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RESPIRATORY SYSTEM › COUGH AND COLD PREPARATIONS › EXPECTORANTS, EXCL. COMBINATIONS WITH COUGH SUPPRESSANTS › Mucolytics
combinations
R05CB10
Forms & Strengths
- Oral syrup (e.g., 5 mL containing 100 mg ambroxol + 200 mg guaifenesin)
- Effervescent tablets (e.g., 200 mg ambroxol + 400 mg guaifenesin per tablet)
- Granules for oral suspension (e.g., 125 mg ambroxol + 250 mg guaifenesin per sachet)
- Immediate‑release tablets (e.g., 30 mg bromhexine + 200 mg acetylcysteine)
- Dissolvable lozenges (e.g., 10 mg carbocisteine + 100 mg menthol)
Adult Dosing
- Syrup: 10–20 mL 3 times daily (total ambroxol 200–400 mg, guaifenesin 400–800 mg per day).
- Effervescent tablet: 1 tablet 2–3 times daily with water (ambroxol 200 mg, guaifenesin 400 mg per dose).
- Granules: 1–2 sachets dissolved in 100 mL water, 3 times daily (ambroxol 125–250 mg, guaifenesin 250–500 mg per day).
- Immediate‑release tablet: 1 tablet every 8 h (bromhexine 30 mg, acetylcysteine 200 mg).
- Lozenges: up to 6 lozenges per day, spaced at least 2 h apart.
Pediatric Dosing
- Children 2–5 y: syrup 2.5 mL (ambroxol 25 mg + guaifenesin 50 mg) every 8 h.
- Children 6–12 y: syrup 5 mL (ambroxol 50 mg + guaifenesin 100 mg) every 8 h.
- Children >12 y or >40 kg: adult dose can be used.
- Granules: ½ sachet for 2–5 y, 1 sachet for 6–12 y, dissolved in 100 mL water, q8h.
- Avoid lozenges in children <6 y due to choking risk.
Indications
- Acute productive (wet) cough due to common cold, bronchitis, or sinusitis.
- Chronic bronchitis with mucus hypersecretion.
- Mucus‑producing respiratory disorders where expectoration is impaired.
- Adjunct to physiotherapy in cystic fibrosis (off‑label).
Mechanism of Action
- Mucolytic component (e.g., ambroxol, bromhexine, acetylcysteine) reduces disulfide bonds in mucoproteins, decreasing viscosity.
- Expectorant component (e.g., guaifenesin, carbocisteine) increases airway surface liquid, stimulates cough reflex, and promotes mucus clearance.
- Some agents (e.g., ambroxol) enhance ciliary beat frequency and surfactant production.
- Combined action facilitates mobilization and expectoration of sputum.
Contraindications
- Known hypersensitivity to any component of the formulation.
- Severe bronchial asthma with active bronchospasm (risk of bronchoconstriction).
- Peptic ulcer disease (especially with high‑dose guaifenesin).
- Severe hepatic or renal impairment for acetylcysteine‑containing combos.
- Use of MAO inhibitors with certain mucolytics (e.g., bromhexine) is contraindicated.
Adverse Reactions
- Gastro‑intestinal upset: nausea, vomiting, abdominal discomfort.
- Skin reactions: rash, pruritus, urticaria.
- Dizziness or headache (especially with bromhexine).
- Rare bronchospasm or worsening cough in asthmatic patients.
- Taste disturbance or oral irritation (lozenges).
Drug Interactions
- Concurrent antitussives (e.g., codeine, dextromethorphan) may diminish efficacy of expectorants.
- MAO‑inhibitors may potentiate side‑effects of bromhexine (e.g., hypertensive crisis).
- High‑dose acetylcysteine can enhance anticoagulant effect of warfarin.
- Uptake of certain antibiotics (e.g., macrolides) may be reduced by increased mucus clearance.
- Alkalinizing agents (e.g., sodium bicarbonate) can affect absorption of some mucolytics.
Curated Content: Needs Vetting Before Put to Clinical Use