How should patients take Ambroxol?😷😷😷

Ambroxol is a very commonly used expectorant in clinical practice. Recently, more and more people pay attention to other pharmacological effects of ambroxol. The following relevant knowledge can help us use ambroxol rationally.

1. Chemical structure of Ambroxol.

Ambroxol is the active product produced by the metabolism of bromhexine. Due to its local anesthetic properties, it is given as a lozenge to soothe sore throats. Ambroxol is broken down by light, so it needs to be stored away from light. Its granule form needs to be dissolved in room temperature water. The injection form of ambroxol will produce free base precipitation of ambroxol due to the increase of the pH value of the solution, so it should not be mixed with an alkaline solution with a pH>6.3.

2. The expectorant effect of ambroxol.

The main components of sputum secreted by humans are a small amount of acidic glycoprotein and a large amount of water. When inflammation occurs in the respiratory tract, there will also be a small amount of residual DNA from damaged inflammatory cells in the sputum. There are disulfide bonds (-S-S-) in the acid glycoprotein molecular structure, so the sputum has a certain viscosity. It is also the main component in white sputum. Ambroxol can reduce the production of acidic mucopolysaccharides in the trachea, bronchial glands and goblet cells to reduce the viscosity of sputum. In addition, it can also promote the movement of cilia on the trachea and increase the expectoration of sputum. Ambroxol is suitable for patients with white and sticky sputum that is not easy to cough up.

3. Common dosage forms and dosages of ambroxol.

Ambroxol is generally administered 2 to 3 times a day. Its half-life is about 10 hours. If ambroxol is in the form of injection, its dosage is about half that of oral administration. Inhaled dosage forms will have smaller doses. 

1. Ambroxol Hydrochloride Tablets: Adults take orally three times a day, 30 to 60 mg each time, after meals.
2. Ambroxol hydrochloride oral solution: 1 to 2 years old, twice a day, 15mg each time. From 2 to 6 years old, three times a day, 15mg each time. 6 to 12 years old, two to three times a day, 30mg each time. Over 12 years old and adults, twice a day, 60mg each time.
3. Ambroxol Hydrochloride Injection: Children under 2 years old twice a day, 7.5mg each time. From 2 to 6 years old, three times a day, 7.5mg each time. 6 to 12 years old, two to three times a day, 15mg each time. Over 12 years old and adults, two to three times a day, 15 to 30mg each time.
4. Ambroxol hydrochloride solution for inhalation: children from 6 months to 2 years old inhale once or twice a day, 7.5mg each time. From 2 to 12 years old, inhale once or twice a day, 15mg each time. Over 12 years old and adults inhale once or twice a day, 15 to 22.5mg each time.

4. What is Neonatal Respiratory Distress Syndrome?

The site of gas exchange in the lungs is the alveoli. Oxygen in the alveoli will diffuse into the blood through the liquid membrane on the inner surface of the alveoli, the epithelial cells of the alveoli, the interstitium between the epithelium of the alveoli and the endothelium of the pulmonary capillaries, the endothelial cells of the capillaries, and then enter the blood. Alveolar epithelial cells are classified into type I and type II. Type II alveolar epithelial cells are inlaid between type I alveolar epithelial cells. It can synthesize and secrete alveolar surfactant. The main component of this surface active substance is phospholipid protein. It reduces the surface tension of the alveoli, preventing the alveoli from collapsing or overinflating. Neonatal respiratory distress syndrome refers to symptoms such as progressive dyspnea and respiratory failure in newborns. Its main cause is a series of symptoms caused by alveolar atrophy due to the lack of alveolar surfactant. Because ambroxol can increase the synthesis and secretion of alveolar surfactant, it has been approved for the treatment of respiratory distress syndrome in premature infants and neonatal infants. The dosage is 30mg/kg as the total daily dosage, divided into 4 doses. It should be administered with a syringe pump and administered intravenously over at least 5 minutes. In addition, when amoxicillin, cefuroxime, erythromycin, doxycycline and other antibiotics are taken together with ambroxol, the concentration of antibiotics in lung tissue can be increased.

5. Off-label use of ambroxol.

Taking large doses of ambroxol has the effects of anti-inflammation, anti-oxidation and scavenging free radicals in the body. It also increases alveolar surfactant. This has a protective and therapeutic effect on lung damage. It is used off-label to prevent postoperative atelectasis in patients with chronic obstructive airway disease. It is used continuously for six days from the third day before the patient's lung surgery to the second day after the operation, with a daily dose of 1000mg. Ambroxol can cause adverse reactions such as nausea, stomach discomfort, and loss of appetite, so it is recommended to take ambroxol oral preparations after meals. Ambroxol may also cause severe skin reactions such as toxic epidermal necrolysis. If patient develops symptoms of progressive rash, discontinue use ambroxol and seek medical attention immediately.