BROXOL SYRUP

Indications

• Chronic obstructive pulmonary disease (COPD)
• Asthma
• Bronchitis
• Respiratory infections with excessive mucus production

Dosage

Children: For children aged 2 to 5 years, the recommended dose is 15 mg to 30 mg daily, divided into two or three doses. For children aged 6 to 12 years, the recommended dose is 30 mg to 60 mg daily, divided into two or three doses.

Adults: The usual adult dose is 30 mg to 120 mg daily, divided into two or three doses.

Mechanism of action

Ambroxol acts by stimulating the secretion of serous mucus in the respiratory tract, which helps to reduce the viscosity of sputum. This mucolytic action enhances the clearance of mucus, facilitating expectoration. It may also influence the production of surfactant in the lungs, contributing to improved lung function.

Pharmacodynamics

Ambroxol exhibits a dose-dependent effect on mucus viscosity and secretion. By enhancing mucociliary clearance, it aids in reducing airway obstruction and improving respiratory function. The onset of action typically occurs within a few hours after administration, with peak effects observed within 1 to 2 days of treatment.

Pharmacokinetics

Ambroxol is well absorbed after oral administration, with a bioavailability of approximately 70%. It is metabolized primarily in the liver through conjugation and oxidation, resulting in active metabolites. The elimination half-life is about 10 hours, and the drug is excreted predominantly via urine, both as unchanged drug and metabolites.

Contra-indications

• Hypersensitivity to ambroxol or any of the excipients
• Severe hepatic impairment
• Severe renal impairment

Adverse effects

• Gastrointestinal disturbances (nausea, vomiting, diarrhea)
• Skin reactions (rash, urticaria)
• Headache
• Dizziness
• Dry mouth
• Anaphylactic reactions (rare)

Interactions

• Ambroxol may enhance the absorption of other drugs due to its mucolytic properties
• Caution should be exercised when used with other cough suppressants

Precautions

• Use with caution in patients with a history of peptic ulcer disease
• Avoid use in patients with asthma unless prescribed by a healthcare professional
• Monitor renal and hepatic function in patients with pre-existing conditions

Pregnancy

Ambroxol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Data on human pregnancy are limited.

Breast-feeding

Ambroxol is excreted in breast milk. Caution is advised when administering to nursing mothers.

Storage

Store in a cool, dry place, away from light. Keep out of reach of children.

Formulations

• Oral solution
• Syrup
• Tablets
• Effervescent tablets

Indications

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Bronchitis
• Respiratory tract infections with productive cough

Dosage

Children: Refer to the BNF for Children for appropriate dosing information.

Adults: Refer to prescribing guidelines for specific dosing recommendations.

Mechanism of action

Guaifenesin works by increasing the volume and reducing the viscosity of secretions in the tracheobronchial passages, thereby promoting the expulsion of mucus. Butaline, on the other hand, is a β2-adrenergic agonist that relaxes bronchial smooth muscle, leading to bronchodilation. This dual action helps to alleviate cough and improve airflow in patients with obstructive airway diseases.

Pharmacodynamics

The pharmacodynamic effects of hydrochloride guaifenesin butaline involve a combination of enhanced mucus clearance due to guaifenesin and bronchodilation from butaline. The bronchodilatory effect is characterized by a rapid onset of action, typically within minutes, and can last for several hours, improving respiratory function and reducing symptoms of bronchoconstriction.

Pharmacokinetics

Guaifenesin is rapidly absorbed from the gastrointestinal tract, reaching peak plasma concentrations within 1 to 2 hours. It is metabolized in the liver and excreted in the urine. Butaline also has a rapid onset of action and is primarily eliminated through hepatic metabolism. The half-life of butaline is approximately 2 to 6 hours, depending on individual factors. Both drugs have a wide distribution in body tissues.

Contra-indications

• Hypersensitivity to guaifenesin, hydrochloride, or terbutaline
• Severe asthma exacerbation
• Cardiac arrhythmias
• Hyperthyroidism

Adverse effects

• Tachycardia
• Nervousness
• Dizziness
• Nausea
• Headache
• Tremors
• Insomnia

Interactions

• Beta-blockers may reduce the effectiveness of terbutaline
• Caution with monoamine oxidase inhibitors (MAOIs) due to potential hypertensive crisis
• Other sympathomimetics may enhance cardiovascular effects

Precautions

• Use with caution in patients with cardiovascular disorders
• Caution in patients with diabetes mellitus
• Assess for potential drug interactions
• Monitor for worsening of respiratory condition

Pregnancy

Use only if clearly needed. Terbutaline is classified as Category C, where potential benefits might outweigh risks.

Breast-feeding

Use with caution. Guaifenesin and terbutaline are excreted in breast milk; assess risk versus benefit.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Oral tablets containing guaifenesin and terbutaline
• Syrup formulations with guaifenesin and terbutaline
• Inhalation solutions (for terbutaline)

Indications

• Muscle strains
• Sprains
• Arthritis
• Minor aches and pains

Dosage

Children: Refer to specific product instructions, as formulations may vary.

Adults: Refer to specific product instructions, as formulations may vary.

Mechanism of action

Sulphatementhol acts by activating TRPM8 receptors, which are responsible for the sensation of coolness. This activation leads to the opening of cation channels, resulting in depolarization of sensory neurons and the perception of a cooling effect. Additionally, it may inhibit the synthesis of pro-inflammatory mediators, contributing to its analgesic effect.

Pharmacodynamics

The pharmacodynamic profile of sulphatementhol includes anti-inflammatory and analgesic properties, making it effective for topical pain relief. Its ability to induce a cooling sensation can distract from pain, while its potential effects on inflammatory pathways help reduce swelling and discomfort in affected areas.

Pharmacokinetics

Sulphatementhol is generally applied topically, where it is absorbed through the skin. The systemic absorption is minimal, leading to localized effects with a reduced risk of systemic side effects. The onset of action is typically rapid due to its direct application to the site of pain, and the duration of effect can vary depending on the formulation and specific concentration used.

Pregnancy

There is limited data on the use of sulphatementhol during pregnancy. Caution is advised and it should only be used if the potential benefits outweigh the risks.

Breast-feeding

It is not known whether sulphatementhol is excreted in human milk. Caution is advised when administering to nursing mothers.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.