Expectorants

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3.4.2. Expectorants

Normally, about 100 ml of secretion is produced in the respiratory tract per day, most of which is swallowed. In diseases of the respiratory system, the activity of the cells lining the respiratory tract - the ciliated epithelium - decreases, and the secretion of sputum, on the contrary, increases and its viscosity increases.

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Thin mucus becomes more difficult to cough up. In addition, despite the independent protective effect of sputum, its excess amount or increased viscosity complicates gas exchange and creates conditions for the proliferation of pathogenic microorganisms. That is why, in case of inflammation of the respiratory tract, even with a productive cough, and even more so with difficulty coughing, it is necessary to use substances that stimulate expectoration or dilute sputum. These drugs restore and improve the movement of mucus through the ciliated epithelium and accelerate its elimination.

Based on their mechanism of action, there are two groups of expectorants:

1) stimulating expectoration (secretomotor agents);

2) sputum thinners (secretolytic or mucolytic agents).

Medicines that stimulate expectoration (drugs of coltsfoot, violet, licorice, oregano, elecampane, thermopsis, istoda, marshmallow and other medicinal plants, terpene hydrate, lycorine, essential oils) help move mucus through the respiratory tract. They have a slight irritating effect on the cells of the gastric mucosa, which reflexively (through the vomiting center of the medulla oblongata) increases the activity of the bronchial glands and enhances contractions of the bronchial muscles. The sputum becomes more abundant, thinner and easier to cough up.

Coltsfoot is one of the most ancient medicinal plants. It is part of the chest and sweatshop collections of almost all countries of the world. Its medicinal value is emphasized by the Latin name “tussilago”, from the word “tussis” - cough. This is a plant with large basal leaves, which on the one hand are glossy and cold (this feeling is compared to a stepmother), and on the other - tender, soft, warm (like the hands of a mother).

Many legends are associated with the flowers of the tricolor violet, which is also called pansies. In the Christian world, this flower is called the flower of the Holy Trinity. Medieval Christians saw an all-seeing eye in the triangular dark center of the flower, and radiance in the stains surrounding it. The triangle personified the faces of the Holy Trinity, originating from the all-seeing eye of God the Father. In England, these violets are called “heart comfort” and are sent to lovers on Valentine's Day.

Licorice ranks first in terms of medicinal qualities among other medicinal plants (by the way, ginseng is in fifteenth place in this classification). It was and is especially valued in China. In Tibetan medicine, licorice is included in 98% of all herbs. The Greeks bought licorice from the Scythians and it was called “Scythian root”.

Properties: its heat is low and sweet and moist

It will help the throat of those who have a cough

suffers and heals

Chest and depths of the lungs, warming, healing

He heals his thirst and everything in such a way that

harms the stomach, expels.

If mixed with water, then

Drinking the decoction helps.

Chest ailments and breathing so

Any organs that serve breathing,

About oregano, Avicenna wrote: “Oregano removes all kinds of fluids from the chest and lungs.” And he recommended elecampane in the form of a “medicine for licking with honey” to improve expectoration. In Rus', elecampane was called nine-strong, implying that it could cure nine serious ailments.

Eat - the cough stops, and also

Sodium iodide and potassium iodide, ammonium chloride and some other drugs (after taking them orally) also stimulate the activity of the bronchi and partially thin the sputum. They exert their effect after absorption in the stomach and release into the mucous membrane of the respiratory tract.

The second group of expectorants consists of drugs that directly thin sputum. They are also called mucolytics (from the Latin mucos - mucus and the Greek lysis - dissolution). They help when the sputum is viscous, mucous or mucopurulent, for example in acute and chronic obstructive bronchitis , pneumonia , bronchiectasis , bronchiolitis , cystic fibrosis , bronchial asthma , atelectasis when the bronchi are blocked by sputum, patients with tracheostomy, and so on. They are often prescribed to prevent complications during operations on the respiratory organs, as well as after anesthesia administered through the trachea. Sputum thinners include enzymes (trypsin, chymotrypsin, ribonuclease), sulfur-containing compounds (acetylcysteine, carbocysteine), derivatives of the alkaloid vizicine (bromhexine, ambroxol). The most widely used products are those containing sulfur and vizicin derivatives.

Preparations of sulfur-containing substances are especially effective for bronchitis and other diseases accompanied by difficulty coughing. As a result of various chemical transformations, they destroy the protein-like polymers that make up sputum. This process can be represented as follows: long “chains”, which are, as it were, cut with “scissors”, for example acetylcysteine, into shorter components. At the same time, the viscosity of sputum decreases, and it is more easily removed from the bronchi. Such drugs can also thin the pus.

Visicin, obtained from the plant Adhatoda vasica , has long been used in the East as an expectorant. Its synthetic analogues - bromhexine and ambroxol - reduce the viscosity of sputum, providing an expectorant effect. This is due to the mechanism of action based on the “scissors” principle (see above), as well as with the activation of the synthesis of pulmonary surfactant - a substance that covers the inside of the alveoli and prevents their collapse, which, in addition, promotes the passage of sputum and its removal. As a result of this, the viscous and sticky bronchial secretion is liquefied, facilitating its movement through the respiratory tract. A distinctive feature of bromhexine and ambroxol is their independent antitussive effect, which is especially important for bronchitis.

The group of expectorant drugs also includes a large number of combined drugs with different mechanisms of action.

Since expectorants eliminate only one symptom of respiratory disease - cough with difficulty in sputum - they are usually used in combination with other drugs (antibacterial and antiviral, antipyretic, decongestant, immunostimulants, vitamins and others).

When combining, it is important to consider the compatibility and interaction of drugs in the body.

Carbocisteine, bromhexine, ambroxol enhance the penetration of antimicrobial agents into sputum and the bronchial mucosa. First of all, this applies to amoxicillin, cefuroxime, erythromycin, doxycycline, sulfonamides (see chapter 3.11). Therefore, for inflammatory diseases of the respiratory tract, carbocysteine, bromhexine, ambroxol are often used in combination with the listed antimicrobial agents that eliminate the main cause of the disease - microbes, and expectorants help remove sputum, which, in addition to dead microbes, contains secretions released during inflammation. Carbocysteine, in addition, prevents the thickening of sputum after taking antibiotics.

Acetylcysteine ​​reduces the absorption of antibiotics, so they should not be mixed during inhalation. If acetylcysteine ​​is prescribed orally, antibiotics (penicillins, cephalosporins, tetracyclines) should be taken no earlier than 2 hours after taking acetylcysteine.

In patients with chronic obstructive bronchitis (bronchitis accompanied by bronchospasm), a good effect is observed when combining drugs that dilate the bronchi with phlegm thinners. Many well-known substances that we mentioned earlier in Chapter 3.2 are used as bronchodilators For example, drugs that stimulate adrenergic receptors , such as fenoterol, salbutamol and others, have a bronchodilator effect. In addition, they have an anti-edematous effect. m-Anticholinergic blockers (ipratropium bromide) relax the smooth muscles of the bronchi and eliminate bronchospasm. The antispasmodic has the same effect . All of these medications reduce the amount of mucus secreted by the ciliated epithelium of the bronchi, reduce inflammation and swelling of the mucous membrane, and facilitate the separation of sputum.

Drugs belonging to the group of expectorants are listed below. More complete information on them can be found on the website www.rlsnet.ru.

Ambrohexal (ambroxol) mucolytic, expectorant, increasing the production of surfactant, solution for oral administration and d/inhalation; syrup; table Hexal AG (Germany)

Ambrosan (ambroxol) expectorant, mucolytic, secretomotor, antitussive tablet. PRO.MED.CS Praha as (Czech Republic)

Anise oil Doctor Theiss (anise oil) expectorant, anti-inflammatory, antimicrobial caps. Dr. Theiss Naturwaren (Germany)

ACC (acetylcysteine), mucolytic, expectorant , gran. solution for oral administration Hexal AG (Germany)

Bromhexine 8-drops (bromhexine) mucolytic, expectorant, antitussive drops for oral administration Krewel Meuselbach (Germany)

Bromhexine-Ferein (bromhexine) mucolytic, expectorant, antitussive syrup Bryntsalov-A (Russia)

Bromhexine-Egis (bromhexine) mucolytic, expectorant, antitussive solution d/in.; solution for oral administration; table Egis (Hungary)

Bronchosan (bromhexine) mucolytic, expectorant, antitussive drops for oral administration and d/inhalation. Slovakofarma (Slovakia)

Vero-bromhexine (bromhexine) mucolytic, expectorant, antitussive tablet. Veropharm (Russia), manufactured by: Veropharm (Belgorod branch) (Russia)

Gedelix (herbal product) expectorant, mucolytic, antispasmodic drops for oral administration; syrup Krewel Meuselbach (Germany)

Gelomirtol (herbal product) secretolytic, secretomotor, mucolytic caps. solution/intestinal. Pohl-Boskamp (Germany)

Gelomirtol forte (herbal product) secretolytic, secretomotor, mucolytic caps. solution/intestinal. Pohl-Boskamp (Germany)

Doctor IOM (herbal product) local irritant, distracting, anti-inflammatory, expectorant syrup Unique (India)

Doctor IOM herbal cough lozenges (herbal product) locally irritating, distracting, anti-inflammatory, expectorant lozenges Unique (India)

Dr. Theiss cough syrup with plantain (herbal remedy), expectorant, antimicrobial syrup Dr. Theiss Naturwaren (Germany)

Codelac (herbal product) antitussive, expectorant table. ICN Pharmaceuticals (USA), manufactured by: ICN Tomskhimpharm (Russia)

Lazolvan (ambroxol) mucolytic, expectorant, increasing the production of surfactant solution for oral and inhalation; syrup; table Boehringer Ingelheim Pharma (Austria)

Mucodin (carbocysteine) mucolytic, expectorant capsule; syrup; syrup for children Zorka Pharma ad (Yugoslavia)

Sinupret (herbal product) expectorant, secretolytic, anti-inflammatory, antiviral pill; drops for oral administration Bionorica (Germany)

Terpincode (codeine + sodium bicarbonate + terpinhydrate) antitussive, expectorant table. ICN Pharmaceuticals (USA), manufactured by: ICN Tomskhimpharm (Russia)

Tussamag (thyme extract) expectorant, bronchodilator drops for oral administration; ratiopharm syrup (Germany), produced by: Merckle (Germany)

Tussin (guaifenesin) mucolytic, expectorant syrup Sagmel, Inc. (USA)

Fluifort (carbocysteine ​​lysine salt) mucolytic, expectorant, gran.dose; syrup Pharma Riace (Italy), produced by: Dompe Farmaceutici (Italy)

Fluditec (carbocysteine) expectorant, mucolytic syrup; syrup for children Laboratoire Innotech International (France)

Halixol (ambroxol) expectorant, mucolytic, increases the production of surfactant syrup; table Egis (Hungary)

Eucabal balm C (herbal product) expectorant emulsion d/inhalation; emuls.external Esparma (Germany)

Eucabal cough syrup (herbal remedy) expectorant, mucolytic, anti-inflammatory syrup Esparma (Germany)

Eucalyptus Dr. Theiss (camphor + pine needles oil + eucalyptus oil) anti-inflammatory, local irritant, expectorant, antiseptic ointment Dr. Theiss Naturwaren (Germany)

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Expectorants - which drug to choose?

Cough is a symptom familiar to every person. We first encounter it in early childhood, cough often and thickly in kindergartens and continue to do this in elementary school. We drink a lot of tasty and not very expectorants in syrups, tablets and drops. Gradually the cough goes away, only to remind itself again after a while. Do we know why we cough? Do we know how to treat a cough correctly? And on what basis do we choose expectorants?

Before you continue reading: If you are looking for an effective method of getting rid of a runny nose, pharyngitis, tonsillitis, bronchitis or colds, then be sure to look at this section of the site after reading this article. This information has helped so many people, we hope it will help you too! So, now back to the article.

The modern pharmaceutical market sometimes amazes us with the variety of cough medications. A completely confused person can spend a long time looking at shop windows filled with expectorant variety. And take the first package you come across to finally dispel the pharmacy obsession.

Let's try to put all the expectorants on their shelves and clearly understand when, how much, and, most importantly, what exactly should be taken for a cough.

Main causes of cough

But before we do therapy, we need to understand why we cough. After all, sometimes a symptom requires medical intervention and urgent measures, and self-medication is dangerous.

So, coughing is a completely normal, physiological process that helps clear our airways of excessive secretions, foreign particles and, of course, germs. Frequent cough is almost always a symptom of the disease. It is completely wrong to believe that a cough is necessarily a cold. Reasons for such symptoms include:

Of course, in most cases, cough is the result of respiratory infections: ARVI, influenza, pneumonia, whooping cough, tuberculosis. Typically, an acute cough lasting less than three weeks is caused by a common cold;

  • reactive respiratory diseases.

    Such pathologies include bronchial asthma, chronic obstructive pulmonary disease and chronic bronchitis, including smoker’s bronchitis;

  • gastroesophageal reflux.

    The backflow of hydrochloric acid into the esophagus is most often the cause of a cough of unknown origin;

  • contaminated air;
  • foreign body;
  • taking antihypertensive drugs that block ACE (Enalapril, Ramipril and others);
  • psychogenic factor;
  • other factors, including tumors and severe respiratory disease.

    • Self-medication of cough: be careful!

    You can treat a cough yourself by taking expectorants only in cases of infectious diseases. However, one cannot lose vigilance even with a seemingly innocent cough that accompanies ARVI.

    Sometimes dangerous symptoms noticed in time save a life, so don’t relax and monitor your condition. Let's list the manifestations that require contacting a specialist.

    If, against the background of a “cold” cough, a sharp deterioration occurs - a severe fever begins, weakness, sweating, purulent thick sputum appear - call a doctor immediately!

    If your cough has been bothering you for more than three weeks, immediately go to your local physician!

    If streaks of blood appear in your cough, you need to immediately consult a pulmonologist!

    We will return to cough, which can be treated on our own, and will deal with a detailed description of expectorants.

    Why are expectorants needed?

    If we say that coughing is a physiological reflex, then why are expectorants needed? Let's figure it out.

    In a healthy person, the glands of the trachea and bronchi produce tracheobronchial secretion. It helps our respiratory tract cope with bacteria and viruses, and is also involved in the removal of small particles coming from the air. We don’t even notice how we swallow about 100 ml of this mucus per day.

    If an infection has entered the body, the volume of tracheobronchial secretion can increase to 1.5 liters per day. Such sputum is an excellent substrate for the further prosperity of pathogenic microorganisms. The body tries with all its might to get rid of the pathological secretion, and a cough begins.

    However, thick, difficult-to-clear mucus does not want to leave the respiratory tract. Liquefying viscous secretions is the main function of expectorants used to treat wet coughs.

    Expectorants and antitussives: what is the difference?

    If expectorants primarily help to dilute mucus and facilitate its removal, then antitussives act exactly the opposite. Most antitussives have a central effect and block the cough reflex. Antitussive drugs are prescribed only for dry, so-called “barking” cough, the main symptom of which is the complete absence of bronchial secretions.

    Therefore, when treating a cough, it is important not to confuse the cards and not take medications for dry and wet coughs at the same time. Remember that expectorants based on ambroxol, carbocysteine ​​and acetylcysteine ​​should absolutely not be combined with centrally acting antitussives.

    Classification of expectorants

    There is no clear classification of expectorant drugs. Nevertheless, in pharmaceutical practice it is customary to distinguish:

    • drugs that have an irritating effect: products based on medicinal plants;
    • carriers of sulfhydryl groups: acetylcysteine, carbocysteine;
    • vasicine derivatives: bromhexine, ambroxol;
    • combined expectorants.

    Expectorants: pharmacological action

    Drugs that stimulate expectoration have many names. Secretolytics, expectorants, expectorants - all these terms combine the same drugs. The mechanism of action of expectorants may be different.

    Irritant medications

    Thus, some drugs promote irritation of receptors in the gastric mucosa, resulting in reflex stimulation of the bronchial glands and increased production of bronchial secretions. The sputum is liquefied and gradually eliminated. Expectorant irritants include most medicinal herbs: marshmallow root, thermopsis herb, terpin hydrate, essential oils.

    Drugs that directly affect bronchial receptors

    Another mechanism of action of expectorants is based on a direct effect on the bronchial mucosa and subsequent stimulation of sputum production. These drugs include potassium iodide and ammonium chloride.

    Drugs with sulfhydryl groups

    Sulfhydryl groups are capable of oxidizing and breaking disulfide bonds of mucopolysaccharides in bronchial secretions. Thanks to this, the sputum becomes less viscous, and the pus thins out.

    The alkaloid vasicine, which is obtained from the leaves of the Adhatoda vasica plant, has long been used as an effective expectorant. Scientists were able to synthesize a synthetic analogue of vasicin - bromhexine, which, upon breakdown, turns into ambroxol.

    Ambroxol promotes the destruction of mucopolysaccharides and mucoproteins that make up sputum. In addition, vasicin preparations stimulate the production of bronchial secretions and increase the motor activity of the ciliated epithelium, which lines the walls of the respiratory tract. Separately, I would like to emphasize the anti-inflammatory and local anesthetic effect of ambroxol.

    Vasicin preparations act at various stages of the pathological process and are among the most popular and effective means for separating sputum, used for wet coughs.

    Now, knowing how different expectorants work, we can move on to describing specific drugs.

    Treating coughs with the power of plants

    Herbal expectorants are highly safe and well tolerated, and reviews of people who prefer natural medicines fully confirm this. The pharmaceutical industry produces many drugs in this group.

    Ivy-based medicines

    Saponins, which ivy is rich in, have a pronounced expectorant, antispasmodic and mucolytic effect, and some ivy-based products are approved for use by newborns and infants. Additionally, pregnant and breastfeeding women can take these medications after consulting with their doctor.

    Ivy preparations are also distinguished by their versatility: they can be used for both wet and dry coughs.

    Gedelix, Prospan and Gerbion ivy syrup are registered in Russia.

    Expectorants containing plantain are also very popular and are effective against all types of cough. Most of them can be used during pregnancy and lactation.

    These drugs include Dr. Theis syrup with plantain, as well as combined products Eucabal (plantain and thyme extract), Herbion plantain syrup (plantain and mallow extract, vitamin C) and others.

    Thyme-based products

    Common thyme herb extract has antimicrobial activity, as well as expectorant, mucolytic and antitussive effects. Preparations containing thyme extract are used for wet and dry coughs of various etiologies, including smoker’s cough.

    Among the expectorants with thyme are Bronchicum lozenges, Bronchicum C, approved during pregnancy and lactation, as well as Dr. Theis Bronchosept drops, Tussamag.

    An herbal preparation produced by the German company Bionorica, Bronchipret contains a combination of ivy and thyme extract. Bronchipret is widely prescribed for tracheitis, laryngitis, bronchitis and other respiratory diseases. In pediatrics, Bronchipret drops are used from three months of life.

    Another product from Bionorica, Bronchipret TP tablets contain extracts of thyme and primrose. The indications for this form are identical to the drops, but the tablets should not be given to children under 12 years of age.

    The Slovak preparation Herbion primrose syrup also contains a combination of primrose and thyme. This remedy is prescribed for all types of cough for children from two years of age and adults.

    Expectorant medicines based on thyme also include Pertussin, familiar to many from childhood - a stunningly aromatic cough syrup, which, in addition to the main component, contains potassium bromide.

    The recipe for drugs based on the rhizome and roots of marshmallow was developed by Soviet pharmacists. Since then, products with marshmallow extract have been the favorite Russian expectorant medicines, combining effectiveness and efficiency.

    The Russian pharmaceutical industry produces Mucaltin and marshmallow syrup. Let us add that Mucaltin can be used by dissolving it in a third of a glass of warm boiled water.

    These means are also more traditional for the domestic industry. We have long been accustomed to cheap cough tablets containing thermopsis herb and sodium bicarbonate, which additionally thins phlegm. The Russian company Pharmstandard also produces another similar drug called Thermopsol.

    Expectorant herbal remedies in combination

    Pharmaceutical manufacturers produce combination medications containing herbal ingredients in various variations. Their effectiveness is approximately the same, and their safety allows them to be used in pediatric practice. We list the most famous drugs in this group:

    • Stoptussin-Fito (extracts of thyme, thyme, plantain);
    • Cough syrup with plantain and coltsfoot (contains extracts of plantain and coltsfoot herb, as well as mint and eucalyptus oils);
    • Dry cough syrup (extracts of marshmallow roots, licorice, anise oil, ammonium chloride, sodium bicarbonate and benzoate);
    • Amtersol (ammonium chloride salts, potassium bromide and sodium benzoate, licorice root extract, thermopsis herb).

    Other expectorant herbal remedies

    You can’t ignore the good old medicines that our mothers and grandmothers used to treat us.

    Pectusin, which contains eucalyptus leaf oil and racementol, has an antiseptic, mild anesthetic and expectorant effect.

    Breast elixir (anise seed oil, licorice extract and ammonia solution) is a classic expectorant. The standard dosage for both adults and children over two years of age is 20–40 drops three times a day.

    Licorice syrup containing licorice root extract, take 1 tablespoon 3-4 times a day.

    Medicinal plant materials as an expectorant

    Infusions and decoctions of medicinal herbs and mixtures, which we can prepare ourselves, provide excellent results. Medicinal plants that have long been famous for their expectorant effect include marshmallow and licorice roots, plantain and coltsfoot leaves, thyme and thyme herbs.

    Domestic pharmaceutical factories also produce several types of ready-made breast preparations:

    • collection No. 1 - coltsfoot leaves and oregano herb;
    • collection No. 2 - leaves of plantain and coltsfoot, licorice roots;
    • collection No. 3 - marshmallow rhizomes, pine buds, anise fruits, sage herb;
    • collection No. 4 - shoots of wild rosemary, licorice, chamomile flowers, calendula, violets;
    • expectorant collection - wild rosemary shoots, rhizomes with elecampane roots, calendula and chamomile flowers, coltsfoot and plantain leaves, licorice roots.
    • phytopectol No. 1 (chest collection No. 1) - marshmallow roots, oregano herb and coltsfoot leaves;
    • phytopectol No. 2 (breast collection No. 2) - leaves of coltsfoot, plantain, licorice roots.

    Let us add that decoctions are made from roots and rhizomes, and infusions are made from herbs, leaves and flowers. According to medicine technology, decoctions should be prepared in a water bath for about 30–40 minutes, then left for 10 minutes and filtered. To prepare infusions, 15–20 minutes of water bath and 45 minutes of infusion are enough, after which they can also be filtered and drunk.

    Guaifenesin preparations

    Guaifenesin-based expectorants have been used in medicine for quite some time. This active substance is of plant origin - it is extracted from the bark of the guaiac tree, which grows in South and Central America.

    Guaifenesin has two main effects: a sedative and an expectorant. Guaifenesin preparations stimulate secretory cells of the bronchial mucosa and also destroy acidic mucopolysaccharides in sputum. Expectorants containing guaifenesin are prescribed to treat cough in children over two years of age.

    Guaifenesin medications include Coldrex Broncho and Tussin. In addition, pharmaceutical companies produce a large range of complex expectorant medications containing guaifenesin. These include Ascoril expectorant and Cashnol, Joset, Stoptussin.

    Favorite expectorants: ambroxol preparations

    Some of the most famous and effective cough medicines contain ambroxol. It went on sale back in 1978, and immediately took a special place among expectorants.

    Dozens of names of drugs containing this active substance are registered on the Russian pharmaceutical market. Many dosage forms of ambroxol are equally popular among patients. Manufacturers produce tablets and syrups, drops and injections, lozenges and solutions for inhalation.

    Unlike expectorants of other groups, ambroxol significantly relieves acute sore throat. Therefore, in addition to the dosage forms traditional for cough medications, ambroxol is also available in the form of lozenges for resorption. The dosage of the active substance in such preparations is usually 20 mg. Ambroxol lozenges can quickly relieve severe sore throats, and the effect lasts for at least three hours. In addition, the medicine relieves inflammation and reduces redness and hyperemia of the mucous membrane.

    Ambroxol: indications and contraindications

    The drug is prescribed for all diseases of the respiratory tract, which are accompanied by the appearance of difficult, viscous sputum. Acute and chronic bronchitis, pneumonia (pneumonia), bronchial asthma of various etiologies, chronic obstructive pulmonary disease (COPD) is an incomplete list of pathologies for which ambroxol can be used. Injectable forms of ambroxol are also prescribed for respiratory distress syndrome, which develops in newborns, and more often in premature infants, and is characterized by hypoxia and respiratory depression.

    Ambroxol is contraindicated for:

    • individual intolerance;
    • peptic ulcer of the stomach and/or duodenum;
    • convulsive syndrome.

    You should be especially careful when prescribing ambroxol to infants who have not yet learned to cough up sputum. A sharp dilution of bronchial secretions in infants can contribute to the occurrence of bronchial congestion.

    Pregnancy and lactation

    In the first trimester of pregnancy, expectorants containing ambroxol are strictly prohibited. At later stages, the medicine can be used if the benefit to the mother is much higher than the risk to the child. However, practice shows that in most cases, safer expectorants can be selected for pregnant and lactating women.

    Ambroxol dosage

    The average adult dosage of oral, that is, internal, ambroxol preparations is 30 mg three times a day. Children are prescribed 7.5–15 mg two or three times a day.

    The dosage of drops for inhalation usually ranges from 15 to 22 mg 2-3 times a day. The dose of the injection solution is the same 15 mg intramuscularly or intravenously, and in severe cases it can be increased to 30 mg 2-3 times a day. The pediatric dose is calculated based on the child’s weight: 1.2–1.6 mg per kilogram of weight three times a day.

    The course of treatment can last several weeks. However, if a week after starting treatment the cough has not decreased, you should definitely consult a doctor.

    Tolerability of ambroxol

    Ambroxol preparations are well tolerated and cause virtually no side effects. Allergic reactions, nausea, abdominal pain, or headache may occur in 0.1% to 1% of patients taking expectorants with ambroxol.

    Experts warn that ambroxol should not be prescribed simultaneously with antitussives, in particular codeine, pseudoephedrine and others.

    Ambroxol preparations in the Russian Federation

    Ambroxol-based expectorants registered in Russia include:

    • Ambrobene produced by the Israeli company Teva;
    • AmbroHexal (manufacturer - German concern Hexal);
    • Ambroxol Richter, Hungarian company Gedeon Richter;
    • Ambrosan, made in the Czech Republic;
    • Bronchoxol, a Russian drug from the Moscow Pharmaceutical Factory;
    • Bronchorus, manufactured by the Russian company Sintez;
    • Lazolvan, a German drug from Boehringer Ingelheim;
    • Medox, Czech drug, Zentiva;
    • Flavamed, which is produced by the German concern Berlin Hemi;
    • Fervex for cough, Bristol Mayer and others.

    Ambroxol is also part of combined expectorant medications. The most famous among them is the domestic elixir Codelac Broncho with thyme (ambroxol, sodium glycyrrhizinate, thyme herb extract) produced by Pharmstandard.

    Good old. Bromhexine

    When we buy the usual inexpensive pills, we hardly think about the metamorphoses that the medicine undergoes in our body. Many would be surprised to learn that the most common Bromhexine literally half an hour after administration is 99% absorbed into the blood, after which it is metabolized and converted into. ambroxol.

    This means that all pharmacological properties and indications, contraindications for Bromhexine and Ambroxol are almost identical.

    Bromhexine is produced in the form of tablets containing 4 and 8 mg of the active substance, children's syrups with a dose of 4 mg in 5 ml and drops for internal use and inhalation. Unlike ambroxol, bromhexine is not produced in the form of lozenges for resorption.

    Bromhexine is prescribed to children from two to ten years old 2-4 mg three times a day, and over 10 years old and adults 8 mg three times a day.

    In severe cases, the dosage can be increased to 16 mg, and the frequency of use for children is twice a day, and for adults - up to four.

    Bromhexine preparations are well tolerated and rarely cause side effects.

    The trade names of almost all bromhexine-based expectorants registered in the Russian Federation do not differ from the international name. Among the most popular drugs are Bromhexine Berlin Chemie produced by the German corporation Berlin Chemie Menarini; Bromhexine Nycomed, a drug from the Danish company Nycomed; Bromhexine Ratiopharm, produced by the Israeli concern Teva.

    Domestic analogues of bromhexine belong to a more economical price category.

    Acetylcysteine: modern and effective

    Acetylcysteine ​​preparations also occupy an important place among expectorants. The ability of N-acetylcysteine ​​to break disulfide bonds in bronchial mucus allows this substance to be used not only for cold coughs, but also in the treatment of cystic fibrosis, pulmonary tuberculosis and other diseases.

    Acetylcysteine ​​is one of the most important medications needed in the healthcare system. It is included in the corresponding list of drugs, which is compiled by specialists from the World Health Organization.

    Acetylcysteine ​​preparations are available in the form of:

    • powder for preparing internal solutions or hot tea. The dosage of such forms is 100, 200 or 600 mg;
    • effervescent tablets that dissolve in cool boiled water;
    • solutions for inhalation;
    • solutions for injections.

    Contraindications to taking acetylcysteine ​​include peptic ulcer of the stomach and duodenum, bleeding in the lungs, pathologies of the adrenal glands, liver or kidney failure.

    During pregnancy, acetylcysteine ​​preparations are used if the benefit of the medication for the mother outweighs the potential risk for the child.

    Side effects include rash, hives and itching. Some patients may experience shortness of breath and difficulty breathing during treatment. Isolated cases of bronchospasm have been reported. Given these data, in patients with broncho-obstructive syndrome, acetylcysteine ​​is combined with bronchodilators that prevent bronchospasm.

    The dose of acetylcysteine ​​is selected individually. As a rule, for adults, 400–600 mg of the active substance, divided into two or three doses, is sufficient. Children are prescribed 300–400 mg of acetylcysteine ​​per day.

    For inhalation, use 2–5 ml of a solution containing 20% ​​acetylcysteine. The frequency of procedures is 2–3 times a day.

    Acetylcysteine ​​for injection is prescribed intramuscularly or intravenously at 300 mg once a day. The pediatric dose is calculated based on the ratio of 10 mg per kilogram of body weight per day.

    When prescribing acetylcysteine-based expectorants and antibiotics simultaneously, special attention should be paid to the fact that acetylcysteine ​​may interact with some antibacterial drugs. These include tetracyclines (except doxycycline), ampicillin, amphotericin B and others. Therefore, at least two hours should pass between taking antibiotics and acetylcysteine.

    We list the most famous expectorant drugs containing acetylcysteine:

    • N AC-ratiopharm produced by Teva;
    • Acestin, a German drug from Stad;
    • ACC, a drug from the German company Hexal. It is distinguished by a wide variety of release forms, including ACC 100, ACC 200, ACC Long, ACC injection and others;
    • Mukobene, an Austrian drug from Merkle;
    • Fluimucil, which is produced by the Swiss company Zambon.

    Carbocysteine-based expectorants

    Just like acetylcysteine, carbocysteine ​​promotes the rupture of disulfide bridges connecting glycoproteins of tracheobronchial secretions. Carbocysteine ​​preparations are prescribed for wet cough with viscous sputum.

    Expectorants based on carbocysteine ​​are absolutely contraindicated during pregnancy and breastfeeding, as well as for diseases of the kidneys, bladder (cystitis), and peptic ulcers.

    Unlike acetylcysteine, medications containing carbocysteine ​​do not provoke bronchospasm and do not interact with antibiotics. From this point of view, the use of drugs in this group is safer.

    Adults are prescribed 2 capsules of carbocisteine ​​or 15 ml of 5% syrup three times a day. After improvement, the dosage is reduced (1 capsule or 10 ml of syrup three times a day).

    Children aged 2–12 years are prescribed 2.5-10 ml of baby syrup (2.5%) four times a day.

    The most common and effective expectorants based on carbocysteine ​​include:

    • Fluditec, syrups 2.5% and 5%, manufacturer - Laboratory Innotek, France;
    • Libexin-Muco, children's and adult syrups, Sanofi, France;
    • Bronchobos, a drug produced in Bosnia, is available in the form of capsules and syrups.

    Folk expectorants

    We cannot ignore folk, homemade expectorants, which undoubtedly have the right to life.

    The middle of the radish is cut out, honey is poured into it and left for a day for extraction. After this, the solution is taken 3-4 times a day, 1 tablespoon.

    Popular wisdom says that warm milk, to which honey, baking soda, alkaline mineral water and other ingredients are added, is a strong remedy for the discharge of phlegm.

    Honey, both in its pure form and dissolved in warm tea, milk or just warm water, has a calming and mucolytic effect.

    Official medicine often fully supports the treatment of cough with traditional methods. In a potentially healthy person, “mild” expectorant therapy gives excellent results. But regardless of whether you take medications or prefer to drink raspberry tea, if there is a sharp deterioration, consult a doctor immediately. And then complications will bypass you.

    The article above and comments written by readers are for informational purposes only and do not encourage self-medication. Consult a specialist regarding your own symptoms and illnesses. When taking any medicine, you should always use the instructions that come with the medicine and your doctor's advice as a guide.

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    Source: http://cc-t1.ru/stati/otharkivajushhie_sredstva.html

    Effective folk expectorants for cough treatment

    Cough is a protective reflex mechanism that is controlled by the central nervous system and helps clear the airways. Expulsion of sputum is impossible without coughing; this protective mechanism is a reliable assistant to all expectorants.

    A wet or productive cough is a pathology of the body that needs to be gotten rid of. Effective folk expectorants help remove mucus from the bronchi and lungs at home. This treatment is required for a wet cough that is protracted and needs help.

    Causes of wet cough

    As a rule, expectorants should be used for wet coughs. A wet cough occurs for a number of different reasons. The main ones are viral and bacterial pulmonary diseases that provoke the appearance of sputum.

    An acute wet cough usually goes away within two weeks. Chronic can last a month or more. With bronchial asthma, a chronic cough is observed, which is severe.

    The list of diseases that cause a wet cough includes bronchitis, laryngitis, tracheitis, pneumonia, pleurisy, bronchial asthma, whooping cough.

    For what type of cough should you take expectorants?

    A wet cough is a direct indicator that the body needs help to remove accumulated mucus. Often, a wet cough occurs against a background of a dry one. The body tries to get rid of a wet cough as quickly as possible, since the sputum that accumulates in the lungs and bronchi serves as a very good breeding ground for pathological microorganisms. If no action is taken, a productive cough can develop into a chronic form and cause harm to health.

    Symptoms of a wet cough

    With a wet cough, a person feels general weakness. There is poor appetite, wheezing in the lungs is heard during coughing, chest pain, sputum may acquire a greenish tint, and the temperature reaches 38 degrees.

    Medicinal expectorants

    The list of drugs that are prescribed for sputum in the lungs, bronchi and throat includes:

    • Mucolytics.
    • Antibacterial drugs.
    • Anti-inflammatory.
    • Bronchodilator.
    • Cough receptor stimulants.

    Expectorant folk remedies

    Folk remedies that help remove phlegm have been used for a long time and have proven their effectiveness.

    • Water is considered the very first expectorant for wet coughs, which promotes the removal of sputum. Drinking enough water will prevent the phlegm from becoming viscous and unable to pass out of the body. During the day you need to drink enough water, about two liters.
    • Honey and horseradish

    — Honey one tablespoon.

    - One tablespoon of horseradish.

    Wash the horseradish root, peel it and turn it into a paste using a blender. Combine the two products, take in the morning on an empty stomach before breakfast. The product effectively promotes expectoration of phlegm, as it has cleansing properties.

    Grind a small onion to make a paste. Mix a tablespoon of onion with a tablespoon of liquid honey. Take an expectorant medicine three times a day, a teaspoon.

    — Horseradish juice 100 ml

    — Honey a tablespoon, lemon juice 100 ml.

    Mix all the ingredients of the recipe and take once in the morning, before meals.

    — Viburnum fruits 200 gr.

    Pour the fruits into boiling water and simmer over low heat for ten minutes. Strain the broth and add honey to taste. Take half a glass three times a day.

    Which expectorant folk remedy is best for a child?

    • Black radish

    The next cough expectorant that children will especially enjoy taking is black radish syrup.

    To prepare the medicine, you need to take one medium-sized black radish and honey. Clean the vegetable from dirt and wipe dry. Cut off the top and use a knife to scoop out some of the flesh. Place three tablespoons of honey in the cavity of the radish. Cover the top with the cut off crown and place in the refrigerator. When the radish produces juice, you can take this tasty and effective expectorant morning and evening, one tablespoon of juice.

    When the first portion is finished, put the honey in the hole again and wait for the juice to release. And do this until the radish is completely dry.

    To prepare a homemade antitussive, you need to take a glass of viburnum and a glass of sugar, grind everything into a paste and leave in the refrigerator for a week. Take a tablespoon twice a day. People suffering from hypertension should not take viburnum.

    There are not only useful medicines that help cough up mucus, but also tasty ones that can be given to children. One of the recipes is figs with milk.

    In order to prepare an expectorant at home, you need to choose fresh or dried figs.

    Place figs in a container with boiling milk and simmer the fruits over low heat for five minutes. Leave the product for twenty minutes. Take expectorant medicine three times a day, 100 ml.

    Grind the banana in a blender, put it in a container, add the rest of the ingredients, mix everything thoroughly, pour in hot milk. Drink a healthy drink three times a day.

    All the components included in the recipe help relieve cough and act as a strong expectorant, which children should like.

    What herbs help cough up phlegm?

    There are quite a few herbs that are effective for expectoration and removal of phlegm.

    Marshmallow root makes sputum less viscous and promotes expectoration: 1 tablespoon of roots is poured into 1 glass of boiling water and simmered over low heat for 15 minutes. Then add another glass of boiling water, leave for half an hour and take half a glass after each meal.

    Licorice root is a very strong expectorant and is used as decoctions and inhalations. For the decoction, the recipe is as follows: 10 grams of roots are poured with a glass of boiling water and simmered for 10 minutes. Then add another glass of boiling water and leave for 1 hour. Strain and drink 1 tablespoon up to 6 times a day.

    Coltsfoot. The plant contains many useful elements, such as saponins and organic acids, which help make the sputum less viscous. The ciliated epithelium facilitates the passage of sputum. Tannins, which are also found in the plant, promote quick and easy expectoration.

    Thyme has anti-inflammatory and expectorant properties. Contains mineral salts, malic acid and other essential elements.

    Oregano is another herb that is used for dry and wet coughs. People call it motherwort; it has a gentle effect on the body and removes mucus; it can also be used by children.

    There are many more herbs that can be used as expectorants.

    In order to prepare decoctions from the above herbs, a standard recipe is used.

    - Two tablespoons of medicinal herbs.

    You can place the plant in a thermos and pour boiling water over it. Leave for two hours and take half a glass three times a day.

    Inhalations that promote expectoration of sputum

    Inhalations are a very good folk remedy for clearing the lungs and bronchi of mucus and excess phlegm. You can use an inhaler or the usual method of inhaling steam over a basin. The best time to take inhalations is the evening before bed.

    Pour hot water into a basin and add baking soda. Breathe over the steam for five minutes.

    For inhalation, you need to boil the potatoes, drain a little water and inhale the steam for up to ten minutes.

    • Expectorant inhalations with essential oils

    For inhalation, essential oils of pine, juniper, sage, and cedar are used. You can drop 2-3 drops of oil into an inhaler or breathe healing steam over a container of hot water.

    Compresses to thin phlegm when coughing

    One of the effective means that helps cope with mucus and remove phlegm is a compress.

    Lubricate the chest and shoulders with a sweet product, put film and cotton wool on top and wrap it with a warm scarf. The compress can be left overnight.

    For compresses, you can use ordinary mustard plasters; they also warm up well, increase blood circulation and promote expectoration of phlegm.

    Potatoes are used for the heating procedure. Boil a few potatoes, turn them into puree, place them in a bag and, wrapped in a soft cloth, place them on the chest. Wrap the compress with a warm scarf. After two hours, remove the product. You can repeat the procedure throughout the week.

    The next version of the compress, which has expectorant properties, is vodka and potatoes.

    Boil five potatoes in their skins and mash them until pureed. Add a tablespoon of vodka, a tablespoon of honey and a tablespoon of butter. The potatoes should be at body temperature, carefully place the entire mass on the chest in a thick layer, put film and a towel on top, and wrap it in a woolen scarf. Keep the compress for one and a half hours.

    — A glass of hot water.

    Combine mustard with water and stir well. Place a paper napkin on your chest. Soak a towel in the mustard solution, wring it out and place it on your chest. Wrap the top with film and a warm scarf. After five minutes, remove the compress and put on a warm towel; change the cooled towel to a hot one within thirty minutes.

    • Massage of the chest and back is considered an effective action for coughing up mucus and clearing the airways. Massage helps the sputum to move away from the mucous membranes of the lungs and bronchi and is eliminated outside. The airways are cleared. The procedure can be performed with warming ointments.

    Precautions for home treatment of cough

    If the cough continues for a long time and no folk expectorants alleviate the disease, you should consult a doctor. To urgently seek medical help, a sick child or adult must exhibit one or more of the following symptoms:

    • elevated body temperature up to 10 degrees for a long time;
    • blood is coughed up with sputum;
    • weight loss, feeling unwell, chest pain;
    • nausea and vomiting;
    • barking cough.

    Treat dry and wet cough correctly, seek medical help in time, and safe, effective folk expectorants prepared at home will help you with treatment. Health to everyone!

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    For myself, I consider black radish juice to be the best expectorant. My brother and I were treated with it since childhood. Nature has not yet come up with a better idea. Good luck to everyone.

    Source: http://dar-zdorovya.ru/otharkivayushhie-sredstva.html