Bromhexine hydrochloride is a well-established mucolytic agent indicated for the symptomatic treatment of productive cough and respiratory conditions characterized by viscous mucus. As a derivative of the vasicine alkaloid, it works by depolymerizing mucopolysaccharide fibers, reducing sputum viscosity, and facilitating expectoration. This mechanism enhances airway clearance, improves breathing comfort, and supports recovery in acute and chronic bronchopulmonary disorders. Clinically valued for its efficacy and favorable safety profile, bromhexine remains a cornerstone in respiratory therapy protocols worldwide.

Features

• Active ingredient: Bromhexine hydrochloride
• Available in 8 mg tablets, oral solution, and syrup formulations
• Mechanism: Depolymerizes acid mucopolysaccharides in bronchial secretions
• Onset of action: Noticeable within 2–3 days of initiation
• Half-life: Approximately 6–12 hours
• Metabolism: Hepatic, via cytochrome P450 enzymes
• Excretion: Primarily renal

Benefits

• Reduces sputum viscosity, enabling easier expectoration and less strained coughing
• Improves mucociliary clearance, enhancing the natural defense mechanisms of the respiratory tract
• Alleviates chest congestion and shortness of breath associated with excessive mucus
• Supports faster resolution of symptoms in acute bronchitis, COPD exacerbations, and bronchiectasis
• May reduce the frequency and severity of respiratory infections by improving airway hygiene
• Compatible with a range of adjunct therapies including bronchodilators and antibiotics

Common use

Bromhexine is commonly prescribed for respiratory conditions where thick, tenacious mucus impedes airway function. Typical indications include acute and chronic bronchitis, bronchial asthma, emphysema, cystic fibrosis, and bronchiectasis. It is also used pre- and post-operatively to prevent pulmonary complications and in conditions such as sinusitis or otitis media with effusion where mucus clearance is beneficial. Off-label uses sometimes include adjunctive therapy in COVID-19 and other viral respiratory infections to manage mucus-related symptoms.

Dosage and direction

Adults and adolescents over 14 years:
8 mg (one tablet or equivalent liquid dose) three times daily. In severe cases, dosage may be increased to 16 mg three times daily under medical supervision.

Children 6–14 years:
4 mg three times daily. Liquid formulations are preferred for accurate dosing.

Children under 6 years:
Dosing should be individualized based on weight and clinical need; typically 2 mg two to three times daily. Use only under pediatric guidance.

Administration after meals may reduce gastrointestinal discomfort. Tablets should be swallowed whole with water; oral solution should be measured using the provided dosing syringe or cup. Treatment duration depends on clinical response but usually continues until productive cough resolves.

Precautions

• Use with caution in patients with a history of gastric ulceration, as bromhexine may cause gastrointestinal irritation.
• Hepatic or renal impairment requires dosage adjustment and closer monitoring.
• Not recommended during the first trimester of pregnancy unless clearly needed.
• Avoid in patients with known hypersensitivity to bromhexine or related compounds.
• Patients should maintain adequate hydration to support mucolytic action.
• Monitor for signs of bronchospasm in asthmatic individuals, though this is rare.

Contraindications

• Hypersensitivity to bromhexine hydrochloride or any excipients in the formulation.
• Severe hepatic failure or acute renal impairment where drug accumulation is likely.
• Peptic ulcer disease in active phase.
• Not recommended for use in children under 2 years of age due to limited safety data.

Possible side effect

Most side effects are mild and transient. Common adverse reactions include:

• Gastrointestinal disturbances: nausea, vomiting, diarrhea, epigastric pain
• Dizziness or headache
• Mild skin reactions such as rash or urticaria
• Increased sweating
• Rarely, transient elevations in liver enzymes

Serious side effects are uncommon but may include severe allergic reactions (angioedema, anaphylaxis) or bronchospasm. Discontinue use and seek medical attention if severe reactions occur.

Drug interaction

• Bromhexine may enhance the penetration of antibiotics (e.g., amoxicillin, erythromycin) into bronchial secretions, potentially increasing their efficacy.
• No clinically significant interactions with bronchodilators, corticosteroids, or antihypertensives have been reported.
• Concurrent use with antitussives that suppress cough reflex is not recommended, as this may hinder mucus clearance.
• Theoretical potential for interaction with CYP2D6 substrates, though clinical significance is low.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. Resume the regular dosing schedule. Consistent dosing supports steady mucolytic activity.

Overdose

Symptoms of overdose may include nausea, vomiting, and gastrointestinal distress. There is no specific antidote. Treatment is supportive and symptomatic. Gastric lavage or activated charcoal may be considered if ingestion was recent. Maintain hydration and monitor vital signs. Contact a poison control center or healthcare provider immediately.

Storage

Store at room temperature (15–30°C), protected from light and moisture. Keep the container tightly closed. Do not freeze liquid formulations. Keep out of reach of children. Discard any unused medication after the expiration date.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice. Always consult a healthcare provider for diagnosis, treatment decisions, and personalized dosage recommendations. Individual response to bromhexine may vary based on clinical condition, comorbidities, and concomitant medications.

Reviews

Bromhexine has been extensively studied and widely used since the 1960s. Clinical trials and meta-analyses support its efficacy in reducing sputum viscosity and improving symptoms in obstructive airway diseases. Patient reports frequently highlight improved ease of expectoration and reduced coughing effort. Healthcare professionals value its reliability and low interaction potential. Long-term use data confirm its safety in chronic respiratory conditions.