Bromhexine
Mechanism of action:
Bromhexine is a mucolytic that is used to reduce mucous viscosity and aid its expectoration. (AMH, 2004)Contra-indications:
There has been no evidence to show that Bromhexine is contra-indicated in any disease state, or concurrently used any drug.Disease state information:
All evidence indicated that Bromhexine can be used for the treatment of an acute cough of unknown or URTI cause as well as for chronic cough with bronchiectasis, chronic bronchitis or chronic obstructive pulmonary disease (COPD) as an underlying cause.Protocols for the use of Dextromethorphan:
Within the Cochrane Database of Systematic Reviews, Schroeder and Fahey (2004) reviewed the use of OTC medicines for acute cough in children and adults in ambulatory settings. Schroeder and Fahey found that Bromhexine has been included in one adult trial. The first trial was performed by Nesswetha (1967) with n= 99 adults. Each participant was given a dose of Bisolvon linctus (Bromhexine hydrochloride) 4mg three times daily for an average of four days with placebo. Of those patients, 15.2% found that frequent cough (every two to five minutes) was more prevalent in the placebo group as compared to patients on active treatment of 8.6%, thus leading to a relative risk reduction of about 50% for frequent cough. The outcomes in this study were reported based on a four point scale. This trial however, did not report on any adverse effects. Crockett et al. (2004) performed 1 randomised controlled trial to demonstrate the use of mucolytics for bronchiectasis. The dose given was 30mg three times daily, which is higher compared to current medical practice. The results show that high doses of bromhexine with antibiotics improve sputum expectoration and reduction in sputum production however FEV1 remained unchanged throughout the trials. There is therefore, not enough evidence to evaluate the routine use of mucolytic for bronchiectasis. Poole & Black (2004) performed a randomised, double blind, placebo controlled study whereby subjects with chronic bronchitis were given mucolytic agents regularly for a period of at least 2 months. The results show that mucolytic agents are associated with small reduction in exacerbations and reduce the number of days of disability; however the lung function remains unchanged. Comparing mucolytic and placebo treatments, it appears that there is no difference in terms of total number of adverse effects.
