Mucolytics: a list of drugs for children and adults

In acute respiratory infections, we often encounter such an unpleasant phenomenon as coughing. It can be exhausting and annoying, makes breathing difficult and significantly reduces the quality of life. It is very important for the doctor to determine what type of cough the patient has: dry or wet. The first type is considered unproductive and is characterized by difficulties in discharge of sputum. A wet cough is called productive and shortens the patient's recovery time. Having discovered 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 with sputum discharge or expectoration.

What are mucolytics?

In order to help a patient with a dry cough, the doctor usually prescribes mucolytics.

The list of drugs in this group is quite extensive. According to the method of exposure to the human body, these drugs can be divided into three groups:

• Flour-regulating substances. They affect the amount of secreted mucous secretion. This group includes glucocorticosteroids, M-anticholinergics and carbocysteine.
• Mucokinetics are drugs that significantly improve mucus discharge. 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.

Various mechanisms for liquefying sputum

If we consider the mechanism by which molecules of acid mucopolysaccharides of human mucous secretions can be destroyed with the help of drugs, then two main pathways can be distinguished - this is the enzyme method and the non-enzymatic pathway. In the first case, enzymes break down 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 ATX or ATS drugs under the code R05CB “Mucolytics”. The list of main active ingredients also provides a specific alphanumeric designation:

• R05CB01 - Acetylcysteine.
• R05CB02 - Bromhexine.
• R05CB03 - carbocysteine.
• R05CB06 - Ambroxol.
• R05CB10 - drugs with a combined composition.
• R05CB13 - Dornase alfa (deoxyribonuclease).

Only the attending physician decides which mucolytic drugs to prescribe for a particular patient.

He makes this appointment only after a thorough examination and is guided by the results of relevant analyzes. Let's take a closer look at how each active substance included by pharmacists in the R05CB group works.

Mucolytics with acetylcysteine

Acetylcysteine ​​effectively helps to liquefy sputum, and therefore was included in the mucolytic group. The list of drugs with this active substance includes about two dozen names of drugs of various forms. Acetylcysteine ​​is characterized by the following mechanisms of action:

• It has in its molecule sulfhydryl groups of a reactive orientation, which act destructively on the disulfide compounds of mucopolysaccharides, due to which the mucus is characterized by increased viscosity. As a result, sputum is diluted and excreted 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 hydrates the body from toxic substances, greatly facilitating the patient's condition.

Of the preparations containing acetylcysteine ​​as the active substance, it can be noted:

• "Mukobene" - tablets; 100, 200 or 600 mg.
• "Mukomist" - a solution in ampoules, 20% for topical application and inhalation.
• "Mukoneks" in the form of granules, 0.1 g for the preparation of syrup.
• "Fluimucil" in the form of granules, 100 and 200 mg; tablets for effervescent drink, 600 mg.
• “ATSTS” in the form of tablets for the preparation of an effervescent drink - 100, 200, 600 mg; 300 mg / 3 ml injection solution in ampoules; granules for oral solution, 100, 200 mg.
• "Acetylcysteine" in the form of a powder, 200 mg; solution for injection, 10%; solution for the implementation of ngalations, 20%;
• "Atsestin" - tablets for internal use, 100, 200, 600 mg; 200 mg and 600 mg effervescent tablet.

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 gastric ulcer in the acute stage. Side effects may occur in the form of headache, stomatitis, drowsiness and tinnitus, less often gastrointestinal disorders, allergies, tachycardia. Acetylcysteine ​​should not be drunk with antitussive drugs. It also enhances the effect of nitroglycerin and inhibits the absorption of antibiotics.

Mucolytics with Bromhexine

Medicines containing this substance as an active ingredient are often prescribed for coughing and are positioned as mucolytics. The list of drugs is limited to five pharmaceutical products. Once in the human body, bromhexine acts as follows:

• lowers the viscosity of bronchial secretions through the depolarization of mucus polysaccharides;
• stimulates the cells of the bronchial mucosa, which secrete neutral type polysaccharides;
• promotes the formation of surfactant;
• produces an expectorant effect;
• inhibits the cough reflex.

Mucolytic drugs, the list of which is given below, contain bromhexine as the main active substance.

These include:

• "Solvin" - solution for internal administration, 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 drugs containing bromhexine are contraindicated in individuals with individual intolerance to this component, as well as in children under 6 years of age. They can cause digestive upsets, headaches, increased sweat, skin rashes, and bronchospasm. Pregnant and lactating women are rarely prescribed medications with bromhexine.

Carbocysteine ​​preparations

This medicinal substance is also included in the Mucolytics group. The list of drugs with carbocysteine ​​includes about ten items, however, they all have the same pharmaceutical effect:

• reduce the content of neutrals and increase the production of acidic glycopeptides, normalize their proportion;
• reduce viscosity and regulate sputum elasticity;
• regenerate the mucous membrane of the respiratory system and restore its normal structure;
• increase the factor of local specific resistance lgA;
• normalize the allocation of sulfigryl groups;
• activate the activity of the ciliary epithelium of the bronchi.

Very often, such mucolytics are prescribed to patients.

The list of drugs and preparations containing carbocysteine ​​is given below:

• "Libexin Muco" in the form of a 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 to obtain a suspension, 2.7 mg; syrup, 90 mg / l; syrup 2% (for children) and 5%.

Carbocysteine ​​mucolytics, drugs and preparations described above cannot be taken if there is an allergy to the main component, as well as peptic ulcer, impaired normal functioning of the kidneys, acute glomerulonephritis, cystitis, pregnancy, and breast-feeding. Preparations in the form of capsules are contraindicated in children under 12 years of age, and in the form of syrup - up to 2 years. Carbocysteine-based cough mucolytics can cause digestive upsets and allergic reactions.

Medicines with Ambroxol

These drugs are the most popular among patients. Ambroxol has the following effects on the human body:

• reduces the rate of viscosity and adhesion of sputum;
• 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;
• actively promotes surfactant production;
• stimulates the work of the cilia of the bronchi and prevents them from sticking together.

Due to the presence of these factors of action of ambrokol, he was included in the Mucolytics group.

The list of drugs containing this component is very extensive. Here are the most common drugs with Ambroxol:

• "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 a 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;
• "Suprim-coffee" - in the form of tablets, 30 mg.
• "Mucobron" - in the form of tablets, 30 mg.
• "Drops Bronhovern" - a solution for internal administration, 7.5 mg / ml.
• "Ambrobene" - in the form of capsules, 75 mg; 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 a syrup of 0.3 and 0.6 g / 100 ml.
• "Remebrox" - in the form of a 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.
• "Bronchovale" - tablets, 30 mg; syrup, 15 mg / 5 ml.

Depending on the form of release of the drug, there are contraindications to taking medications based on ambroxol. Such mucolytic drugs for children under 2 years old are suitable only if the dosage of the active substance does not exceed 3 mg / ml, as a rule, it is syrups or solution. Tablets should not be drunk for 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, 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 active substances that are different in action, which provide sputum thinning, so they were included in the Mucolytics typology. With dry cough, the list of drugs prescribed by a doctor from the list described earlier in the article can be supplemented with the following medicines:

• "Sinupret" is a remedy with herbal components. It contains gentian root, primrose and elderberry flowers, sorrel and verbena grass. The drug is in the form of tablets and an alcohol solution.
  
  The complex of active substances contributes to the effective discharge of mucus from the sinuses and upper respiratory tract. Both dosage forms should not be taken for children under 6 years of age and for people with lactase deficiency, as well as in the presence of an allergy to the components of the drug.
• 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, edema and hyperemia of the mucous tissues of the respiratory system decrease. The drug is contraindicated in convulsions, atherosclerosis, hypertension, diabetes, thyrotoxicosis, pheochromocytoma, closed-angle glaucoma, ulcer, prostate adenoma, glucose-6-phosphate dehydrogenase deficiency, during pregnancy and lactation, children under 6 years old, allergic to components. Do not drink this syrup with beta-blockers, tricyclic antidepressants, MAO inhibitors and with medicines containing the same active substances as Rinicold Broncho.

Ribonuclease for dry cough

Mucolytics prescribed by doctors usually for dry cough, the list of which was presented earlier, can be attributed to the drugs traditional and tried and tested. A completely new and modern way to get rid of viscous sputum in the respiratory system is the use of ribonuclease or dornase alpha. This substance is a genetically engineered product, an analogue of the natural human enzyme, which is responsible for the cleavage of extracellular DNA.

If the patient has cystic fibrosis, which is characterized by an acute infectious process, an accumulation of purulent secretion with high viscosity is observed. As a result, the function of external respiration is impaired in patients. Purulent secretion contains extracellular DNA in large quantities. These particles are released from the decaying white blood cells, which are formed as a response mechanism during infection, and have a high viscosity. Ribonuclease hydrolytically cleaves sputum DNA and, as a result, the mucus liquefies.

Dornase alpha is part of the Pulmozyme preparation, which is available in the form of a solution for inhalation. The active substance content is 2.5 mg / 2.5 ml. This drug is successfully used for cystic fibrosis, as well as chronic pulmonary diseases: bronchiectasis, COPD, congenital malformations in children, pneumonia, immunodeficiency respiratory infections.

“Pulmozyme” has few contraindications. The drug can not be prescribed to pregnant and lactating women, as well as children under 5 years of age. Side effects during treatment with this agent rarely occur and can manifest itself in the form of 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 delivery, sternum pain, weakness.

Be treated promptly and correctly

This article addressed the question: “What drugs are mucolytics?” A list of the most common drugs of this group has been named.

It is worth noting in a special way that the purpose 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 the responsibility 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, in the presence of symptoms of the disease, do not delay a visit to the doctor. Be healthy!