
Solvin tablets: 8 mg of bromhexine in 1 tablet and 4 mg in 5 ml of elixir;
Syrup Bromhexine Berlin Chemi 4 and 8 mg of the active substance per 5 ml, in a bottle - 60 ml;
Bromhexine Berlin Chemi in the form of dragees, 4 and 8 mg per 1 piece, in convalence - 25 dragees.

Pharmacological action of Bromhexine

According to the instructions, Bromhexine reduces the viscosity of sputum by breaking complex bonds within polysaccharide molecules. As a result, sputum turns into a liquid state and is easily coughed up from the bronchi. Therefore, in this way, the lungs and bronchi are cleansed.

In addition, Bromhexine activates the production of internal lubrication of the alveoli (surfactant) and improves the respiratory function of the lungs.

Indications for use

According to the instructions, Bromhexine is prescribed for diseases of the lungs, bronchi and trachea, such as:

acute or chronic bronchitis;
bronchial asthma;
obstructive diseases of the bronchi and lungs;
inflammatory diseases of the upper respiratory tract: tuberculosis, tracheitis, laryngitis, tracheobronchitis, pharyngitis and others;
pneumonia.

The drug effectively relieves the symptoms of a wet (productive) cough.

Contraindications to the use of Bromhexine

A contraindication to the use of Bromhexine according to the instructions is individual sensitivity to its components.

During pregnancy, Bromhexine syrup and tablets can only be taken after consultation with the doctor, although the medicine does not have any compelling contraindications for this category of patients.

Side effects of Bromhexine

Bromhexine syrup, tablets and elixir can cause side effects such as:

in the digestive system: vomiting and nausea, pain in the stomach, bleeding, in some cases, exacerbation of peptic ulcer;
in the nervous system: headache, weakness, frequent dizziness;
in the immune system: allergic reactions, in particular, rash, itching, swelling, urticaria and others.

Instructions for use Bromhexine and dosage

In the form of tablets, Bromhexine is taken orally. When treating with this remedy, food is not oriented. The dosages of the tablets are as follows:

for adult patients, 0.016 g per dose, which is equivalent to 2 tablets (1 tablet - 0.008 g) three to four times a day;
for children aged 3 to 4 years - 2 mg per dose with the same frequency as for adults;
for children aged 5-14 years - 4 mg of the drug three times a day.

The therapeutic effect of Bromhexine appears already 1-2 days after the start of treatment. On average, the course lasts from 4 days to a month.

When using the drug in the form of a solution for inhalation, it must be diluted with distilled water in equal proportions, heated to body temperature. Patients with asthmatic bronchitis or bronchial asthma should take a bronchodilator before the procedure - a drug that widens the lumen in the lungs. Inhalations are carried out 2 times a day for adults (4 ml) and children from 10 years (2 ml). The younger age category (6-10 years) is prescribed 1 ml and 5 drops (2-6 years).

In severe cases, parenteral administration of the drug may be prescribed. The same method is used to prevent the accumulation of thick sputum in the bronchi in the postoperative period. Bromhexine is injected under the skin at a dosage of 1 ampoule. Also, if necessary, intravenous and intramuscular administration is allowed. The procedure is carried out 2-3 times a day in slow mode for two to three minutes. For intravenous use, the drug is supplemented with saline or glucose. Do not use with alkaline solutions.

Sometimes Bromhexine is used with cardiac, bronchodilator and antibacterial drugs.

Dragee Bromhexine Chemi 8 is taken in a daily dosage of 3-4 jokes for adults and adolescents over 14 years of age. In severe cases, the dose of Bromhexine Berlin Hemi is doubled. Children of the age category from 6 to 14 years old are prescribed Bromhexine Chemi in the form of a syrup at a dosage of 5-10 ml (or 1 tablet of 8 mg of the active substance) three times a day.

special instructions

The drug should not be taken simultaneously with drugs that block the cough reflex, for example, sinekod, codex, stoptussin, terpinkod. Otherwise, sputum stagnation in the bronchi may occur, which entails the development of primary and secondary infectious processes. It is also possible to increase inflammation and damage the wall of the bronchial tree. When combining Bromhexine, it can be taken during the day, and antitussives - at bedtime.

Name:

Bromhexine (Bromhexin)

Pharmacological
action:

Mucolytic expectorant.
Reduces the viscosity of bronchial secretions by depolarizing the acidic polysaccharides contained in it and stimulating the secretory cells of the bronchial mucosa, which produce a secret containing neutral polysaccharides.
It is believed that bromhexine promotes the formation of surfactant.

Pharmacokinetics
Bromhexine is rapidly absorbed from the gastrointestinal tract and is extensively metabolized during the "first pass" through the liver. Bioavailability is about 20%. In healthy patients, Cmax in plasma is determined after 1 hour.
Widely distributed in body tissues. About 85-90% is excreted in the urine mainly in the form of metabolites. The metabolite of bromhexine is ambroxol..
The binding of bromhexine to plasma proteins is high. T1 / 2 in the terminal phase is about 12 hours.
Bromhexine crosses the BBB. In small quantities it penetrates the placental barrier.
Only small amounts are excreted in the urine with a T1 / 2 of 6.5 hours.
The clearance of bromhexine or its metabolites may be reduced in patients with severely impaired liver and kidney function.

Indications for
application:

Bronchopulmonary diseases, accompanied by the formation of sputum of increased viscosity:
- bronchial asthma;
- cystic fibrosis;
- pulmonary tuberculosis;
- pneumonia;
- tracheobronchitis;
- obstructive bronchitis;
- bronchiectasis;
- emphysema;
- pneumoconiosis.

Mode of application:

Take Bromhexine inside(regardless of how you write) in the form of tablets.
Doses for adults - 0.016 g (16 mg = 2 tablets of 0.008 mg) 3-4 times a day; for children from 3 to 4 years old - 0.002 g (2 mg), from 5 to 14 years old - 0.004 g (4 mg) 3 times a day; children under 3 years of age are not prescribed the drug.
The effect of the drug begins to appear usually 24-48 hours after the start of treatment. The course of treatment - from 4 days to 4 weeks.

Solution for inhalation should be diluted 1:1 with distilled water and warmed to body temperature to prevent coughing. In patients with bronchial asthma or asthmatic bronchitis, a bronchodilator (a drug that expands the lumen of the bronchi) should be taken before inhalation. Inhalation is carried out twice a day for adults 4 ml, children over 10 years old - 2 ml each, children aged 6 to 10 years old - 1 ml each, children aged 2 to 10 years old - 10 drops each and children under 2 years old - 1 ml each. 5 drops per inhalation.
parenteral(bypassing the digestive tract) introduction The drug is recommended for treatment in severe cases, as well as in the postoperative period to prevent the accumulation of thick sputum in the bronchi. Enter 1 ampoule subcutaneously, intramuscularly or intravenously 2-3 times a day slowly over 2-3 minutes.
Intravenously the drug is administered together with glucose or saline.
The drug is incompatible with alkaline solutions.
If necessary, bromtexin is prescribed simultaneously with antibacterial, bronchodilator, cardiac and other means.

During treatment, it is recommended to consume a sufficient amount of liquid, which supports the secretolytic effect of Bromhexine.
In children, treatment should be combined with postural drainage or chest vibration massage, which facilitates the evacuation of secretions from the bronchi.

Side effects:

From the digestive system: dyspeptic phenomena, transient increase in the activity of hepatic transaminases in the blood serum.
From the CNS: headache, dizziness.
Dermatological reactions: increased sweating, skin rash.
From the respiratory system: cough, bronchospasm.

Contraindications:

Age up to 3 years;
- I trimester of pregnancy;
- hypersensitivity to bromhexine.

In case of gastric ulcer, as well as indications of gastric bleeding in history, Bromhexine should be used under medical supervision.
Carefully use in patients with bronchial asthma.

Interaction
other medicinal
by other means:

Bromhexine can be prescribed in combination with bronchodilators, antibacterial drugs, agents used in cardiology, and other drugs.
Incompatible with alkaline solutions.
Bromhexine is not used simultaneously with drugs containing codeine, because. this makes it difficult to cough up loose sputum.
It is used as part of combined preparations of plant origin with essential oils (including eucalyptus oil, anise oil, peppermint oil, menthol).

Pregnancy:

During pregnancy and lactation, Bromhexine is used in cases where the intended benefit to the mother outweighs the potential risk to the fetus or child.

Overdose:

Symptoms: increased adverse reactions.
Treatment: artificial vomiting, fluid intake (milk or water) in the first 1-2 hours after ingestion, symptomatic therapy.

Release form:

1 tablet Bromhexine contains:
- active ingredient: bromhexine hydrochloride - 8 mg;
- excipients: sugar, lactose monohydrate, potato starch, stearic acid, microcrystalline cellulose.

IN 5 ml Bromhexine syrup contains:
- active ingredient: bromhexine hydrochloride - 4 mg;
- excipients: propylene glycol - 1250.0 mg, sorbitol (sorbitol) - 2000.0 mg, succinic acid - 12.5 mg, eucalyptus rod leaves oil (eucalyptus oil) - 0.75 mg, sodium benzoate - 2.5 mg , apricot flavor - 5.0 mg, water (purified water) - up to 5 ml.

Tradename: Bromhexine.

International non-proprietary name: Bromhexine.

Release form: tablets 8 mg.

Description: tablets of white color, ploskotsilindrichesky, with a facet.

Compound: one tablet contains: active ingredient - bromhexine hydrochloride - 8 mg; Excipients: sucrose, lactose monohydrate, potato starch, stearic acid 95, microcrystalline cellulose type 101.

Pharmacotherapeutic group: remedies for coughs and colds. Expectorants, excluding combinations with antitussives. Mucolytics.

ATX code: R05CB02.

Hypersensitivity to bromhexine and / or to any auxiliary component of the drug, including lactose and sucrose, peptic ulcer of the stomach and 12 duodenal ulcer in the acute phase, pregnancy (I trimester), lactation period, children's age (up to 3 years ).

Tablets should be taken orally, after meals, with plenty of liquid.

Adults and adolescents over 14 years of age are prescribed 1-2 tablets (8-16 mg) 3 times a day.

Children and adolescents from 6 to 14 years old, as well as persons weighing less than 50 kg, 1 tablet (8 mg) 3 times a day. Children under 6 years of age should take dosage forms with a lower dosage.

Children under 6 years of age should take lower dosage forms of bromhexine and only on the recommendation of a doctor.

The therapeutic effect may appear on the 4th-6th day of treatment. The course of treatment is from 4 to 28 days (determined individually depending on the indications and the course of the disease). Patients with renal insufficiency or impaired liver function are prescribed lower doses or increase the interval between doses.

Suction: When administered orally, Bromhexine is almost completely (99%) absorbed in the gastrointestinal tract within 30 minutes. C max in the blood is reached approximately 1 hour after taking the drug.

Distribution: bioavailability is low (about 20%) due to the effect of "first pass" through the liver. Binding to blood proteins is high and is 80-90% (95% on average), penetrates the blood-brain and placental barriers. 2 hours after ingestion, the accumulation of bromhexine in the lung tissue is recorded, exceeding the plasma level by 1.5-4.5 times.

Metabolism: in the liver, bromhexine undergoes demethylation and oxidation, and is metabolized to the pharmacologically active ambroxol.

Derivation: the half-life (T ½) is 15 hours due to slow reverse diffusion from the tissues. Excreted by the kidneys. After oral administration of radioactive labeled bromhexine, 97.4 ± 1.9% of the dose was found in the urine, of which less than 1% is unchanged substance. In chronic renal failure, excretion of metabolites is impaired. Total clearance 800 ml/min; determined solely by hepatic blood flow. In severe liver failure, the clearance of bromhexine decreases, and in chronic liver failure, the clearance of its metabolites decreases. After repeated dosing, no signs of accumulation were found. The cumulation coefficient is 1.1.

The pharmacokinetics of bromhexine in the elderly or in patients with hepatic or renal insufficiency has not been studied. There is limited experience with this drug in these patient populations. Due to the slower excretion of bromhexine in patients with severe liver and kidney disease, it is recommended to increase the interval between its use.

Pharmacokinetic interactions

No interaction studies have been conducted with oral anticoagulants and digoxin. Co-administration of ampicillin, oxytetracycline or erythromycin does not affect the pharmacokinetics of bromhexine.

Bromhexine is a prominent representative of the group of mucolytics and secretory drugs. It is a synthetic analogue of a plant called justice vascularis, but with less pronounced side effects compared to the extract of this plant. Due to the special structure of the molecule, bromhexine and its metabolites are able to simplify the structure of mucus mucopolysaccharides. In other words, the drug contributes to the "untwisting" of mucopolysaccharide molecules and, through this, to a decrease in their ability to capture water molecules. As this ability decreases, mucus thins.

In addition to this effect on mucus, Bromhexine can also affect the cells that produce it. The result of this exposure is the formation of more less viscous mucus, as well as an increase in surfactant production in the lungs. Surfactant is a substance necessary for the alveoli of the lungs to expand after exhalation. In the absence of surfactant, a condition called respiratory distress syndrome occurs. It is manifested by progressive shortness of breath, blueness of the skin and mucous membranes and, ultimately, the death of the patient if appropriate medical care is not provided.

The third effect of the drug is its ability to stimulate the excretion of the resulting liquid sputum by increasing the oscillatory movements of the villi of the respiratory epithelium. As a result, mucus accumulates in the lumen of the large bronchi and trachea, which has a large number of cough receptors. Excess sputum irritates the aforementioned receptors and a reflex coughing up of mucus occurs, accompanied by its removal from the bronchial tree.

Bromhexine has a high bioavailability. In other words, this drug is able to penetrate absolutely into all tissues of the body, overcoming all biological barriers. In accordance with the foregoing, the drug is contraindicated in pregnant women in the second and third trimester, as well as nursing mothers, since it can disrupt the process of lung formation of both the fetus and the newborn. However, if the child is directly ill, the use of the drug is justified.

Types of medication, commercial names of analogues, release forms

Bromhexine is available in the following dosage forms:

pills;
dragee;
elixir;
syrup;
drops for oral administration oral solution).

Tablets and dragees can be used by both adults and children aged two years and older. For younger children, the use of oral drops, syrup and elixir is recommended due to the fact that they are easier to dose the drug, unlike tablets. In 1 ml of solution for oral administration of syrup and elixir is 0.8 mg of the active substance.

Bromhexine is found in pharmacies under the following commercial names:

Bromhexine Berlin-Chemie;
Phlegamine;
Bronchostop;
Solvin;
Bromhexine-ratiopharm;
Bromhexine-Egis and others.

Manufacturers of Bromhexine

Firm manufacturer	Commercial name drug	Manufacturer country	Release form	Dosage
*Berlin-Chemie*	*Bromhexine 4 Berlin-Chemie*	Germany	Solution for oral administration (4 mg in 1 ml solution)	INadults and children older than 14 years, the drug is prescribed at a dose of 8-16 mg ( 10 - 20 ml of medicine) 3 times a day. the drug is prescribed at a dose of 8 mg ( 10 ml) 3 times a day. *Children under 6 years old* the drug is prescribed in a dose of 2-4 mg ( 2.5 and 5 ml) 3 times a day.
*Berlin-Chemie*	*Bromhexine 8 Berlin-Chemie*	Germany	Dragee (8 mg/dr.)	*Adults and children* the drug is prescribed in the amount of 8-16 mg ( 1 - 2 dragees) 3 times a day. *Children 6 to 14 years of age and patients weighing less than 50 kg* the drug is indicated in the amount of 8 mg ( 1 dragee) 3 times a day. *Children under 6 years old* 2 - 4 mg ( half or quarter of a dragee) 3 times a day. However, due to the fact that the dragee is inconvenient to divide into parts, children under 6 years of age are recommended to use syrups, elixirs and oral solutions.
*Pharbita*	*Bromhexine*	Netherlands	Pills (8 mg)	the drug is prescribed at a dose of 8-16 mg ( 1 - 2 tablets) 3 times a day. *Children from 6 to 14 years old* administration of the drug in the amount of 8 mg is indicated ( 1 tablet) 3 times a day. *Children under 6 years old* 2 - 4 mg ( half and quarter tablets) 3 times a day.
*Pharmstandard-Leksredstva*	*Bromhexine*	Russia	Pills (8 mg)
*Pliva Krakow*	*Phlegamine*	Poland	Syrup (2 - 4 mg / 5 ml)	*Children under 6 years old* shown from 2 to 4 mg of the drug 3 times a day. *Children 6 to 14 years of age and patients weighing less than 50 kg* the drug is indicated at a dose of 8 mg 3 times a day. *Children over 14 and adults* shows the appointment of the drug in the amount of 8 - 16 mg 3 times a day.
*Wave International*	*Bromhexine Elixir*	India	Elixir (4 mg/5 ml)	*Adults and children over 14 years old* is prescribed in a dose of 8 - 16 mg ( 10 - 20 ml). *Children 6 to 14 years of age and patients weighing less than 50 kg* - 8 mg ( 10 ml) 3 times a day. *Children under 6 years old* - 2 - 4 mg ( 2.5 and 5 ml).

The mechanism of the therapeutic action of the drug

Once in the gastrointestinal tract, Bromhexine almost completely penetrates into the bloodstream and spreads throughout the body. The maximum concentration of the drug in the blood is reached after two hours. As Bromhexine enters the liver, its gradual restructuring occurs with the formation of intermediate metabolites, which also have a pronounced mucolytic and secretomotor effect. The best known metabolite of bromhexine is a drug called ambroxol. Bromhexine is a drug that can accumulate in tissues, so its initial mild effect occurs 2 to 4 hours after the first application, and the maximum effect develops from 4 to 5 days of treatment.

Both bromhexine and its metabolites affect both mucus and mucus-producing cells. Due to the fact that this drug is not able to selectively affect the respiratory epithelium, its effect extends to the rest of the mucous cells of the body. This feature explains some of the side effects of bromhexine, described below. In addition, the drug is able to penetrate the biological barriers of the body - the blood-brain, hematoplacental, and also into mother's milk, and therefore bromhexine is contraindicated in pregnant women in the second and third trimester during normal pregnancy, as well as nursing mothers. In the first trimester, the use of the drug is allowed, since the intensive development of the lung tissue of the fetus begins approximately only from the fifth month of intrauterine development. If there is an urgent need to prescribe drugs of this group to a nursing mother, the child must be transferred to artificial feeding for the duration of her treatment.

Upon contact with mucus, Bromhexine acts on the mucopolysaccharides that make up its composition and “unwinds” them, simplifying the structure of the latter. As the structure simplifies, the ability of mucopolysaccharides to bind water molecules decreases, which is externally manifested by a decrease in the viscosity of mucus. Upon contact with mucus-forming cells, Bromhexine binds to specific receptors on the cell surface, triggering a cascade of complex biochemical reactions. As a result, the mucous cells begin to produce more secretion of reduced viscosity.

In addition to the above effects, Bromhexine leads to an acceleration of the maturation of alveolocytes - cells located in the alveoli of the lungs and producing a specific secret called surfactant. Surfactant is vital for the normal respiration of any mammal, as it is responsible for the alveoli collapsing during inhalation. In its absence, a condition called respiratory distress syndrome develops. It is manifested by shortness of breath, blueness of the skin and mucous membranes, loss of consciousness and, ultimately, the death of the patient. Therefore, bromhexine can be prescribed to pregnant women in the second and third trimester, however, only with the threat of premature birth. The purpose of prescribing the drug is to prevent respiratory distress syndrome in a newborn by accelerating the maturation of alveolocytes in his lungs.

The last but not least property of bromhexine is the ability to accelerate the oscillatory movements of the villi lining the epithelium of the respiratory tract. Through this, liquid sputum is mechanically removed from the bronchial tree, and therefore it accumulates in the upper airways and irritates the cough receptors. As a result, the cough is reduced, it becomes productive ( expectoration) and less painful.

Due to the fact that the drug is metabolized by the liver, and excreted from the body by the kidneys, diseases of these organs can lead to accumulation of the drug in the body and, ultimately, to its overdose. For this reason, in patients with chronic liver failure and renal failure, it is important to adjust the dose based on the function of the above organs. Liver function is checked through tests such as the level of prothrombin, fibrinogen, bilirubin, etc. Kidney function is assessed by determining creatinine clearance.

For what pathologies is it prescribed?

Bromhexine is indicated for diseases of the bronchopulmonary system, accompanied by the formation of viscous sputum. Such diseases are acute and chronic bronchitis, pneumonia, bronchiectasis, bronchial asthma, chronic obstructive pulmonary disease, cystic fibrosis, tuberculosis, silicosis, etc. Also in some countries of the world, the use of bromhexine and its analogues is practiced to prevent neonatal distress syndrome.

The use of bromhexine

Name of the disease	Mechanism of therapeutic action	Dosage of the drug
*Acute and chronic bronchitis*	Bromhexine acts on the mucous cells of the respiratory epithelium, leading to the release of less viscous sputum in larger quantities. The drug reduces the viscosity of the mucus itself by simplifying the structure of the mucopolysaccharides that make up its composition. In addition, bromhexine increases the frequency of oscillatory movements of the villi of the respiratory epithelium, which results in an acceleration of sputum secretion from the bronchi. The drug can be used to prevent neonatal distress syndrome, however, in practice, the metabolite of bromhexine, ambroxol, is more often used for this purpose.	*Adults and children over 14 years old* the drug is indicated at a dose of 8-14 mg 3-4 times a day. *Children 6 to 14 years of age and patients weighing less than 50 kg* the drug is prescribed 8 mg 3 times a day.
*Pneumonia*
*bronchoectatic lung disease*
*Bronchial asthma*
*Chronic obstructive pulmonary disease*
*Tuberculosis*
*Silicosis*
*cystic fibrosis*		Due to the need to take the drug daily, it is extremely important to choose the optimal dose that causes the desired effect and is not complicated by side reactions. Thus, medium doses of the drug are initially prescribed, which are gradually reduced to a level at which their effect is maintained, and side reactions are minimal.

How to apply the medication?

Bromhexine is taken with or after food. The frequency of administration and dose should correspond to the age of the patient and the severity of his illness.

Adults and children over 14 years old bromhexine is prescribed mainly in the form of tablets and dragees 3-4 times a day, 8-16 mg each.

Children from 6 to 14 years old the drug is indicated in the form of syrups containing a single dose of 8 mg 3 times a day.

Reception of bromhexine should be accompanied by an increase in daily fluid intake due to the fact that the drug accelerates its excretion through the lungs. If the patient has chronic renal or hepatic insufficiency, the dose of the drug must be reduced or the interval between its doses should be increased in order to avoid overdose.

Possible side effects

Bromhexine may cause the following side effects:

allergic reactions;
disorders of the gastrointestinal tract;
disorders of the central nervous system;
other adverse reactions.

allergic reactions

Allergic reactions are manifestations of an exaggerated response of the body upon contact with a substance that is absolutely harmless and normally never causes tissue damage. Allergy symptoms never develop at the first contact of the body with the allergen, since specific antibodies and immune cells sensitized against the allergen are necessary for the development of immune aggression. To create them, the body needs time, on average, equal to two weeks.

Bromhexine can cause the following allergic reactions:

contact dermatitis;
Quincke's edema ( angioedema);

Hives
Urticaria is the most common manifestation of an allergy. The reason for its development in most cases is the use of an allergen with food. Subsequently, after 15 - 30 minutes on the abdomen, back, hips, buttocks, neck, elbows of the patient, a small-dotted rash appears, slightly protruding above the skin surface. The appearance of a rash is often accompanied by itching of varying intensity. As the allergy progresses, the affected area expands, and the elements of the rash merge and protrude more strongly above the surface of the skin, forming blisters. The size of the blisters can be different - from 1 - 2 centimeters to 20 - 30 cm in diameter, especially on the trunk.

contact dermatitis
This manifestation of an allergic reaction is characteristic of skin contact with an allergen. In this case, an allergic rash appears in the form of blisters, as with urticaria, however, the contours of the lesion clearly correspond to the boundaries of contact between the skin and the allergen.

Quincke's edema
Quincke's edema, or angioedema, is a specific type of allergic reaction that often develops in response to an allergen entering the mucous membrane of the nose or mouth. A feature of Quincke's edema is the predominant lesion of loose connective tissue located around the eyes and mouth, in the cheeks, lips, earlobes, scrotum, labia, etc. There are acute and chronic edema. Acute edema develops within minutes and poses an immediate threat to the patient's life, as it tends to spread to the vocal cords. Swelling of the vocal cords sharply reduces the amount of air entering the lungs, up to the complete cessation of its circulation. Chronic edema develops according to the same scenario, but much longer. In this case, the patient has at least 6 to 8 hours to seek medical help.

Anaphylactic shock
Anaphylactic shock or anaphylaxis develops in most cases when a certain amount of the allergen enters the patient's blood. In this case, a highly sensitized organism immediately releases a huge amount of antibodies into the blood. As a result, antibodies attack the allergen, form complexes with it, which are deposited on the inner lining of the vessels and cause local inflammation. Considering the fact that the number of circulating immune complexes is enormous, the inflammatory reaction caused by their deposition is also pronounced. Inflammation is accompanied by the release of substances into the blood, leading to vasodilation ( histamine, serotonin, bradykinin, etc.), and consequently lower blood pressure. Thus, the clinical manifestation of anaphylaxis is a sharp drop in blood pressure with loss of consciousness after the allergen enters the bloodstream.

Gastrointestinal disorders

As mentioned earlier, bromhexine reduces the viscosity of the secretion of all glands of the body, including gastric ones. Mucus on the inner surface of the stomach protects it from the aggressive action of hydrochloric acid contained in gastric juice. When liquefying mucus under the influence of high doses or long-term use of bromhexine, the gastric mucosa is corroded, accompanied by the formation of erosions and even peptic ulcers.

In addition to the above side effect, bromhexine can sometimes lead to irregular stools, an unpleasant taste in the mouth, heartburn, nausea, vomiting, etc.

Central nervous system disorders

Due to the fact that bromhexine is able to penetrate the blood-brain barrier and directly affect the neurons of the brain, its use in certain cases can lead to a number of side effects. The chance of side effects of this drug is increased when an excessive dose is taken, especially for a long time.

The most common side effects from the nervous system are:

severe weakness;
dizziness;
nausea;
paresthesia ( goosebumps);
increase in body temperature ( rarely) and etc.

Other adverse reactions

The side effects included in this subgroup are associated partly with the weak dehydrating effect of bromhexine, partly with its effect on the autonomic nervous system in people with vegetative-vascular dystonia.

Among the side effects of this group are:

excessive sweating;
thirst;
dry mucous membranes;
increased heart rate;
lowering blood pressure, etc.

Overdose

An overdose of bromhexine threatens with the development of severe complications, such as nausea, vomiting, pallor of the skin, severe general weakness, a drop in blood pressure and loss of consciousness. In order to avoid an overdose, the drug should be taken only as prescribed by a doctor at a dose prescribed according to the attached instructions.

In case of intentional or accidental overdose of the drug, an ambulance should be called immediately. Prior to her arrival, the following steps must be taken:

If the patient is conscious, then bring him to the knee-elbow position and induce vomiting by pressing on the root of the tongue. Then make you drink at least 1 liter of water ( better 2 - 2.5 liters) and repeat artificial vomiting. Continue alternately taking water and vomiting until clean vomit appears. After that, you should drink activated charcoal at the rate of 1 tablet per 10 kg of body weight.
If the patient is unconscious, then it is necessary to give him a horizontal position and turn to the side to avoid getting vomit into the respiratory tract. Put a pillow, folded clothes or any impromptu stand under your head and wait for the arrival of a specialized team.

Interaction with other drugs

Bromhexine is not recommended for use with drugs that suppress the cough center. As a result of this interaction, the resulting liquid sputum will not be coughed up and, accordingly, will accumulate in the airways, supporting the inflammatory process.

The combined use of bromhexine and antibiotics, especially penicillin and cephalosporin, has a positive effect, since bromhexine increases the concentration of the latter in the bronchial lumen.

Approximate cost of medication

The cost of bromhexine varies significantly depending on the region of the Russian Federation. The table below shows the average prices for the drug in pharmacies of some major Russian cities. The difference in prices is explained by different manufacturers of the drug and its expiration date ( the more time left before the expiration date, the more expensive the drug).

City	The average cost of the drug
City	Tablets for adults	Tablets for children	Dragee	Solution for oral administration	Syrup
*Moscow*	30 rubles	48 rubles	30 rubles	127 rubles	116 rubles
*Kazan*	42 rubles	42 rubles	98 rubles	71 ruble	120 rubles
*Krasnoyarsk*	28 rubles	28 rubles	75 rubles	75 rubles	98 rubles
*Khabarovsk*	40 rubles	40 rubles	74 rubles	87 rubles	109 rubles
*Samara*	26 rubles	26 rubles	74 rubles	80 rubles	108 rubles
*Stavropol*	45 rubles	45 rubles	74 rubles	78 rubles	96 rubles

Bromhexine is a mucolytic drug with an expectorant effect that reduces the viscosity of sputum, making it thin and easier to cough up.

Release form:

Tablets 8 mg;
Tablets Bromhexine for children 4 mg;
Oral solution 4 mg/5 ml;
Syrup 4 mg/5 ml

It is a prodrug that is converted into ambroxol in the body. Bromhexine enhances the activity of goblet cell lysosomes, which are part of the epithelium of the respiratory tract. This leads to the release of lysosomal enzymes responsible for the hydrolysis of mucoproteins and mucopolysaccharides.

Bromhexine hydrochloride activates the production of surfactant and neutral polysaccharides, and also normalizes mucociliary clearance.

Bromhexine is rapidly absorbed from the gastrointestinal tract and is extensively metabolized during the “first pass” through the liver. Bioavailability is about 20%. In healthy patients, Cmax in plasma is determined after 1 hour.

Indications for use

What helps Bromhexine? According to the instructions, the drug is prescribed in the complex treatment of bronchopulmonary diseases, accompanied by the formation of sputum of increased viscosity:

bronchial asthma;
cystic fibrosis;
pulmonary tuberculosis;
pneumonia;
tracheobronchitis;
obstructive bronchitis;
bronchiectasis;
emphysema;
pneumoconiosis.

Instructions for use Bromhexine, dosage of syrup and tablets

Solution, tablets and syrup are taken orally. The therapeutic effect usually appears on the 4th-6th day of application. The duration of treatment is from 4 to 28 days.

The dosage is determined by age, according to the instructions for use, Bromhexine dosage for children and adults:

children under 2 years - 2 mg \ 3 times a day;
from 2 to 6 years - 4 mg \ 3 times a day;
from 6 to 10 years - 6-8 mg \ 3 times a day;
older than 10 years and adults - 8 mg \ 3 times a day;

If necessary, the dose can be increased: for adults - up to 16 mg 4 times a day, for children - up to 16 mg 2 times a day.

Bromhexine tablets

According to the instructions, children over 10 years old and adults are prescribed 1 tablet 3 to 4 times a day.

Children from 6 to 10 years old are prescribed half a tablet or 1 tablet 3 times a day.

If necessary, the doctor may increase the dosage to 2 tablets / 3 times a day for adults and 2 tablets / 2 times a day for children.

Side effects

The instruction warns of the possibility of developing the following side effects when prescribing Bromhexine:

On the part of the digestive system: dyspeptic phenomena, a transient increase in the activity of hepatic transaminases in the blood serum.
From the side of the central nervous system: headache, dizziness.
Dermatological reactions: increased sweating, skin rash.
From the respiratory system: cough, bronchospasm.

Contraindications

Bromhexine is contraindicated in the following cases:

hypersensitivity to bromhexine and other components of the drug;
peptic ulcer (in the acute stage).

With caution: in case of renal and / or liver failure, bronchial disease, accompanied by excessive accumulation of secretions, history of gastric bleeding.

Syrup and tablets are contraindicated in children under 2 years of age. Children under 6 years of age, in view of the peculiarities of the dosage, it is advisable to take syrup, over 6 years old - syrup and tablets for children.

Use with caution in patients suffering from bronchial asthma.

Bromhexine is not used simultaneously with drugs containing codeine, because. this makes it difficult to cough up loose sputum.

During pregnancy and lactation, Bromhexine is used in cases where the intended benefit to the mother outweighs the potential risk to the fetus or child.

Overdose

Overdose symptoms - nausea, vomiting, diarrhea and other dyspeptic disorders.

If an overdose is detected in the first 60-120 minutes, induce vomiting and gastric lavage. Subsequently, symptomatic treatment is indicated.

Bromhexine analogues, price in pharmacies

If necessary, you can replace Bromhexine with an analogue of the active substance - these are drugs:

Bromhexine Berlin-Chemie;
Bronchothil;
Solvin;
Bromhexine Nycomed;
Flekoksin;
Vero-Bromhexine;
Phlegamine.

ATX code:

Bronchosan,
Bronchostop,
Solvin,
Phlegamine,
Flekoksin.

When choosing analogues, it is important to understand that the instructions for use of Bromhexine, price and reviews, do not apply to drugs of similar action. It is important to consult a doctor and not to make an independent replacement of the drug.

Price in Russian pharmacies: Bromhexine 8 mg 50 tablets - from 17 to 29 rubles, the price of Bromhexine Grindeks syrup 4 mg / 5 ml 100 ml - from 149 to 198 rubles, according to 502 pharmacies.

Store in a dry, dark place at a temperature not exceeding 25 °C. Shelf life - 5 years.

Terms of dispensing from pharmacies - without a prescription.