A reappraisal of the mucoactive activity and clinical efficacy of bromhexine

Abstract

Since its introduction to the market in 1963, bromhexine, an over-the-counter drug, has been investigated for its activity in animal models and in humans with diverse respiratory conditions. Bromhexine is a derivate of the Adhatoda vasica plant used in some countries for the treatment of various respiratory diseases. Bromhexine has been found to enhance the secretion of various mucus components by modifying the physicochemical characteristics of mucus. These changes, in turn, increase mucociliary clearance and reduce cough. Principal clinical research studies were primarily developed in an era when stringent methodological approaches and good clinical practices were not developed yet. Clinical studies were conducted mainly in patients with chronic bronchitis and in patients with various respiratory diseases, and demonstrated the efficacy of bromhexine in improving respiratory symptoms. Furthermore, the co-administration of antibiotics with bromhexine amplified the actions of the antibiotic. Although the clinical evidence shows only modest but positive results, bromhexine is indicated for its mucoactive activity. Larger trials with adequate methodology are required to identify when treatment with bromhexine can improve clinical outcomes.

Evaluating the efficacy and safety of bromhexine hydrochloride tablets in treating pediatric COVID-19

“…[ 14 ] Bromhexine can reduce sputum viscosity, promote lung ventilation and expectoration, and remove virus residues. [ 15 ]…”

Ambroxol Hydrochloride Inhibits the Interaction between Severe Acute Respiratory Syndrome Coronavirus 2 Spike Protein’s Receptor Binding Domain and Recombinant Human ACE2

“…Both AMB and BHH have been used in the clinic for treatment of respiratory conditions and are extensively studied, because of their multiple pharmacologic effects and safety profile [20][21][22][23][24] .…”

“…In addition to their impact on lung physiology and function with regards to mucociliary clearance, mucokinetic properties, and stimulation of surfactant production, they have also been shown to elicit anti-inflammatory, antioxidative and anesthetic effects [20][21][22][23][24] Additional studies have reported that both compounds induce cellular autophagic-lysosome pathway [29][30][31] . Reports have also shown the involvement of AMB in modulation of the homeostasis of ions such as sodium, hydrogen, and calcium 33,51 .…”

“…Ambroxol hydrochloride ((AMB) 4-[(2-amino-3,5-dibromophenyl) methylamino]cyclohexan-1-ol; hydrochloride) 19 , belonging to the benzylamine structural class, is a demethylated active metabolite of Bromhexine hydrochloride (BHH) 20 . Both AMB and its progenitor, BHH are widely prescribed drugs used to treat respiratory tract infections and disorders [21][22][23][24] , clinically indicated for their secretolytic activity for treatment of acute and chronic bronchopulmonary diseases associated with abnormal mucus secretion and impaired mucus transport 20,21,24 . Traditionally, AMB and BHH have been available, affordable and used as over the counter drugs, with no significant adverse effects 24,25 .…”

“…Both AMB and its progenitor, BHH are widely prescribed drugs used to treat respiratory tract infections and disorders [21][22][23][24] , clinically indicated for their secretolytic activity for treatment of acute and chronic bronchopulmonary diseases associated with abnormal mucus secretion and impaired mucus transport 20,21,24 . Traditionally, AMB and BHH have been available, affordable and used as over the counter drugs, with no significant adverse effects 24,25 . Furthermore, AMB and BHH have been extensively investigated in translational studies because of their multiple activities including mucociliary clearance activity, mucokinetic properties, stimulation of surfactant production, anti-inflammatory and antioxidative actions, and the local anesthetic effect 22,23,[26][27][28] .…”