Ambroxol exerts its therapeutic effects through multiple mechanisms:

1. Mucolytic Action:
   • Depolymerizes mucopolysaccharide fibers in bronchial secretions, reducing mucus viscosity (BNF).
   • Stimulates serous fluid production in the respiratory tract, further thinning mucus (Lippincott).
2. Surfactant Synthesis:
   • Enhances surfactant production by type II pneumocytes, improving alveolar function and reducing mucus adhesion (Lange).
3. Anti-Inflammatory Effects:
   • Inhibits pro-inflammatory cytokines (e.g., TNF-α, IL-1β) and neutrophil infiltration, reducing airway inflammation (Lippincott).
4. Antioxidant Activity:
   • Scavenges free radicals, protecting lung tissue from oxidative stress (Lange).

Ambroxol is indicated for:

1. Acute and Chronic Respiratory Conditions:
   • Chronic bronchitis, COPD, bronchiectasis, and asthma with mucus hypersecretion.
   • Post-operative or post-traumatic respiratory complications.
2. Adjunct Therapy:
   • Facilitates sputum production in tuberculosis and pneumonia.
   • Enhances antibiotic penetration into bronchial tissues (e.g., amoxicillin, erythromycin).
3. Off-Label Uses:
   • Management of dry eye syndrome (due to mucin-modulating effects).
   • Investigated for COVID-19 to reduce mucus plugging and inflammation (not yet BNF-approved).

Dosage varies by formulation and patient age. Always follow prescribing guidelines:

Adults:

• Oral: 30–120 mg daily in 2–3 divided doses (BNF).
• Inhalation: 15 mg via nebulizer, twice daily.

Children:

• Oral: 1.2–1.6 mg/kg/day in divided doses (BNF for Children).

Administration Tips:

• Take oral doses with water after meals to minimize gastrointestinal irritation.

For inhalation, use a nebulizer with proper hygiene to avoid contamination

Ambroxol is generally well-tolerated, but potential side effects include:

Common:

• Gastrointestinal: Nausea, vomiting, diarrhea.
• Mild allergic reactions: Rash, urticaria.

Rare but Serious:

• Severe hypersensitivity (anaphylaxis).
• Bronchospasm in asthmatics.
• Gastric ulcer exacerbation (due to increased secretions).

• Contraindications: Hypersensitivity to ambroxol or bromhexine.
• Pregnancy: Use only if benefits outweigh risks (BNF Category: Not formally established; caution advised).
• Breastfeeding: Limited data; avoid unless essential.
• Special Populations:
  • Use cautiously in patients with peptic ulcers or renal/hepatic impairment.
  • Monitor asthmatics for bronchospasm.

• Antitussives (e.g., codeine): Counteract expectorant effects; avoid concurrent use.
• Antibiotics (e.g., amoxicillin): Ambroxol may enhance bronchial tissue penetration.
• Antiulcer Agents: Reduced efficacy due to increased gastric secretions.

Generic Names in Pharmacy

• Ambroxol hydrochloride (active ingredient)
• Common brand names: Mucosolvan®, Ambrolite®, Surbron®