ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Mucolytic (active metabolite of bromhexine) Pregnancy: Avoid 1st trimester — limited data. 2nd / 3rd trimester: use only if essential.

Ambroxol

Brand names: Mucosolvan, Mucinox

Adult dose

Dose: 30 mg TDS (immediate-release) or 75 mg OD (sustained-release)
Route: Oral
Frequency: Two to three times daily (or once daily SR)
Max: 90 mg/day
Limited UK availability — carbocisteine more commonly used. Take with plenty of fluids to enhance mucolytic effect.

Paediatric dose

Route: Oral
Frequency: BD–TDS
2–5 yrs: 7.5 mg TDS. 6–11 yrs: 15 mg TDS. ≥12 yrs: adult dose. Limited UK paediatric data — refer to country-specific product information.

Clinical pearls

  • Limited UK availability — most British clinicians use carbocisteine 750 mg TDS as first-line oral mucolytic.
  • Possible adjunctive role in COPD exacerbation prevention with chronic bronchitis (Cochrane meta-analysis suggests modest benefit).
  • Emerging interest as a pharmacological chaperone in Gaucher disease type 1 — specialist research-only use.
  • Local anaesthetic effect on mouth/throat at higher doses — useful for sore throat (lozenges available in some markets).
  • Stop immediately if any blistering rash or mucosal lesions develop (SJS/TEN risk).

Contraindications

  • Hypersensitivity to ambroxol or bromhexine
  • Hereditary fructose intolerance (some preparations contain sorbitol)
  • Severe hepatic or renal impairment (caution; reduce dose)
  • 1st trimester of pregnancy

Side effects

  • GI upset: nausea, dyspepsia, vomiting, diarrhoea
  • Dysgeusia, oral hypoaesthesia
  • Rash, urticaria
  • Severe cutaneous reactions (rare — Stevens-Johnson syndrome, TEN — class warning)
  • Bronchospasm (rare)

Interactions

  • Antitussives (codeine, dextromethorphan): may impair clearance of liquefied secretions — avoid combination
  • Antibiotics (amoxicillin, cefuroxime, erythromycin): ambroxol may ↑ tissue levels (theoretical benefit in respiratory infection)

Monitoring

  • Response at 4–6 weeks

Reference: BNFc; BNF 90; SmPC Mucosolvan; EMA PRAC review of ambroxol/bromhexine 2015 (allergic reactions, SJS/TEN); Cochrane Review on mucolytics in COPD. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways