With acute respiratory infections, we often encounter such an unpleasant phenomenon as a cough. It can be exhausting and intrusive, makes breathing difficult and significantly reduces the quality of life. It is very important for the doctor to determine whether the patient's cough is dry or wet. The first type is considered unproductive and is characterized by difficulty in sputum discharge. Wet cough is called productive and shortens the patient's recovery time. Having found a dry type of cough in a patient, doctors often prescribe drugs that thin the viscous mucous secretion that forms in the respiratory system. Due to the increased density of this mucus, the patient has difficulty passing sputum or expectorating.
What are mucolytics?
To help a patient with a dry cough, a doctor usually prescribes mucolytics.
The list of drugs included in this group is quite extensive. According to the way they affect the human body, these drugs can be divided into three groups:
- Mucoregulatory substances. They affect the volume of secreted mucosal secretion. This group includes glucocorticosteroids,M-anticholinergics and carbocysteine.
- Mucokinetics are drugs that significantly improve mucus flow. These include ambroxol, bromhexine, etc.
- Directly mucolytics. These substances contribute to the thinning of the mucous secretion by reducing its viscosity. Mucolytics include proteolytic enzymes, acetylcysteine, etc.
Different mechanisms of sputum thinning
If we consider the mechanism by which the molecules of acid mucopolysaccharides of the mucous secretion of a person can be destroyed with the help of drugs, then two main ways can be distinguished - this is an enzymatic method and a non-enzymatic way. In the first case, enzymes destroy protein bonds, and in the other, disulfide bridges in sputum molecules.
Classification by main active ingredient
All these drugs are combined according to the international classification of medicines ATC or ATC under the code R05CB "Mucolitics". The list of the main active ingredients also provides for a specific letter and number designation:
- R05CB01 – acetylcysteine.
- R05CB02 - Bromhexine.
- R05CB03 – carbocysteine.
- R05CB06 – Ambroxol.
- R05CB10 - drugs with a combined composition.
- R05CB13 – Dornase alfa (deoxyribonuclease).
It is up to the attending physician to decide which mucolytic drugs to prescribe to a particular patient.
He makes this appointment only after a thorough examination and guided by the results of relevant tests. let'sLet's take a closer look at how each active substance included by pharmacists in the R05CB group works.
Acetylcysteine mucolytics
Acetylcysteine is effective in thinning phlegm and has therefore been included in the group of mucolytics. The list of drugs with this active ingredient includes about two dozen names of drugs of various forms. Acetylcysteine is characterized by the following mechanisms of action:
- It has in its molecule reactive sulfhydryl groups, which act destructively on the disulfide compounds of mucopolysaccharides, due to which the mucus is characterized by increased viscosity. As a result, phlegm thins and is excreted from the body more easily.
- This substance helps to reduce activity and reduces the number of pathogenic bacteria that are on the mucous membrane of the respiratory organs.
- It has antioxidant properties. Sulfhydryl groups react with free radicals and oxygen metabolites and remove them from the body. Thus, acetylcysteine has an anti-inflammatory effect and frees the body from toxic substances, greatly alleviating the patient's condition.
From drugs containing acetylcysteine as an active substance, it can be noted:
- "Mukobene" - tablets; 100, 200 or 600 mg.
- "Mukomist" - solution in ampoules, 20% for local use and inhalation.
- "Mukoneks" in the form of granules, 0.1 g for making syrup.
- "Fluimucil" in the form of granules, 100 and200 mg; tablets for fizzy drink, 600 mg.
- "ACC" in the form of tablets for the preparation of a fizzy drink - 100, 200, 600 mg; solution for injection 300 mg/3 ml in ampoules; granules for oral solution, 100, 200 mg.
- "Acetylcysteine" in powder form, 200 mg; solution for injection, 10%; solution for inhalation, 20%;
- "Acestin" - tablets for internal use, 100, 200, 600 mg; effervescent tablets, 200 and 600 mg.
Acetylcysteine and drugs with it are contraindicated in children under 2 years old (and some up to 6 years old), pregnant and lactating women, people with acute gastrointestinal ulcers. Side effects may occur in the form of headache, stomatitis, drowsiness and tinnitus, gastrointestinal disorders, allergies, and tachycardia are less common. Acetylcysteine should not be taken with antitussive drugs. It also enhances the effect of nitroglycerin and inhibits the absorption of antibiotics.
Mucolytics with Bromhexine
Drugs containing this substance as an active ingredient are often prescribed for coughs, and are positioned as mucolytics. The drug list is limited to five pharmaceutical products. Once in the human body, Bromhexine acts as follows:
- reduces the viscosity of bronchial secretions through depolarization of mucus polysaccharides;
- stimulates bronchial mucosal cells that secrete neutral-type polysaccharides;
- promotes the formation of surfactant;
- has an expectorant effect;
- slows down the cough reflex.
The mucolytics listed below contain bromhexine as the main active ingredient.
These include:
- "Solvin" - solution for internal use, 4 mg / 5 ml; tablets for oral use, 8 mg.
- "Bromhexine" in the form of a solution, 4 mg / 5 ml; syrup, 4 mg/5 ml; tablets, 8 mg.
Mucolytic preparations containing bromhexine are contraindicated in persons with individual intolerance to this component, as well as in children under 6 years of age. They can cause indigestion, headache, increased sweating, skin rashes, and bronchospasm. Bromhexine drugs are rarely prescribed for pregnant and lactating women.
Preparations with carbocysteine
This medicinal substance is also included in the Mucolytics group. The list of drugs with carbocysteine includes about ten items, but they all have the same pharmaceutical effect:
- reduce the content of neutral and increase the production of acidic glycopeptides, normalize their proportion;
- reduce viscosity and regulate sputum elasticity;
- regenerate the respiratory mucosa and restore its normal structure;
- increase local resistance factor lgA;
- normalize the isolation of sulfonyl groups;
- activate the activity of the ciliated epithelium of the bronchi.
Very often, these mucolytics are prescribed to patients.
The list of medicines and preparations containing carbocysteine is given below:
- "Libeksin Muko" in the form of syrup, 50 mg/ml.
- "Mucodine" in the form of capsules, 125 mg; syrup for children 125 mg/5 ml and 250 mg/5 ml.
- "Carbocysteine" in the form of syrup 250 mg/5 ml and 125 mg/5 ml (for children); capsules, 375 mg.
- "Fluifort" in the form of granules for suspension, 2.7 mg; syrup, 90 mg/l; syrup 2% (for children) and 5%.
Carbocysteine mucolytics, drugs and preparations described above should not be taken if you are allergic to the main component, as well as with peptic ulcer, impaired normal functioning of the kidneys, acute glomerulonephritis, cystitis, pregnancy and lactation. Preparations in the form of capsules are contraindicated in children under 12 years of age, and in the form of a syrup - up to 2 years. Mucolytic cough preparations based on carbocysteine can sporulate digestive disorders and allergic manifestations.
Drugs with Ambroxol
These drugs are the most popular among patients. Ambroxol has the following effect on the human body:
- reduces mucus viscosity and adhesion;
- facilitates the passage of mucus from the respiratory tract;
- activates the work of serous cells of the glandular tissue of the bronchial mucosa;
- stimulates the production of enzymes that destroy the structure of sputum polysaccharides;
- strongly promotes surfactant production;
- stimulates the work of bronchial cilia and prevents themstick together.
Due to the presence of these action factors, Ambrocol was included in the Mucolytics group.
The list of drugs containing this component is very extensive. Here are the most common ambroxol preparations:
- "Lazolvan" - lozenges, 20 mg; lozenges, 15 mg; solution, 7.5 mg/mL; syrup 15 and 30 mg/5 ml; tablets, 30 mg.
- "Halixol" - in the form of syrup, 30 mg/10 ml and tablets, 30 mg.
- "Medox" - in the form of syrup, 15 mg/5 ml and tablets, 30 mg.
- "Deflegmin" - in the form of drops for oral administration, 0.75% and tablets, 30 mg;
- "Suprima-coff" - in the form of tablets, 30 mg.
- "Mukobron" - in the form of tablets, 30 mg.
- "Bronchovern Drops" - solution for oral administration, 7.5 mg/ml.
- "Ambrobene" - in the form of capsules, 75 mg; solution for injection, 7.5 mg/ml; syrup, 15 mg/5 ml; tablets, 30 mg.
- "Ambrohexal" - in the form of capsules, 75 mg; solution for inhalation and oral administration, 7.5 mg/ml; syrup 3 and 6 mg/ml and tablets, 30 mg.
- "Ambroxol" - in the form of syrup, 3 and 6 mg / ml; tablets, 30 mg and capsules, 75 mg.
- "Ambrolap" - in the form of capsules, 75 mg; syrup, 15 mg/5 ml; tablets, 30 mg; solution for internal use and for inhalation, 7.5 mg/ml.
- "Ambrosan" - in the form of tablets, 30 mg.
- "Ambrosol" - in the form of syrup 0.3 and 0.6 g/100 ml.
- "Remebrox" - in the form of syrup 30 mg/5 ml.
- "Ambrotard 75" - in the form of capsules, 75 mg.
- "Flavamed" - in the form of a solution for oral administration, 15 mg / 5 ml and tablets,30 mg.
- "Bronchoval" - tablets, 30 mg; syrup, 15 mg/5 ml.
Depending on the form of release of the drug, there are contraindications to taking drugs based on Ambroxol. Such mucolytic preparations for children under 2 years of age are only suitable if the dosage of the active substance does not exceed 3 mg / ml, as a rule, these are syrups or a solution. Tablets should not be taken by patients under 6 years of age, capsules - up to 14 years. Also, if the patient has an individual intolerance to ambroxol, these mucolytics cannot be prescribed. Among the side effects of the drug are digestive disorders, increased separation of mucus from the nose, difficulty urinating, and allergic reactions. During pregnancy, as a rule, ambroxol is not prescribed in the first trimester, and at a later date - only on the recommendation of a doctor.
Mucolytics with a combined composition
These drugs contain several different active substances that provide sputum thinning, so they were included in the typology "Mucolitics". With a dry cough, the list of drugs prescribed by a doctor from the list described earlier in the article can be supplemented with the following drugs:
- "Sinupret" - a remedy with herbal ingredients. Contains gentian root, primrose and elderberry flowers, sorrel and verbena grass. The drug is produced in the form of tablets and an alcohol solution.
- "Rinicold Broncho" is a drug that has three main active ingredients: ambroxol (15 mg), chlorphenamine (2 mg), phenylephrine (5 mg) and guaifenesin (100 mg). As a result of taking this syrup, the viscosity of sputum in the bronchi decreases, expectoration is facilitated, lacrimation, itching in the eyes and nose are eliminated, swelling and hyperemia of the mucous tissues of the respiratory system subside. The drug is contraindicated in convulsions, atherosclerosis, hypertension, diabetes, thyrotoxicosis, pheochromocytoma, closed-type glaucoma, ulcers, prostate adenoma, glucose-6-phosphate dehydrogenase deficiency, during pregnancy and lactation, children under 6 years old, allergies to components. You can not drink this syrup along with beta-blockers, tricyclic antidepressants, MAO inhibitors and with drugs containing the same active substances as Rinicold Broncho.
The complex of active substances contributes to the effective discharge of mucus from the sinuses and upperrespiratory tract. Both dosage forms should not be taken by babies under 6 years of age and people with lactase deficiency, as well as those who are allergic to the components of the drug.
Ribonuclease for dry cough
The mucolytics usually prescribed by doctors for dry cough, the list of which was presented earlier, can be attributed to traditional and time-tested drugs. A completely new and modern way to get rid of viscous sputum in the respiratory system is the use of ribonuclease or dornase alfa. This substance is a genetically engineered product, an analogue of a natural human enzyme, which is responsible for the breakdown of extracellular DNA.
If a patient has cystic fibrosis, which is characterized by an exacerbated infectious process, there is an accumulation of purulent secretion with high viscosity. As a result, the function of external respiration is disturbed in patients. The purulent secret contains a large amount of extracellular DNA. These particles are released from the decaying leukocytes produced as a response mechanism during infection and are highly viscous. Ribonuclease hydrolytically cleaves sputum DNA and, as a result, mucus liquefies.
Dornase alfa is part of the drug "Pulmozim", which is available in the form of a solution for inhalation. The content of the active substance is 2.5 mg / 2.5 ml. This drug is successfully used in cystic fibrosis, as well as chronic lung diseases: bronchiectasis, COPD, congenital malformations in children, pneumonia, respiratory diseases of an immunodeficient nature.
Pulmozim has few contraindications. The drug should not be prescribed to pregnant and lactating women, as well as children under 5 years of age. Side effects in the treatment of this drug are rare and can manifest as acute lymphocytic leukemia, aplastic anemia, epilepsy, migraine, conjunctivitis, imbalance, tachycardia, cardiac arrest, bradycardia, pneumonia, bronchospasm, digestive disorders, allergic dermatitis, Quincke's edema, disorders pregnancy and childbirth, chest pain, weakness.
Treat in a timely and correct manner
This article addressed the question: "What drugs are mucolytics?" List of the mostcommon medicines of this group was named.
It is worth noting in a special way that the prescription of the drug, its dosage, as well as recommendations on the duration of the course of treatment and the possibility of replacing the drug with an analogue are issues that are within the competence of only a medical specialist after a thorough diagnosis of the patient. Self-medication in this situation can be not only unproductive, but also capable of causing unpredictable consequences: from side effects of drugs to the development of chronic diseases. Therefore, if you have symptoms of the disease, do not delay a visit to the doctor. Stay he althy!
