Is it possible to take Ambroxol and ACC at the same time. Cheap analogues of ACC Russian and foreign production instructions and comparison. Online Lung Health Tests

18.1. EXPECTORANT MEDICINES

The most effective antitussive drugs with efferent peripheral action are mucolytics. They well dilute the bronchial secret by changing the structure of the mucus. These include proteolytic enzymes (deoxyribonuclease), acetylcysteine ​​(ACC, carbocysteine, N-acetylcysteine ​​(fluimucil), bromhexine (bisolvan), ambroxol (ambrohexal, lasolvan), dornase (pulmozyme), etc.

Classification:

Acetylcysteine

M-derivative of the natural amino acid cysteine. The action of the drug is associated with the presence of a free sulfhydryl group in the structure of the molecule, which cleaves the disulfide bonds of macromolecules, mucus glycoprotein by the reaction of sulfhydryl-disulfide substitution; as a result, M-acetylcysteine ​​disulfides are formed, which have a significantly lower molecular weight, and the viscosity of sputum decreases.

Acetylcysteine:

It has a stimulating effect on mucosal cells, the secret of which has the ability to lyse fibrin and blood clots,

It is able to increase the synthesis of glutathione, which is important for detoxification, in particular, in case of poisoning with paracetamol and pale grebe,

Protective properties have been identified against factors such as free radicals, reactive oxygen metabolites responsible for the development of acute and chronic inflammation in the lung tissue.

Long-term use of acetylcysteine ​​is impractical, as it inhibits mucociliary transport and production of secretory IgA. In some cases, the mucolytic effect of acetylcysteine ​​is undesirable, because the state of mucociliary transport is negatively affected by both an increase and an excessive decrease in the viscosity of the secret. Acetylcysteine ​​is sometimes able to exert an excessive thinning effect, which can cause a syndrome of the so-called "flooding" of the lungs and require the use of suction to remove accumulated secretions, especially in young children. Therefore, conditions must be provided for adequate sputum removal: postural drainage, vibromassage, bronchoscopy.

When taken orally, the drug is rapidly and well absorbed, in the liver it is metabolized (hydrolyzed) into the active metabolite - cysteine. Due to the “first pass” effect, the bioavailability of the drug is low (about 10%). The maximum concentration in the blood plasma is reached after 1-3 hours. T 1 / 2 is 1 hour, the route of elimination is predominantly hepatic.

Indications and contraindications

Acetylcysteine ​​is indicated as an adjuvant in various bronchopulmonary diseases with the presence of thick, viscous, difficult-to-separate mucus or mucopurulent sputum: chronic obstructive bronchitis, bronchiolitis, bronchopneumonia, bronchiectasis, bronchial asthma, cystic fibrosis. Care should be taken to prescribe the drug to patients with broncho-obstructive syndrome, since in 1/3 of cases there is an increase in bronchospasm. Do not prescribe the drug for an attack of bronchial asthma and for bronchial asthma with normal sputum discharge. In otolaryngology, the mucolytic effect of the drug is also widely used in purulent sinusitis, inflammation of the middle ear. Caution requires the use of this mucolytic in acute bronchitis, since the drug can reduce the production of lysozyme and IgA and increase bronchial hyperreactivity. Acetylcysteine ​​is well tolerated, sometimes nausea, vomiting, heartburn may occur when taking the drug; liquefaction of mucus eliminates its protective effect, which can lead, for example, to an exacerbation of peptic ulcer. In such cases, these agents are recommended to be used in smaller doses and mainly in the form of inhalations.

Dosing regimens

Acetylcysteine ​​in adults is used 200 mg 3 times a day or 600 mg 1 time per day in acute conditions for 5-10 days or

2 times a day up to 6 months - for chronic diseases. In newborns, acetylcysteine ​​is used only for health reasons at a dose of 10 mg/kg of body weight, an average of 50-100 mg 2 times a day. In cystic fibrosis, the drug is used in the same single doses 3 times a day. In surgical and endoscopic practice, acetylcysteine ​​is also used endotracheally, by slow instillations and, if necessary, parenterally - intramuscularly or intravenously. The action of the drug begins in 30-60 minutes and lasts for 4 hours. The endobronchial route of administration makes it possible to avoid adverse events. Perhaps the combined administration of drugs - inhalation + oral. Broncho-obstructive syndrome can be avoided by first using a bronchodilator.

Mesna

It has a similar effect to acetylcysteine, but is more effective. Mesna as a mucolytic is usually used by inhalation and intratracheal. It is also used to prevent hemorrhagic cystitis during treatment with cyclophosphamide (in / in and orally). Does not apply to children.

Pharmacokinetics and pharmacodynamics

The drug is easily absorbed and quickly excreted from the body unchanged. Used for inhalation in conditions after neurosurgical and thoracic operations, after resuscitation and chest injuries to improve sputum discharge; with cystic fibrosis, bronchial asthma with difficult sputum discharge, with chronic bronchitis, emphysema and bronchiectasis, atelectasis due to blockage of the bronchi with mucus. Drip infusions are indicated when it is necessary to prevent the formation of a mucous plug and facilitate the suction of secretions from the bronchi during anesthesia or in intensive care, as well as for drainage in sinusitis or otitis media.

Dosing regimens

Inhalation is carried out 2-4 times a day for 2-24 days. To do this, use the contents of 1-2 ampoules without dilution or diluted 1:1 with distilled water. Drip infusion is carried out through an intratracheal tube, 1-2 ml of the drug, diluted with the same volume of water; instilled every hour until the moment of liquefaction and removal of the secret. In asthmatic conditions, the drug is used only in a hospital. With the inhalation use of mesna, cough and bronchospasm are possible (especially in patients with bronchial asthma who do not tolerate aerosols), with

using a 20% solution, a burning retrosternal pain may occur (in these cases, the drug is diluted with distilled water in a ratio of 1: 2). Mesna is combined with almost all antibiotics, except for aminoglycosides.

Fluimucil

The mechanism of action is similar to acetylcysteine, but more active. It also has the least pronounced side effects: it practically does not irritate the gastrointestinal tract. The advantages of fluimucil are the ability to use its solution during nebulizer therapy in patients with COPD, as well as its antioxidant and anti-inflammatory activity.

Rinofluimucil

Used for acute and chronic rhinosinusitis, exudative and recurrent otitis media. In otolaryngology, acetylcysteines used in short courses, locally intranasally (rinofluimucil) in combination with the administration of an antibiotic (in particular, chloramphenicol) into the sinuses, gave preliminary good results in patients with exacerbations of chronic rhinosinusitis with increased secretion viscosity, with prolonged subacute rhinosinusitis. A rapid mucolytic effect was noted, but there was not only a liquefaction of the purulent exudate, but also an increase in its volume. Therefore, the introduction of acetylcysteine ​​into the sinuses requires active drainage, aspiration of the intrasinus secretion within the next 5-6 hours after the administration of the drug; 2-3 doses are enough for a course of treatment. However, with inadequate use of acetylcysteines and in the absence of proper active secretion aspiration in conditions of impaired mucociliary activity, observed in subacute and chronic rhinosinusitis, a worsening of the rhinoscopic picture may be noted.

Interactions

Antibacterial therapy significantly increases the viscosity of sputum due to the release of DNA during the lysis of microbial bodies and leukocytes. In this regard, it is necessary to take measures that improve the rheological properties of sputum and facilitate its discharge. Such a measure is the appointment of mucolytics in combination with antibiotics. With their simultaneous appointment, their compatibility must be taken into account: acetylcysteine ​​reduces the absorption of penicillins, cephalosporins, tetracycline, erythromycin (the interval between doses is 2 hours). Mesna can not be used in conjunction with aminoglycosi- ladies. Acetylcysteine ​​preparations for inhalation or installation should not be mixed with antibiotics, as this occurs

their mutual inactivation. The exception is fluimucil, for which a special form has even been created: fluimucil + IT antibiotic (thiamphenicol glycinate acetylcysteinate). It is available for inhalation, parenteral, endobronchial and topical use. Thiamphenicol has a wide spectrum of antibacterial action. Once in the respiratory tract, it is hydrolyzed to N-acetylcysteine ​​and thiamphenicol. It is effective against bacteria that most commonly cause respiratory tract infections. Fluimucil effectively dilutes sputum and facilitates the penetration of thiamphenicol into the area of ​​inflammation, inhibits the adhesion of bacteria to the epithelium of the respiratory tract.

Acetylcysteine ​​enhances the effect of nitroglycerin, and therefore an interval is required between doses of the drug. Do not combine acetylcysteine ​​with antitussives (possible stagnation due to suppression of the cough reflex). In patients with broncho-obstructive syndrome, acetylcysteines can be combined with bronchodilators β 2 -agonists, theophyllines), a combination with m-anticholinergics is undesirable, since they thicken sputum.

Combined cough medicines.

This group of drugs, usually over-the-counter or prescribed by doctors, contains two or more ingredients. A number of combination drugs include a centrally acting antitussive, antihistamine, expectorant and decongestant (broncholithin, stoptussin, sinecod, hexapneumine, lorain). Often they also include a bronchodilator (solutan, trisolvin) and / or an antipyretic component, antibacterial agents (hexapneumine, lorain). They relieve cough with bronchospasm, SARS or bacterial infection, but they should also be prescribed according to appropriate indications. Often such drugs are not indicated or even contraindicated in young children, especially in the first months of life. In addition, combination products, such as those prescribed by physicians, may combine drugs that are opposite in their effect or contain suboptimal or low concentrations of drugs, which reduces their effectiveness.

II. Drugs of the carbocysteine ​​group

(fluditek, fluifort, bronkatar, mucopront, mucodin)

The mechanism of action of carbocysteine ​​is associated with the activation of sialic transferase, an enzyme of the goblet cells of the bronchial mucosa, under the influence of which the production of acidic mucins slows down. This normalizes the ratio of neutral or acidic

mucus mucins, as a result of which the elasticity and regeneration of the mucous membrane are normalized, its structure is restored, the number of goblet cells decreases (this effect is noted throughout all the mucous membranes of the body) and, as a result, a decrease in the amount of mucus produced. In addition to the above, the secretion of immunologically active IgA (specific protection) and the number of sulfhydryl groups (nonspecific protection) are restored, mucociliary clearance improves (the activity of ciliated cells is potentiated). Thus, carbocysteine, unlike acetylcysteine, bromhexine and ambroxol, also has a mucoregulatory effect. In this case, the action of carbocysteine ​​extends to the upper and lower respiratory tract, as well as the paranasal sinuses, middle and inner ear. Carbocysteine ​​is only active when taken orally. Using Fluditec as an example, it was shown that as a result of optimizing the ratio of acidic and neutral sialomucins between the layer of pathological mucus and the mucous membrane of the respiratory tract, a new layer of mucus with normal rheological properties is formed. It is she who contacts the cilia of the ciliated epithelium, pushing up the old mucus.

Indications and contraindications

The drug is indicated primarily in the initial stage of an acute inflammatory process in the respiratory system, when there is a significant increase in the secretion of liquid mucus and an increased formation of goblet cells is characteristic, as well as chronic inflammation, accompanied by increased production of mucus with altered physicochemical characteristics, but not purulent . Since the action of the drug is manifested at all levels of the respiratory tract: both at the level of the mucous membrane of the bronchial tree, and at the level of the mucous membranes of the nasopharynx, paranasal sinuses and mucous membranes of the middle ear, carbocysteine ​​is widely used not only in pulmonology, but also in otorhinolaryngology. Positive results with the inclusion of mucolytics with a mucoregulatory effect (fluiford, carbocysteine ​​lysine salt) were also obtained in the group of patients with acute and chronic exudative otitis media, as well as relapsing otitis media. Special indications for the use of carbocysteine ​​in children of the first year of life may be the following: "wet" bronchitis, occurring with an abundance of liquid sputum of low viscosity and the danger of "bogging of the bronchi"; bronchopulmonary diseases with impaired cough reflex (against the background of organic and functional lesions)

ny CNS, craniocerebral injuries, after surgical interventions on the central nervous system, etc.); congestive bronchitis against the background of congenital heart defects; bronchitis on the background of the "fixed cilia" syndrome, Sievert-Kartagener syndrome, after intubation, in the postoperative period; prevention of chronic bronchitis in bronchopulmonary diplasia in order to prevent glandular degeneration of the mucous membrane. Side effects develop rarely, mainly in the form of dyspeptic phenomena and allergic reactions. Do not use the drug for exacerbation of peptic ulcer of the stomach and duodenum, as well as conditions in which pulmonary bleeding is noted. The simultaneous use of antitussive and mucolytic drugs is completely unacceptable. It is not recommended to use carbocisteine ​​for pregnant and lactating mothers.

Pharmacokinetics and pharmacodynamics

The maximum concentration in the blood serum and respiratory mucosa is reached after 2-3 hours and remains in the mucous membrane for 8 hours. It is excreted mainly in the urine.

Dosing regimens

Carbocysteine ​​preparations are available only for oral administration (in the form of capsules, granules and syrups). Use the drug orally at 750 mg 3 times a day. The duration of admission is 8-10 days. Possible long-term use (up to 6 months, 2 times a day) in patients with COPD.

Interactions

Carbocysteine ​​is the drug of choice as a mucolytic in bronchial asthma, not only because of its mucoregulatory action, but also due to its ability to potentiate the effects of β 2 -adrenergic agonists, antibacterial drugs, xanthines and glucocorticoids. The combination of carbocysteine ​​with other drugs that suppress the secretory function of bronchial glands (central antitussives, macrolide antibiotics, first-generation antihistamines, etc.) is undesirable; its appointment is not justified with poor secretion. With the simultaneous use of carbocysteine ​​with atropine-like agents, a weakening of the therapeutic effect is possible.

III. Proteolytic Enzymes

(trypsin, chymotrypsin, ribonuclease, deoxyribonuclease)

They reduce both the viscosity and elasticity of sputum, have anti-edematous and anti-inflammatory effects. However, pre-

Parates of this group are practically not used in pulmonology, since they can provoke damage to the pulmonary matrix, bronchospasm, hemoptysis, and allergic reactions. The exception is recombinant α-DNase (pulmozyme). The accumulation of viscous purulent secretions in the airways plays a role in reducing the functional capacity of the lungs and exacerbating the infectious process. The purulent secretion contains very high concentrations of extracellular DNA, a viscous polyanion released from degrading white blood cells that accumulate as a result of infection. Alpha-DNase (pulmozyme) has the ability to specifically cleave high-molecular nucleic acids and nucleoproteins into small and soluble molecules, which helps to reduce the viscosity of sputum, and also has anti-inflammatory properties. The anti-inflammatory action of Alpha-DNase (pulmozyme) and its ability to delay the reproduction of some RNA-containing viruses (herpes virus, adenoviruses) are shown.

Pharmacokinetics and pharmacodynamics

Alpha-DNase is a genetically engineered version of a natural human enzyme that cleaves extracellular DNA. DNase is normally present in human serum. Inhalation of alpha-DNase at doses up to 40 mg for 6 days did not lead to an increase in serum DNase concentrations compared to normal endogenous levels. Serum DNase concentration did not exceed 10 ng/ml. After the appointment of alpha-DNase 2500 IU (2.5 mg) twice a day for 24 weeks, the average serum concentrations of DNase did not differ from the average values ​​before treatment, equal to 3.5±0.1 ng/ml, which indicates a small systemic absorption or small cumulation.

The activity of the drug is determined by the biological method by the amount of acid-soluble substances as a result of DNA hydrolysis under certain conditions. One unit of activity (EA) corresponds to 1 mg of the drug.

Indications and contraindications

Recombinant human deoxyribonuclease (pulmozyme) is used in the treatment of cystic fibrosis, purulent pleurisy, resolution of recurrent atelectasis in patients with spinal cord injury, bronchiectasis, lung abscesses, pneumonia; in the preoperative and postoperative periods in patients with purulent lung diseases.

Dosing regimens

Apply topically, in the form of aerosols for inhalation, intrapleurally, intramuscularly. For inhalation use a fine aerosol; dose - 0.025 mg per procedure; the drug is dissolved in 3-4 ml of isotonic sodium chloride solution or in 0.5% novocaine solution. Endobronchially injected using a laryngeal syringe or catheter solution containing 0.025-0.05 g of the drug. The same dose is administered intrapleurally in 5-10 ml of isotonic sodium chloride solution or 0.25% novocaine solution. In cystic fibrosis through a nebulizer, in addition to bronchodilators, glucocorticoids and recombinant DNase, antibiotics that are active against P. aeruginosa(colimycin, tobramycin, etc.). The maximum single dose for intramuscular injection is 0.01 g. Before starting treatment, sensitivity tests to the drug are carried out: 0.1 ml of the solution is injected intradermally into the flexor surface of the forearm. In the absence of local and general reactions, drug treatment is carried out. As recently completed multicenter studies have shown, daily double inhalations of 2.5 mg of the drug reduce the number of exacerbations, improve the patient's well-being, functional performance and, as a result, the patient's quality of life. In the treatment of cystic fibrosis, the following recommendations have been developed: at the beginning of therapy (usually within 2 weeks), it is necessary to conduct a trial appointment of pulmozyme, when adverse events may be detected that require discontinuation of the drug. In the next 3 months, it is necessary to control functional tests to determine the effectiveness of pulmozyme therapy. If there is no increase in respiratory function, but the patient feels a subjective improvement in the condition, easier breathing and coughing, therapy should be continued. If there is no response to the administration of pulmozyme, it is possible to extend therapy for another 3 months and evaluate the effect of pulmozyme on the frequency of respiratory episodes. If this indicator has improved, pulmozyme therapy is recommended to continue. Pulmozyme should be prescribed during the period of the patient's stable condition, when it is possible to more objectively assess the effect of therapy on the state of the bronchopulmonary system and monitor possible adverse events. When prescribing Pulmozyme, you should not immediately cancel the standard mucolytic therapy that the patient received before. Only when it is clear that the patient has responded well to pulmozyme therapy can one begin to gradually withdraw other mucolytic drugs. Children, starting from the age of 2, can be prescribed pulmozyme if they are fluent in inhalation techniques through the mouthpiece or are calm about inhalation through a mask.

One should not strive for the complete abolition of other mucolytic therapy in seriously ill patients, since all known groups of mucolytics act on different links in the pathogenesis of the formation of viscous sputum and its accumulation in the respiratory tract. It is more expedient to inhale pulmozyme after kinesiotherapy, achieving its maximum penetration into the lungs. Carrying out kinesitherapy after inhalation of pulmozyme should be attributed to the time of the onset of the maximum mucolytic effect in each individual patient. With manifestations of pharyngitis or laryngitis in the first days of the appointment of pulmozyme, you should not immediately cancel the drug. Most likely, these phenomena will pass over time. In case of hemoptysis, you should immediately consult a doctor, since, perhaps, this is not a reaction to pulmozyme, but the first signs of an exacerbation of the bronchopulmonary process. And only when pulmonary bleeding does not go away with the use of antibacterial and hemostatic therapy, pulmozyme should be temporarily canceled in order to conduct a new trial administration of the drug some time after the stabilization of the condition. With repeated episodes of hemoptysis, coinciding with the start of the use of pulmozyme, the drug should not be prescribed. If the condition worsens, shortness of breath increases, attacks of dry cough appear, and respiratory function decreases, the drug should be immediately discontinued. Early administration of pulmozyme improves lung function, prevents respiratory episodes, and reduces inflammatory activity in the lungs.

Drug Interactions

Drug interactions are not known. In a nebulizer, Pulmozyme should not be mixed with other drugs or solutions. Pulmozyme can be effectively and safely used concomitantly with standard drugs for the treatment of cystic fibrosis, such as antibiotics, bronchodilators, digestive enzymes, vitamins, inhaled and systemic glucocorticoids, and analgesics.

IV. Vasicinoids: bromhexine (bisolvan), ambroxol (ambrobene, lazolvan)

Bromhexine has a mucolytic (secretolytic) and expectorant effect, which is associated with the depolymerization and destruction of mucoproteins and mucopolysaccharides that make up sputum, and has a slight antitussive effect. However, the availability of bromhexine, its relatively low cost, and the absence of side effects explain the rather widespread use

drug. Almost all researchers note a lower pharmacological effect of bromhexine compared to the new generation drug, which is an active metabolite of bromhexine, ambroxol hydrochloride.

Pharmacokinetics and pharmacodynamics

The bioavailability of bromhexine when taken orally is low - 80% due to the effect of "first pass through the liver", the drug is rapidly metabolized to form active compounds. When administered orally in tablets or as a solution, Bromhexine is completely absorbed within 30 minutes, in the blood plasma it is 99% bound to proteins, the volume of distribution at a stationary concentration is 400 liters. In addition, bromhexine binds to the erythrocyte membrane. The drug penetrates the blood-brain and placental barrier. Eliminated mainly in the form of metabolites, unchanged drug is eliminated by the kidneys only in the amount of 1%, metabolites are also excreted by the kidneys. In severe hepatic insufficiency, the clearance of bromhexine decreases, and in chronic renal failure, the clearance of its metabolites. The pharmacokinetics of bromhexine is dose-dependent, the drug can accumulate with repeated use.

Indications and contraindications

In cystic fibrosis and bronchial asthma, the drug is used with caution, preferably against the background of bronchodilators, since it is capable of provoking a cough reflex itself, it is also used for acute and chronic bronchopulmonary diseases, but it is not recommended during pregnancy and nursing mothers. Side effects: gastrointestinal disorders, skin reactions are rare. In severe chronic renal failure, dose adjustment and dosing regimen are necessary.

Dosing regimens

Bromhexine is mainly used orally, but inhalation of its solution through a nebulizer is also possible, and in surgery - parenteral administration intramuscularly or intravenously. After inhalation

2 ml of bromhexine solution, the effect occurs after 20 minutes and lasts for 4-8 hours. In tablets, adults are prescribed 8-16 mg 2-

3 times a day, and for children from 6 to 14 years old, 8 mg three times a day, younger than 6 years old -

4 mg 3 times a day. A solution for intravenous administration of 16 mg (2 ampoules) 2-3 times a day is also used, and for children under 6 years old - 4-8 mg once. There is a combined form - ascoril, which contains salbutamol sulfate, bromhexine hydrochloride, guaifenesin and menthol as components.

The clinical effect of ambroxol hydrochloride is significantly superior to bromhexine, especially in terms of the ability to increase the level of surfactant, since, in addition to stimulating the synthesis of surfactant, it blocks its decay. This is the basis for its more pronounced ability to increase mucociliary clearance compared to bromhexine. Being a hydrophobic boundary layer, the surfactant facilitates the exchange of non-polar gases and has an anti-edematous effect on the alveolar membranes. It is involved in ensuring the transport of foreign particles from the alveoli to the bronchial region, where mucociliary transport begins. Having a positive effect on the surfactant, ambroxol hydrochloride indirectly increases mucociliary transport and, in combination with increased secretion of glycoproteins (mucokinetic action), gives a pronounced expectorant effect. The mechanism of action of ambroxol is not fully understood. It is known that it stimulates the formation of low viscosity tracheobronchial secretion due to changes in mucopolysaccharides in sputum. The drug improves mucociliary transport by stimulating the activity of the ciliary system. It is very important that Ambroxol does not provoke bronchial obstruction. Literature data testify to the anti-inflammatory and immunomodulating effect of ambroxol: it enhances local immunity by activating tissue macrophages and increasing the production of secretory IgA, and also has an inhibitory effect on the production of interleukin-1 and tumor necrosis factor by mononuclear cells, which are one of the inflammatory mediators. It is suggested that inhibition of the synthesis of pro-inflammatory cytokinesis may improve the course of leukocyte-mediated lung injury. The antioxidant properties of ambroxol have also been proven, which can be explained by its effect on the release of oxygen radicals and interference in the metabolism of arachidonic acid in the focus of inflammation; the drug protects it from bleomycin-induced pulmonary toxin and fibrosis, inhibits neutrophil chemotaxis in vitro.

Pharmacokinetics and pharmacodynamics

After oral administration, the drug is rapidly and completely absorbed, but 20-30% of it undergoes rapid hepatic metabolism due to the "first pass" phenomenon. The duration of action after taking a single dose is 6-12 hours. Ambroxol passes through the placental and blood-brain barrier, as well as into breast milk, is metabolized in the liver: dibromanthranilic acid and glucuronic conjugates are formed.

Modes and methods of dosing

Ambroxol hydrochloride has a wide range of dosage forms: tablets, oral solution, syrup, retard capsules, solution for inhalation and endobronchial administration, injection solution. The dose of the drug for children under 5 years old is 7.5 mg 2-3 times a day, for children over 5 years old - 15 mg 3 times a day. For patients over 12 years of age, Ambroxol is prescribed 30 mg 3 times a day or 1 retard capsule per day. The duration of the course of treatment is from 1 to 3-4 weeks, depending on the effect and nature of the process. Adults and children over 12 years of age are prescribed 30 mg tablets 3 times a day for the first 3 days, and then twice a day; children aged 6-12 years - 15 mg 2-3 times, under 6 years old - 15 mg once, from 2 to 5 years 7.5 mg 2-3 times a day. The total volume of the inhaled substance should be 3-4 ml (if necessary, the drug is diluted with saline), the inhalation time is 5-7 minutes. It should be remembered that medicinal particles almost do not precipitate in places of atelectasis and emphysema. Obstructive syndrome also significantly reduces the penetration of aerosol into the respiratory tract, so inhalation of mucolytic drugs in patients with bronchial obstruction is best done 15-20 minutes after inhalation of bronchodilators. It must be borne in mind that when using a mask, a mucolytic improves the rheological properties of sputum, but at the same time, the use of a mask reduces the dose of a substance inhaled into the bronchi. Therefore, young children need to use a mask of the appropriate size, and after 3 years it is better to use a mouthpiece rather than a mask. The combined use of an inhaled form of a mucolytic drug with its parenteral administration (intramuscularly or intravenously) significantly improves the effectiveness of therapy, especially in patients with complicated and chronic bronchopulmonary diseases. The parenteral method of mucolytic administration ensures rapid penetration of the drug, including in the presence of severe inflammatory edema, bronchial obstruction and atelectasis. However, if there is a lot of mucus in the lungs, the drug does not affect the parietal layer of the secret, which does not allow to achieve the most effective expectorant effect. In such cases, it is better to combine the endobronchial and inhalation delivery methods with the intake of retard capsules, the administration of which once a day is quite effective.

Indications and contraindications

Ambroxol hydrochloride is used for acute and chronic respiratory diseases, including bronchial asthma, broncho-

ectatic disease, respiratory distress syndrome in newborns. You can use the drug in children of any age, even in premature babies. Perhaps the use of women in the II and III trimester of pregnancy. Side effects are rare; these are nausea, abdominal pain and allergic reactions, sometimes dryness in the mouth and nasopharynx.

Interactions

The combination of ambroxol with antibiotics certainly has advantages over the use of a single antibiotic, even if the effectiveness of the antibacterial drug has been proven. Ambroxol helps to increase the concentration of the antibiotic in the alveoli and bronchial mucosa, which improves the course of the disease in bacterial infections of the lungs. When combined with antibiotics, the drug increases the penetration of amoxicillin, cefuroxime, erythromycin and doxycycline into the bronchial secretion, which can be a significant factor affecting the effectiveness of antibiotic therapy. A statistically significant improvement in the parameters of external respiration functions in patients with bronchial obstruction and a decrease in hypoxemia while taking ambroxol were shown.

Lazolvan can be used together with β 2 -agonists in one nebulizer chamber. Side effects when using it are rare and manifest as nausea, abdominal pain, allergic reactions, dry mouth and nasopharynx.

Evidence base for the use of expectorant drugs

Opinions on the use of mucolytics (mucoregulators) in the treatment of patients with COPD are ambiguous. The mucolytic properties of these drugs, their ability to reduce adhesion and activate mucociliary clearance are successfully implemented in COPD patients with dyscrinia and hypersecretion. In the same place where bronchial obstruction is associated with bronchospasm or irreversible phenomena, mucolytics do not find a point of application. An analysis of 15 randomized, double-blind, placebo-controlled trials of oral mucolytic drugs for 2 months showed a slight decrease in the average number of days of disability and the number of exacerbations after treatment, which indicates a negligible role of mucolytics in the treatment of exacerbations of COPD. This did not allow the inclusion of these drugs in the basic therapy of patients with COPD (level of evidence D). The GOLD program discussed the antioxidant effect of N-acetyl-

cysteine ​​and, like N-acetylcysteine, have been shown to reduce the incidence of COPD exacerbations. This is important in patients with frequent exacerbations (Evidence B). The well-known National Mucolytic Study, conducted in the USA in stable patients with COPD, showed that mucoregulators (iodinated glycerol - organidin was studied) are able to bring subjective relief to patients, but objective evidence of the effectiveness of drugs has not been obtained. A study on oral N-acetylcysteine ​​conducted by the Swedish Lung Society showed that mucolytic drugs can reduce the number of exacerbations in patients with chronic bronchitis. It has been shown that, despite the weak relationship between the amount of tracheobronchial secretion and the severity of bronchial obstruction, there is a significant correlation between secretion hyperproduction, the number of hospitalizations and even the risk of death in patients with severe ventilation disorders. The results obtained in the study did not reveal a significant increase in FEV 1 in the general COPD group, but the scoring by patients of their well-being and dyscrinia shows a significant positive trend, however, in the presence of dyscrinia syndrome, the most objective criterion for the effectiveness of a mucolytic in the treatment of COPD is FEV 1. Thus, when choosing therapy in patients with COPD, one should focus on a specific nosological form, taking into account the severity of one or another pathogenetic mechanism: dyscrinia, bronchospasm, obstruction.

It is not recommended to prescribe cough suppressants to patients with bronchial asthma: this disrupts bronchial drainage, exacerbates bronchial obstruction and, as a result, worsens the patient's condition. This applies to codeine and non-codeine drugs, such as libexin, synecode, etc.

Most severe cases of asthma that do not respond to bronchodilator drugs are associated with widespread obstruction of the airways with mucous plugs, which leads to the progression of the obstruction process, and, as a result, status asthmaticus may develop. This is confirmed by the fact that in most of those who died from asthma, the lumen of the bronchi is clogged with thick and viscous sputum. This happens in cases where the rate of accumulation of mucus exceeds the rate of its evacuation from the respiratory tract and it is possible to eliminate the stagnation of mucus in the lungs only with the help of various expectorants. In Russia, mucolytics are widely used in patients with COPD, but in European and American guidelines they are given a modest role due to their unproven effectiveness.

Selection of drugs, monitoring their effectiveness and safety

Along with expectorant drugs, mucociliary transport of β 2 -adrenergic agonists and theophylline are enhanced, which, by expanding the bronchi, reducing spasm of the bronchial muscles, and reducing mucosal edema, accelerate the movement of the ciliated epithelium and increase the secretion of mucus.

When conducting pharmacotherapy with expectorant drugs, a stable clinical effect is observed on the 2-4th day, depending on the nature and severity of the course of the disease. In patients with acute bronchospastic syndrome, the effect is observed when prescribing beta 2-agonists, theophylline in combination with acetylcysteine ​​or drugs that stimulate expectoration. It should be borne in mind that in a number of patients with COPD, after the first day of expectorant therapy, an increase in sputum adhesion and viscosity was noted; this, apparently, was due to the separation of sputum accumulated in the bronchi and containing a large amount of detritus, inflammatory elements, proteins, etc. In the following days, the rheological properties of sputum improve, its amount significantly increases, viscosity and adhesion decrease (usually by the 4th day of the use of expectorant drugs), which indicates the correctness of their choice. Stabilization of the clinical effect was noted on the 6-8th day and was characterized by a decrease in the level of adhesion when used in patients with COPD lazolvan by 49.8%, bromhexine - by 46.5%, potassium iodide - by 38.7%, bromhexine in combination with chymotrypsin - by 48.4%. Less significant changes were observed in patients taking chymotrypsin (30.0%) and mukaltin (21.3%).

In cases where there is a diffuse lesion of the bronchial tree, significant changes in the rheological properties of sputum and a decrease in mucociliary transport, complex application is necessary. drugs that stimulate expectoration, and bromhexine; it is also logical to combine proteolytic enzymes or acetylcysteine ​​with bromhexine.

In patients with chronic bronchospastic and inflammatory syndrome β 2 -agonists, theophylline is best combined with ambroxol hydrochloride or acetylcysteine. In patients with chronic obstructive pulmonary disease (COPD), the effect of mucolytics on reducing the average number of days of disability and the number of exacerbations after treatment has not been proven, which indicates a minor role of mucolytics in the treatment of exacerbations of COPD. This did not allow the inclusion of these drugs in the number of basic therapies for patients with COPD (level of evidence D). N-acetylcysteine ​​has been shown to reduce the frequency of COPD exacerbations. This is important for patients

ents with frequent exacerbations. Despite the absence of a relationship between the amount of tracheobronchial secretion and the severity of bronchial obstruction, a significant correlation was found between secretion hyperproduction, the number of hospitalizations, and even the risk of death in patients with severe ventilation disorders. In the presence of dyscrinia syndrome, the most objective criterion for the effectiveness of a mucolytic in the treatment of COPD is FEV 1. When choosing therapy in patients with COPD, one should focus on a specific nosological form, taking into account the severity of one or another pathogenetic mechanism: dyscrinia, bronchospasm, obstruction.

A sharp decrease in viscosity and adhesion and a significant increase in the amount of sputum secreted cause a deterioration in the general condition, increased cough and the appearance of shortness of breath in some patients, which is due to bronchorrhea. With the development of these symptoms, it is necessary to cancel expectorant drugs, it is possible to add M-anticholinergics such as ipratropium bromide (Atrovent) or tiotropium bromide (Spiriva).

It is not recommended to prescribe cough suppressants to patients with bronchial asthma: this disrupts bronchial drainage, exacerbates bronchial obstruction and, as a result, worsens the patient's condition. Most severe cases of asthma that do not respond to bronchodilator drugs are associated with widespread obstruction of the airways with mucous plugs, which requires the appointment of mucolytics. In Russia, mucolytics are widely used in patients with COPD, but in European and American guidelines they are given a modest role due to lack of evidence of their effectiveness.

18.2. COUGH MEDICINES

Antitussive drugs include:

1. Medicines, central action

Narcotic antitussive drugs (codeine, dextramethorphan, dionine, morphine) suppress the cough reflex by inhibiting the cough center in the medulla oblongata. With prolonged use, physical dependence develops. These drugs depress the respiratory center.

Non-narcotic antitussive drugs (glaucine, oxeladin, petoxyverine, sinekod, tussuprex, broncholithin) are

they have antitussive, hypotensive and antispasmodic effects, do not depress breathing, do not inhibit intestinal motility, do not cause addiction and drug dependence.

2. Peripherally acting drugs

Libeksin. The drug with an afferent effect acts as a mild analgesic or anesthetic on the mucous membrane of the respiratory tract, reduces the reflex stimulation of the cough reflex, it also changes the formation and viscosity of the secret, increases its mobility, and relaxes the smooth muscles of the bronchi.

Enveloping and local anesthetics. Enveloping agents are used for coughing that occurs when the mucous membrane of the upper epiglottis of the respiratory tract is irritated. Their action is based on the creation of a protective layer for the mucous membrane of the nose and oropharynx. Usually these are lozenges or syrups of plant origin (eucalyptus, acacia, licorice, etc.), glycerin, honey, etc. Local anesthetics (benzocaine, cyclacin, tetracaine) are used only in a hospital according to indications, in particular for afferent inhibition of the cough reflex during bronchoscopy or bronchography.

The group of antitussive non-narcotic drugs of central action is indicated for cough associated with irritation of the mucous membranes of the upper (epiglottic) respiratory tract due to infectious or irritative inflammation (ARVI, tonsillitis, laryngitis, pharyngitis, etc.), as well as for dry, obsessive cough, accompanied by pain syndrome and / or violating the quality of life of the patient (aspiration, foreign body, oncological process), children with whooping cough. Apply before meals 1-3 times a day (according to indications). In patients with dry cough in acute bronchitis, the ingress of foreign particles, the use of libexin, glaucine is not effective enough. In these cases, the appointment of codeine or dionine at night (within 2-3 days) is justified. With pleurisy, stagnation in the pulmonary circulation, the development of cough aggravates the course of the underlying disease and requires the use of codeine.

With the development of a cough reflex due to factors that are not associated with bronchopulmonary diseases, the use of both non-narcotic and narcotic antitussive drugs is indicated, depending on the severity of the syndrome.

Cough is a reaction of the body to completely different diseases of the respiratory tract, often of an inflammatory nature. Sometimes it goes away on its own and does not require outside help. But, with a weakened immune system, the cough drags on for a long time, tormenting the patient and giving him a lot of inconvenience.

For the treatment of inflammatory pathologies of the bronchopulmonary system, there are many drugs, one of which is ACC. It is used to treat dry and wet (wet) cough, both in adults and in pediatrics. ACC is a safe and popular remedy that has repeatedly proven its effectiveness in the fight against viscous sputum, but because of its high cost, cheap ACC analogues are becoming popular. Pharmacological affiliation - mucolytic, ATX code: 05CB01.

Acetylcysteine, the main substance of ACC, has a pronounced anti-inflammatory, expectorant, thinning and antioxidant effect. The main task of the drug is to thin and remove sputum that is difficult to separate from the respiratory tract. Thanks to the cleansing of the bronchi, inflammation is removed, cough is eliminated, and the protective function of the mucosa is restored.

ACC with a dry cough is most in demand, so there is no doubt whether to purchase the drug or not. It is necessary as soon as possible to help the bronchi to be cleared of sticky sputum, which prevents the patient from recovering. Cough is not able to expel such sputum, so mucolytics will be required. ACC and its analogues, cheap or more expensive, allow the bronchopulmonary system to get rid of accumulated mucus and get rid of cough.

For ease of use, the drug is available in different forms. Patients can use effervescent tablets, hot drink (prepared from powder), solution (powder base). One of the latest innovations of Salutas Pharma GmbH (Germany) is ready-made syrup, which is available in bottles of 100 and 200 ml.

In terms of taste, ACC has a variety. There are forms with orange, cherry, lemon and blackberry flavors.

The action of ACC occurs on the first day of admission, and on the second day, patients note that they have wet sputum, and they already have something to expectorate. The feeling of tightness, pain, and other more unpleasant symptoms in the sternum are reduced.

What pathologies are treated with ACC?

The drug is used for all diseases accompanied by the accumulation of viscous, thick and difficult to separate sputum in the bronchi. These pathologies include:

• acute and chronic bronchitis;
• COPD (chronic obstructive pulmonary disease);
• pneumonia;
• bronchial asthma (mild and moderate degree);
• bronchiectasis;
• lung abscess;
• tracheitis and laryngotracheitis;
• cystic fibrosis (a systemic disease in which the secretion of mucus in the body is disrupted);
• sinusitis;
• inflammation of the middle ear.

How to dose the drug correctly?

Depending on the disease, the severity of symptoms and the age of the patient, the dose of ACC may vary.

So with cystic fibrosis, a maximum daily dose of up to 800 mg is allowed, while the patient's body weight should not be less than 30 kg.

Infants (from the third week of life) and babies up to 2 years of age are prescribed up to 150 mg per day, dividing the dose by 50 mg. Children from 2 to 5 years old are allowed to give up to 400 mg per day (we divide the drug into 4 doses). After 6 years, the maximum daily dose increases to 400-600 mg per day, it is also divided (three doses per day).

With uncomplicated cough, the course of treatment for ACC is a week. If necessary (chronic diseases), the drug is used up to 6 months.

ACC is dissolved in a liquid (100 ml), it is better to use water, but you can also use compote, juice, cool tea. Reception is made after meals. Doctors do not advise drinking ACC before bedtime, because. increased sputum flow, even in a horizontal position, can increase coughing. Therefore, the last dose should be immediately after dinner (around 18:00).

Instructions for use ACC prohibits the use of the drug in the following cases:

• intolerance to acetylcysteine ​​and all complementary components;
• severe allergic anamnesis;
• bleeding from the lung tissue;
• tendency to bronchospasm;
• hypotension;
• hemoptysis;
• fructose intolerance;
• ulcerative processes of the gastrointestinal tract;
• hepatitis and more severe kidney disease in children.

Against the background of taking ACC, the following negative reactions are possible:

• a sharp decrease in blood pressure;
• headache;
• the appearance of noise in the ears;
• nausea, diarrhea;
• stomatitis;
• itchy dermatoses;
• tachycardia;
• asthma attack;
• other.

Clinical trials of ACC did not reveal a negative effect of the drug on the fetus, but it is not recommended to use it at all stages of gestation and during breastfeeding.

If the patient is not satisfied with the price or side effects appear, ACC can always be replaced with cheaper analogues, both domestic and foreign. In this case, it is better to use drugs with a different active substance, because. structural analogues are more likely to cause the same undesirable symptoms.

ACC - cheap analogues for children and adults

To determine which analogues will be cheaper, let's first look at some ACC prices:

• orange granules No. 20 - 140 rubles;
• syrup 200 ml - 350 rubles;
• syrup 100 ml - 225 rubles;
• ACC 200 tablets No. 20 - 250-320 rubles;
• ACC long 600 mg effervescent tablets No. 10 - about 400 rubles.

The most popular analogue of ACC is the Swiss drug fluimucil. It is a structural analogue, and has much in common with ACC, even their price is the same.

1. You can buy cheaper, for example, acetylcysteine ​​​​made in Estonia (Vitale-HD). At a lower price, you can also buy Ambrohexal, Ambrobene or the domestic drug Ambroxol. These funds have another active substance - ambroxol.
2. Bromhexine is also considered a cheap analogue of ACC. The price for 100 ml of syrup (Russia) is 80 rubles, made in Latvia - 125 rubles.
3. Popular, but more expensive analogues are ascoril and lazolvan.

To replace the drug, always contact the specialist who prescribed the cough treatment. If this is not possible, you will have to work a little on your own. To do this, you need to take the instructions for the main drug, in our case it is ACC, and compare it with the intended substitute.

Many instructions already give a hint in the form of a list of potential analogues. The main thing is to pay attention to the list of warnings, indications, as well as age, especially when the child needs therapy. In principle, it is necessary to conduct a comparative assessment, and highlight all the advantages of the analogue.

Which is better - ACC or its analogues? Such a concept has its own relativity, since for one patient, for example, ACC is suitable, and for another, a remedy with a different composition. The clinical picture of the disease, the intake of concomitant medicinal substances, a history of chronic pathologies - all this together affects the exact determination of the desired drug. That is why without a medical education it is not advisable to conduct experiments on yourself and your loved ones.

Comparing drugs, you can only highlight the pros and cons, in order to better navigate the choice of analogues, as well as acquire a less toxic and more effective remedy.

ACC - instructions and analogues

ACC or lazolvan - which is better to choose?

The drugs differ in their composition, therefore, they are not structural analogues. The active substance of ACC is acetylcysteine, in lazolvan the main component is ambroxol. Funds are issued by different countries. ACC is produced by companies in Slovenia and Germany, and lazolvan is produced by France, Germany, Spain and Greece.

In terms of the number of dosage forms, lazolvan has an advantage, it has five of them, while ACC has only three.

Both drugs have a pronounced mucolytic effect, i. liquefy sputum, but their mechanism of "work" is different. Unlike lazolvan, ACC also exhibits antitoxic and antibacterial effects.

Sometimes the funds in question are prescribed in parallel. One drug is taken orally, the other is used by inhalation.

In pediatric practice, lazolvan is successfully used from a very early age, and ACC, starting from two years (for cystic fibrosis from birth). Lasolvan is often used for inhalation, so some pediatricians prefer it.

The price of drugs depends not only on the dosage form, but also on the country of manufacture. In general, the funds under consideration are close in price, and may differ within 20%, and in some pharmacies, lazolvan is more expensive, in others, on the contrary, ACC.

What is better ACC or Ambrobene?

The drugs differ in their composition, but they have the same pharmacological affiliation - mucolytics. The active ingredient in Ambrobene is Ambroxol hydrochloride.

Ambrobene's variety of dosage forms (there are five of them) is an advantage over ACC.

According to recent studies, it has been established that it has antiviral activity, has a mild analgesic effect, relieves inflammation, and removes toxins. Studies have also shown that ambroxol hydrochloride slows down the spread of the harmful protein alpha-synuclein, which causes the progression of a severe disease like Parkinson's disease.

Despite the way ACC and Ambrobene act, their main task is the same - to save the patient from thickened sputum.

We also allow the combined use of these funds. This combination is indicated when the disease becomes more serious.

According to the observations of pediatricians, and taking into account the instructions for the preparations, for the smallest patients, including infants, it is better to use ambrobene.

As for the price, let's do a little calculation. For a course of cough treatment with a common viral infection, you will need about 20 tablets of ambrobene. The price for them is 150 rubles. Tablets ACC 200 No. 20 cost about 300 rubles, this amount is also suitable for a course of treatment.

So, we see that the treatment of ACC will cost twice as much. Which is better to choose is up to the doctor and the patient.

ACC or fluimucil - which works better?

The means under consideration are structural analogues, and this suggests that they have the same principle of operation. After taking both drugs, the productivity of cough improves markedly by the end of the first day of administration, and after a few days this symptom itself recedes due to the release of sputum and the cleansing of the bronchopulmonary tree.

Firms and countries-manufacturers for drugs are different. Someone prefers the products of Switzerland or Italy (fluimucil), and someone prefers Slovenia and Germany (ACC).

If somewhere you can find significant differences in the presented funds, then these are the forms of release. These funds have different variations not only in the form of release, but also in dosages, which makes it possible to use the medicine at any age. It should be noted right away that according to these criteria, ACC has an advantage.

For example, ACC has a syrup, but fluimucil does not have this form. But fluimucil has a solution for oral administration, inhalation and injection (ACC does not have such forms). More details about all doses and forms are written in the official instructions, where you can more clearly read the information of interest.

Pulmonologists consider it undoubted - this is the use of an agent for inhalation and injection, due to which acetylcysteine ​​​​gets to its destination faster. This speed of action of the drug is especially important in acute cases of the disease.

Syrups are more popular in children's practice, so it is better for kids to advise ACC in cherry flavored syrup. But, in any case, only a pediatrician selects the right drug for children.

Parents must make sure that the child takes the syrup correctly. It is also important to give patients an alkaline drink to enhance the action of ACC or fluimucil.

Comparing prices, it was noticed that fluimucil in the form of effervescent tablets at a dose of 600 mg would be the cheapest.(about 150 rubles for 10 pieces). The price of ACC for the same dose and number of tablets is much more expensive, and is about 400 rubles. The cost of other forms is not particularly different, fluimucil is literally 10% cheaper.

Bromhexine or ACC?

The drugs are analogues only in therapeutic action. The active substance of bromhexine repeats its name, the drug is classified as a stimulant of the motor function of the respiratory tract and secretolytics.

As well as ACC, Bromhexine affects the secretion of bronchial glands, due to which thick sputum is liquefied. Under the influence of the means under consideration, sputum secretion and its evacuation from the bronchi improves.

The toxicity of ACC is lower, so the list of contraindications is shorter. Bromhexine perfectly suppresses the cough center, and ACC acts on the peripheral cough mechanism. This feature of these funds allows you to prescribe them in a complex, and the effect of treatment is much better than a single dose. The drugs complement each other perfectly.

Despite this possibility, this is not a reason to immediately take ACC and Bromhexine together. It all depends on the clinic of the inflammatory process and the ability of the bronchi to self-cleanse.

All forms of bromhexine are lower in cost, for example, the price of its 100 ml syrup is 100 rubles cheaper than the same syrup from ACC.

ACC or Askoril?

Comparing these drugs, let's pay attention, ACC is a mono drug (the active component is acetylcysteine), and ascoril is a combined remedy, which includes three active substances: bromhexine, guaifenesin and salbutamol.

Even an ordinary person, without a medical education, will understand that ascoril has a more powerful effect, because. supplied with three medicinal substances. In addition to the mucolytic and expectorant effect, ascoril also has a bronchodilator property (relieves spasm of the smooth muscles of the bronchi). Simply put, it relieves the feeling of tightness in the chest (suffocation).

If you look at the offers of pharmacies, then in most cases ascoril and ACC will practically coincide in price. So, for example, the price for a bottle of syrup in 200 ml is approximately 400 rubles for both drugs.

The cardinal difference between the drugs in question is that ascoril is not used for coughing, which is not accompanied by obstruction and asthma attacks.

Conclusion

ACC and its analogues help both with dry and wet cough, and it is up to the doctor to choose a substitute for the active substance or a suitable drug for therapeutic action. Especially unacceptable is the self-administration of drugs such as ascoril, which includes an active substance (salbutamol), which expands the bronchi.

Do not select analogues at your own peril and risk, approaching the choice based only on the price, cheaper does not mean more efficient! Competent appointment - a chance for quick healing! Be healthy!

It is important to treat a cough to the end, because otherwise severe complications may appear. It must be remembered that coughing is only a symptom, and therefore, first of all, you need to deal with the root cause. The drug must be selected with care, depending on the cause.

How to choose the right cough medicine

In order for the treatment to be effective, it is important to choose the right drug. First of all, it is necessary to determine the type of cough and what disease it is related to.

There are 2 large groups of cough attacks:

1. Unproductive or dry cough. As a rule, it is accompanied by a sore throat. It is characterized by strong coughing attacks that follow each other. It interferes with sleep, after it there are pains in the muscles of the abdomen and chest. The cause of the cough is irritation of the cough receptors, and in this situation it is recommended to use antitussive drugs (for example, Pectusin).
2. Productive cough. With it, sputum is removed from the lungs, trachea and bronchi. This type goes away as soon as the body gets rid of excess fluid in the airways. In the normal course of the disease, sputum comes out well. But if it is not enough or the consistency is too viscous, the process is disrupted. In these cases, drugs with expectorant action help (Doctor MOM). Mucolytics are also prescribed, which have the ability to thin sputum and help with the withdrawal from the respiratory tract (Ambroxol or ACC).

Before choosing a medicine, you should consult with your doctor. Because if you take what is intended for a different type, you will not only not be cured, but you can also do harm.

To cure a cough, along with drugs, it is worth monitoring the state of the air in the room where the patient is located. It must be damp, to achieve this, leave a damp towel or bowl of water. In addition, it is necessary to drink as much liquid as possible (at least 1.5-2 liters per day).

Ambroxol is one of the best mucolytic agents

In the drug Ambroxol, the main active ingredient is ambroxol hydrochloride. You can buy this medicine in the form of a syrup for children and tablets for adults.

The drug has several mechanisms of action:

1. Improving the functioning of ciliated cilia through the production of low-viscosity sputum. Thus, the productivity of coughing attacks increases.
2. Supports the alveolar network and the functioning of the lung tissue. This is due to the activation of the secretion of the surfactant.

• bronchitis;
• pneumonia;
• poor sputum discharge in asthma;
• bronchiectasis;
• respiratory diseases with viscous sputum;
• sinusitis.

Reviews about this drug are positive. Anna from Moscow noted: “My husband fell ill with ARVI and drank Ambroxol for coughing. It has greatly eased the cough. Used tablets, taking 1 three times a day. In just a few days, relief came. ”

The advantage of the drug over analogues is that when taken, the amount of sputum does not increase much. Therefore, the body is cleansed faster. This remedy is effective in the treatment of diseases of adults and children.

Benefits of using the drug:

1. High efficiency and fast results.
2. Different forms of release of the drug (solution for inhalation, for internal use, syrup, tablets, simple and effervescent).
3. The absence of sugar in the solution.
4. Few contraindications.

Cons of the drug:

• can not be used by pregnant women;
• the risk of an allergic reaction;
• bitter aftertaste.

Ambroxol should not be used simultaneously with antitussive drugs. The fact is that such drugs suppress cough urges and complicate sputum discharge.

ACC for cough relief

ACC is one of the effective means in the fight against cough. The active substance is acetylcysteine. The drug acts as an expectorant, thinner and anti-inflammatory agent. The main purpose of the drug is to rid the respiratory tract of sputum.

ACC has different forms of release:

• effervescent tablets;
• solutions;
• syrup;
• powder (drinks are made from them).

After taking the medicine, it becomes easier on the first day from the start of use. Coughing improves, sensations of discomfort and pain in the chest area decrease.

When is it relevant to use this medicine:

• pneumonia;
• acute bronchitis;
• Chronical bronchitis;
• sinusitis;
• otitis;
• laryngotracheitis;
• mild asthma;
• moderate asthma.

Patients note the speed of the drug and the improvement of the condition from the first application. Alena from Volgograd says about him: “I drink effervescent ACC with acute respiratory infections and acute respiratory viral infections. Relief comes from the first use, and the cough completely disappears in just a week.

The benefits of the drug:

1. Pleasant taste and convenient form of release.
2. Side effects happen infrequently.
3. The drug removes mucus from the respiratory tract.
4. Cough instantly becomes easier to bear, and after a few days it completely disappears.

Negative sides:

1. Fairly high price.
2. A large number of contraindications (including gastrointestinal diseases, pregnant and lactating mothers).
3. Danger of developing an allergic reaction.

As for ACC and Ambroxol, they are not analogues, since their active substances are different. The drugs have a thinning and expectorant effect. If we talk about compatibility, then these medicines are often prescribed in parallel with each other. In addition, doctors sometimes prescribe medications along with mucolytics that reduce bronchial edema.

Joint reception of ACC and Ambroxol

Question: “Can I take ACC and Ambroxol together?” Asks Nadezhda.

The doctor of the highest category, pulmonologist - Sosnovsky Alexander Nikolaevich answers:

There are no official manufacturer's instructions regarding the combined use of ambroxol and ACC (acetylcysteine). This means that the simultaneous use of both drugs is acceptable. Only a logical question arises - why? Both drugs are mucolytics. They dilute sputum, but they can only indirectly increase its discharge. This requires expectorants.

Therefore, mutual synergy from ambroxol and ACC should not be expected. It makes sense to combine any of them with antibiotics, antivirals or expectorants. Taking ambroxol and ACC together is only to achieve polypharmacy and enhance the side effects of both drugs.

Continuous use of beclamethasone

Whistling in the chest during sleep

2 week old baby diagnosed with pneumonia by x-ray

Citrus fruits help strengthen the immune system, but they are not always allowed to be used for lung diseases. Consult with your physician for clarification.

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All about lung and respiratory health

The information on the site is provided for reference purposes only. At the first sign of disease, consult a doctor!

JMedic.ru

Bronchitis is a disease that is caused by inflammation of the bronchi, which entails hypersecretion of viscous mucus and a strong cough symptom. That is why it is advisable to use expectorants for bronchitis for effective treatment.

However, given that there are a lot of all kinds of medicines on the pharmaceutical market, good and not so good, it is not so easy to cure yourself.

Causes and pathogenesis of the disease

There can be many reasons for the occurrence of bronchitis, however, the most common of them are as follows:

1. Viral or bacterial disease of the respiratory tract. As a result of the interaction of micro- and macroorganism (virus, bacteria and humans), a typical inflammatory reaction occurs.
2. Bronchial asthma or obstructive bronchitis, to put it in the old way. In this case, the inflammation is due to the action of the allergic component.
3. Smoker's bronchitis or chronic obstructive pulmonary disease that results from the deposition of some kind of dust (suspended particles) on the inner lining of the bronchial tree. The same inflammation, however, has been building up over the years.

As a result, as a result of edema of the bronchus wall (its mucous membrane), there is a narrowing of the lumen of the bronchus, the release of a large amount of mucus and a violation of its secretion by the cells of the ciliated epithelium. Naturally, in this case, a very strong cough is observed - the process of "flooding" of the bronchial tree occurs, but all these cough shocks are of little effect due to the fact that the cells of the ciliated epithelium are not able to function normally. There is a violation of mucociliary clearance.

It should be noted that at the very beginning of the disease, there is not a wet (accompanied by sputum discharge), but a dry cough, which is caused by irritation of the cell wall.

That is why the use of expectorant drugs is of key importance in the treatment of this disease.

Examples of drugs

Ambroxol

One of the most basic drugs of this series is ambroxol hydrochloride (it is known under such trade names as Ambroxol - production of the Borshchagovsky plant, Darnitsa, Abrol - products of the Kusum company, Ambrobene - the German company Teva, Lazolvan - the original Swiss drug and many others). They differ in price and very significantly - for 1 unit of Lazolvan's product, you can buy 3-4 packs of Ukrainian Ambroxol. What is the paradox - the quality is quite comparable.

This medicine is available in the form of a syrup (for children) and in the form of tablets (for adults).

The mechanism of action of the drug has a different focus. The main active ingredient affects the formation of a large amount of low-viscosity sputum (which can significantly simplify the work of ciliated cilia of epithelial tissue). This effect is achieved by the destruction of the disulfide bridges of those substances that make up the secretion of sputum. A similar mechanism leads to an increase in the effectiveness (productivity) of coughing.

An important property of Ambroxol is its ability to enhance the synthesis of surfactant - a substance that supports the mechanical basis of the lung tissue and the alveolar network.

Moreover, due to the medicinal properties of ambroxol hydrochloride, the secretion of surfactant is potentiated in specially designed cells that transit fluids through the alveolar-capillary drainage.

The advantage of this medicine is also that under its influence there is no significant increase in the volume of sputum secreted.

Treatment regimen: young children are given at the rate of 0.5 teaspoon twice or thrice a day (correlating with the severity of the child's condition), older children - one teaspoon three times a day, adults and adolescents - one tablet three times a day. In children under 1 year old, it is better to use an ambrobene solution.

Recently, nebulizer therapy has been widely used - the method of inhalation of a solution of Lazolvan or Ambrobene, 5 minutes 3 times a day. Very effective treatment for both children and adults.

An earlier analogue of Ambroxol, Bromhexine, is also an effective drug, but is now produced and sold only in the form of tablets.

The next expectorant that has received worthy recognition among doctors and patients is ACC - acetylcysteine. Its treatment mechanism is in many ways similar to Ambroxol, but this drug has the advantage that it exists not only in the form of tablets and syrup, but also in the form of a sachet. It is easier to dose this medicine than Ambroxol - children should be given a sachet of 100 mg twice a day, adolescents 200 mg twice a day, adults 600 mg 1 time a day. In addition, there is a tablet form of ACC-long - an effervescent tablet, taken at the rate of 1 for 24 hours (very convenient for a busy person).

Children under 2 years of age should not be given the drug.

It should also be borne in mind that ACC is more expensive than Ambroxol.

A more effective drug - Carbocysteine ​​​​(Langes) has a more pronounced therapeutic effect and fewer side effects.

Phytopreparations and dietary supplements

Regarding all other drugs to improve the excretion of sputum (meaning herbal origin). Vivid examples are Alteyka, Prospan, Gedelix, Doctor Tays, Mukaltin, Antitussin, Pertussin and more. Despite the conviction of people in their safety and effectiveness, the expediency of their use is under a very big question, and according to many criteria. Even starting from the positions of the currently advertised evidence-based medicine, there is no evidence (scientific) of the effectiveness of these drugs. Not to mention the empirical approach - the difference is at the placebo level, nothing more.

But the worst thing is how high the number of complications that occur after taking this kind of drugs (especially in children). As a rule, these are all kinds of allergic and peudo-allergic reactions - ranging from angioedema, urticaria and ending with all types of anaphylaxis, Lyell's syndrome).

Alternative treatment

Traditional medicine is generally a separate issue that will be discussed over a long period of time. Probably, until there are significant changes in the minds of our people and modern medicine reaches a more or less decent level.

For cough, even our distant ancestors used oregano, thyme and chamomile. Yes, this is all, of course, very good, but after all, no one in the twenty-first century will use pigeon mail if there is an Internet.

Similarly, in medicine, all such remedies are an anachronism, and in order to obtain a high therapeutic effect at home, we will use only the best modern and proven remedies. By the way, about the fact that "pharmacists poison people with chemicals", as many people think now. Considering the ecological situation, all “herbs” bought on the spontaneous market are much more dangerous for human health than drugs that have passed many controls that are not related to traditional medicine.

The only good non-drug (one might say, folk) remedy is an alkaline drink.

Recipe: 0.5 teaspoon of soda per glass of hot milk 3 times a day. At home, it replaces the infusion of sodium bicarbonate, carried out in a hospital.

conclusions

It is advisable to combine expectorants for bronchitis with drugs aimed at reducing swelling of the bronchus, for example, with Erespal. It is not recommended to take antitussive drugs of central action (codeine) in order to avoid a pronounced syndrome of flooding of the bronchial tree. Drink plenty of fluids.

In case of ineffectiveness of treatment with expectorants alone, it is necessary to add antibacterial therapy (Amoxiclav, Zinnat), it is possible at home.

The optimal scheme for the treatment of bronchitis at home:

1. Bed rest, alkaline drink.
2. Ambroxol 1 tab. 3 times a day (7 days course).
3. Erespal 1 tab. 2 times a day (5 days course).

Acct or Ambroxol, which is better to use when coughing

Cough therapy can be carried out by means with a different type of effect on the respiratory system. Often, to achieve the desired result, you need to combine medicines from adjacent groups. The list of the most effective means traditionally includes ACC or Ambroxol. Should they be used together or separately? Below is the answer to this and other questions.

Brief drug comparison

ACC is a synthetic cough medicine based on acetylcysteine. The drug stimulates the excretion of sputum by thinning the mucus.

Ambroxol is a drug with a pronounced expectorant effect. The drug also dilutes sputum and stimulates the elimination of mucus from the bronchi.

The difference between cough medicines lies in the mechanism of action. ACC destroys mucus molecules by destroying the disulfide "bridges" that bind mucopolysaccharides in the sputum structure. Due to this chemical reaction, the viscosity of mucus decreases, and its elimination from the bronchi is accelerated.

Ambroxol affects the glands located in the mucous membrane of the respiratory tract. The result is a stimulation of goblet cell activity with an increase in the liquid component of sputum, which makes the process of its discharge easier. The drug further enhances the motor function of the ciliated epithelium of the bronchi. The transport of mucus to the outside improves with the normalization of microcirculation.

Fact! ACC additionally increases the synthesis of glutathione, a substance with pronounced antitoxic and antioxidant activity. The negative impact of free radicals and products of secondary drug metabolism is minimized.

ACC pros and cons

Treatment of cough with ACC alone is less common. The reason is the effect of the agent on viscous mucus. If for some reason sputum has not had time to form, the effectiveness of the medicine drops.

• fast onset of action - up to 1 hour;
• good sputum liquefaction, which provides quick clearance of bronchial mucus;
• interesting dosage form. ACC is available in the form of effervescent tablets that dissolve in water, which accelerates the absorption of the drug into the blood.

The good efficacy of the drug against the background of a small number of adverse reactions and contraindications makes ACC in demand on the pharmaceutical market.

• narrow range of indications;
• the need to prescribe additional funds for effective cleaning of the respiratory tract. Due to the lack of influence on the cilia of the epithelium, the drug actually has only a mucolytic effect. The rate of excretion of liquefied mucus depends on the individual characteristics of the human respiratory system.

Despite these disadvantages, ACC in the treatment of cough, accompanied by the formation of thick sputum, takes pride of place. Before using the medication, you should consult your doctor.

Ambroxol, pros and cons

Which is better: ACC or Ambroxol? This question is often asked by patients to doctors. Many make Ambroxol the favorite of the competition.

1. Large evidence base for the effectiveness of the remedy. Dozens of clinical studies have proven the feasibility of prescribing Ambroxol for the treatment of cough of various etiologies;
2. Variety of dosage forms. The drug is sold in tablets, syrups of various concentrations, solutions for inhalation;
3. Safety;
4. "People's" love. Ambroxol is the most commonly prescribed cough medicine.

An important advantage of this cough remedy is the effect on the alveoli of newborns. The drug stimulates the synthesis of surfactant, which prevents gluing of the respiratory sacs of the lungs. This therapy is carried out for premature babies suffering from a lack of the corresponding bioactive substance in the body.

1. The impossibility of using the drug in patients suffering from gastric ulcer;
2. The need for dose selection for each age group. Treatment of children under 12 years of age requires the purchase of a syrup with a concentration of Ambroxol 15 mg / 5 ml, which is not always available in pharmacies;
3. The need to drink large amounts of fluid during treatment to stimulate the function of the mucous glands of the bronchi.

How are they similar and what is the difference between them

ACC and Ambroxol reach the maximum concentration in the blood at the same time, within 1-3 hours. The half-life of the funds is almost the same.

General properties of cough medicines:

• liquefaction of sputum;
• elimination of predominantly wet cough;
• availability. The price for both medicines fluctuates within the limits of rubles;
• safety;
• similar contraindications. Medicines should not be taken for gastric ulcer or duodenal ulcer due to the risk of aggravating the patient's condition.

Is it possible to use Ambroxol and ACC at the same time

Given the above features, it becomes logical to ask whether it is possible to take ACC and Ambroxol together. In 95% of cases the answer is yes. Standards for the treatment of cough, accompanied by the formation of thick sputum, provide for the simultaneous administration of both drugs.

Good compatibility of agents and interaction of bioactive substances, which accelerate the destruction and elimination of mucus, ensure the recovery of the patient with the normalization of the function of the bronchial epithelium.

If it is necessary to use antibacterial agents, Ambroxol further enhances the concentration of antimicrobial drugs that penetrate the alveoli, increasing the rate of destruction of pathogenic microorganisms.

The compatibility of Ambroxol and ACC has been proven by clinical studies. The dosage and frequency of taking funds in each case is selected individually for the effective elimination of cough. The average duration of complex therapy is 1 week.

ACC or Ambroxol, which is better for coughing for children and adults

ACC and Ambroxol are not always used together. The choice of the appropriate drug depends on the characteristics of the clinical case, the age of the patient, the individual characteristics of the organism.

Adult patients suffering from dry unproductive cough without fever are traditionally prescribed ACC. The reason is a convenient dosage form (effervescent tablets) and good responsiveness of the body to therapy.

Premature babies are prescribed only Ambroxol. Patients from 2 years of age can take any of the drugs described. In the case of using Ambroxol, it is necessary to buy a syrup with a dose of 15 mg / 5 ml.

These situations remain conditional. In each case, the doctor comprehensively assesses the patient's condition and prescribes the most appropriate drug. Often, drug replacement is required due to the nature of the interaction of chemicals with the human body.

Conclusion

Ambroxol and ACC are excellent cough suppressants. High efficiency and affordable price make the drugs leaders among the medicines used in the treatment of diseases of the respiratory system. Means can be used both independently and in combination. The main thing is the selection of an adequate dose and the implementation of the doctor's recommendations.

Ambroxol, Erespal and ACC.

Do not forget about folk methods. Milk with honey. Figs. Onion juice with honey. compresses.

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  ACC or Lazolvan - which is better?

  Sputum hyperproduction may be a risk factor for patients prone to obstructive reactions in acute and chronic bronchopulmonary diseases. According to the International Organization for the Study of Asthma and Allergy, about 30% of children are prone to obstruction. Why is broncho-obstructive syndrome dangerous? Excessive mucus production leads to blockage of the respiratory tract and respiratory failure. To prevent this from happening, mucolytic agents are used in medical practice. They regulate the production of bronchial secretions, dilute sputum, help it move through the respiratory tract and thus contribute to their purification.

  What is the difference?

  The preparations in question belong to the pharmacological group of mucolytic agents. The main active ingredient in ACC is acetylcysteine(the name of the drug comes from the abbreviation of this component).

  As an active ingredient, Lazolvan contains another substance - ambroxol.

  ACC is produced by Hexal (Germany) and Sandoz (Slovenia). Lasolvan is produced in several countries (Germany, Greece, Spain, France) under the auspices of Boehringer Ingelheim International. The drugs are produced in several dosage forms and in different dosages.

  In the brand line there are such forms of release:

  • syrup with an active ingredient concentration of 20 mg / ml;
  • granules for the preparation of a solution for drinking in dosages of 100, 200 and 600 mg;
  • effervescent tablets (ACC 100, 200 and Long, respectively, 100, 200 and 600 mg).

  Lazolvan is produced in the form:

  • tablets of 30 mg,
  • solution for drinking and inhalation at a dosage of 7.5 mg / ml,
  • lozenges of 15 mg,
  • syrup 15 and 30 mg,
  • capsules with prolonged action and increased to 75 mg dosage of ambroxol (Lazolvan Max).

  How is the action different?

  The basic principle of action of mucolytics, including such as ambroxol or acetylcysteine, is based on the thinning of sputum - a complex of substances secreted by various cells of the tracheobronchial tree.

  With each breath, a person captures millions of dust particles and microorganisms along with the air. If there were no natural mechanism for cleaning the lungs, then as much dust would accumulate in them as you see when you shake out the vacuum cleaner.

  The mucus secretion produced by goblet cells, Clara cells and submucosal cells, as well as the ciliated cells of the respiratory tract, are the "master screws" of the lung clearance mechanism.

  Mucus traps inhaled microparticles. Ciliated cells, so named for the huge number of outgrowths that oscillate in one direction, form an upward flow of mucus that is excreted from the respiratory tract. You will be surprised, but the ciliated cells are able to act very quickly: the speed of movement of the mucous secretion with normal viscosity is 1-2 cm per minute.

  Slime is a mixture of:

  • proteins,
  • lipids
  • water,
  • electrolytes,
  • mucoproteins and mucopolysaccharides.

  The latter substances provide bronchial secretion with viscoelastic properties that help to capture microparticles. With inflammation, sputum becomes more viscous, its amount increases, and the activity of the ciliated epithelium, on the contrary, decreases.

  The mucolytic effect of ACC is based on the fact that it dissolves mucus by destroying disulfide crosslinks between mucopolysaccharide molecules. After absorption, acetylcysteine ​​passes into cysteine, which not only has antioxidant properties itself, but is also a direct precursor of glutathione, one of the main antioxidants in our body.

  In addition to mucolytic and antioxidant, it has a number of other beneficial effects:

  • antibacterial,
  • anti-inflammatory,
  • antitoxic.

  If we compare ACC with Lazolvan in terms of therapeutic efficacy, then an almost similar result is revealed, although ambroxol, the main mucolytic substance of Lazolvan, has a different mechanism of action.

  Ambroxol is a derivative of bromhexine, which in turn is a synthetic analogue of the plant alkaloid vasicin. The main point of application of its biological action is the activation of the synthesis and secretion of pulmonary surfactant.

  Surfactant is a mixture of surfactants of a lipid and protein nature that prevents the lung alveoli from collapsing. It helps to carry out gas exchange, and its role is so important that a decrease in its production leads to hypoxia.

  The expectorant effect of ambroxol is based on the fact that it increases the activity of the ciliated epithelium, contributing to the rapid discharge of sputum. In addition, ambroxol, like ACC, has antioxidant and anti-inflammatory properties.

  Can they be taken together?

  Due to the difference in the mechanism of action, drugs can be prescribed in some cases together. For example, a combination of taking the oral form (table) of ACC and inhalation with Lazolvan is possible.

  In addition, combination preparations containing ambroxol and acetylcysteine ​​have recently appeared.

  In a clinical study conducted on 30 patients with COPD (chronic obstructive pulmonary disease), it was shown that when using a combination of 30 mg of ambroxol and 200 acetylcysteine ​​for 10 days (3 times a day) in patients against the background of a pronounced improvement in the function of external respiration, no adverse events were observed.

  However, we should not forget that there are many reasons leading to inflammation of the respiratory tract, the appearance of cough and sputum. Therefore, in each specific case, only a doctor can prescribe Lazolvan and ACC at the same time, based on the patient's history and safety considerations for his health.

  What is best for children?

  At this age, they are prescribed quite often, because in children under 5 years of age there is a tendency to increase bronchopulmonary secretion against the background of insufficient synthesis of surfactant.

  The high safety of drugs allows the use of Lazolvan in children from a very young age, and ACC - starting from 2 years.

  Often Lazolvan is the drug of choice in children in the treatment of infectious diseases, since it has the ability to increase the content of antibiotics in bronchial secretions. It can be prescribed in the form of inhalations, which increases the effectiveness of therapy.

  Differences in contraindications and costs

  What is better to choose in the nearest pharmacy with an equivalent therapeutic value. Let's compare the prices of the most popular products.

  100 ml Lazolvan syrup costs about 210 rubles. The same amount of ACC syrup is 20% more expensive. The cost of a pack of Lazolvan tablets (20 pcs.) Is approximately 170 rubles. The same number of ACC 200 effervescent tablets will cost 35% more.

  You will be interested to know:

  Comments

  Thanks! Very clear and well written

  ACC is combined with Ambrobene, is it possible to take them at the same time?

  Is it possible to drink ACC and Ambrobene together?

  The drugs can be taken at the same time.

  Let's take a look at the composition. ACC contains acetylcysteine, which has an expectorant and mucolytic effect. It dilutes sputum, promotes its exit from their respiratory tract. Ambroben contains Ambroxol, which has a different mechanism of action, but the same effect. These substances do not interact with each other, are not incompatible. And the proof of this is the presence of a combined agent that contains both acetylcysteine ​​and ambroxol. This is Pulmobreeze.

  However, with a normal cough, one drug is enough for a person. Even taking two, a person will not get rid of sputum much faster. Therefore, it is not very rational to take drugs at the same time, spending extra money on them. It's better to stop at one.

  Ambrobene, like ACC, has a mucolytic and expectorant effect on the bronchi in acute bronchitis, chronic bronchitis, and for the treatment of cough. These two medicines thin the mucus and clear the airways.

  The active component of Ambrobene is Ambroxol, ACC has an acetylcysteine ​​component.

  Together, Ambrobene and ACC can be taken, but with moderate and severe bronchopulmonary diseases and not with self-treatment.

  To rapid and effective treatment while taking these two drugs will lead if you do inhalation with Ambrobene and ACC tablets.

  ACC in the form of syrup can be given to children from 2 years of age.

  Ambrobene syrup is indicated for children from infancy.

  Ambrobene (holds lazolvan + mukosolvan) and ACC are designed to thin sputum and what's the point of giving them together.

  You can replace them with Mukoltin, it is cheaper and sometimes more effective.

  The difference between these pills is only in terms of treatment. ACC is given to the child for 3 days, and Ambrobene is longer.

  At the same time, inhalation with Berodual can be carried out (as well as ACC for no more than 3 days), it expands the bronchi and sputum will come out better.

  In ambrobene, the active ingredient is ambroxol, and ACC is acetylcysteine, their action is different, although both drugs are prescribed for dry cough, as they contribute to thinning and better sputum separation. For me, ACC is a stronger and more effective drug, but it should not be taken for a long time. There are cases when doctors prescribe both of these drugs at the same time, but usually this happens in a severe course of the disease, when the use of one of these drugs is not very effective. But then it is recommended to use different forms of administration, inhalation with ACC and ambroxol orally in tablets or in the form of a suspension. It is not recommended to combine these drugs without a doctor's prescription, since the side effects from taking them double, these drugs already have enough contraindications.

  They can not be drunk at the same time, but you can alternate. If you drink, for example, three times a day at a standard dose of each of the drugs, then they will enhance the effect of each other, that is, it is fraught with an overdose and side effects. But on the other hand, you can drink one of the medicines during the day, and the other - in the morning and in the evening. Since they act in a similar way, such treatment will also be effective and safe.

  First, we will study the instructions enclosed in the box with the drug.

  Most likely there will be an answer to this question.

  And it will be negative, because drugs of similar action - sputum thinning.

  Those. you can start with ACC, and after three days finish the treatment with ambrobene.

  It is forbidden. Both drugs greatly thin the sputum, in this regard they have a similar effect. That is, taking both drugs, you essentially exceed twice the recommended dosage, and this cannot be done. If you drank one of the drugs for 5-7 days, and the cough did not go away, you can replace it with another.

Catad_tema Colds and SARS - Articles

Mucolytic drugs in the daily practice of a doctor

O.V. Zaitseva, Professor, Head of the Department of Pediatrics, Moscow State University of Medicine and Dentistry, Roszdrav, Dr. med. Sciences

It is known that inflammatory diseases of the respiratory tract are characterized by a change in the rheological properties of sputum, hyperproduction of viscous secretion and a decrease in mucociliary transport (clearance). This is especially pronounced in young children.

Therefore, the main goal of therapy in such cases is to thin the sputum, reduce its adhesiveness and thereby increase the effectiveness of coughing.

Medications that improve sputum separation can be divided into several groups:

• means of stimulating expectoration;
• mucolytic (or secretolytic) drugs;
• combined preparations (contain two or more components).

DRUGS THAT STIMULATE Expectoration

This group includes herbal preparations (thermopsis, marshmallow, licorice, etc.) and preparations of resorptive action (sodium bicarbonate, iodides, etc.). They contribute to an increase in the volume of bronchial secretions. Means that stimulate expectoration (mainly herbal remedies) are often used in the treatment of cough in children. However, this is not always justified. Firstly, the effect of these drugs is short-lived, so it is necessary to take small doses every 2-3 hours. Secondly, an increase in a single dose causes nausea and, in some cases, vomiting. Thirdly, drugs in this group can significantly increase the volume of bronchial secretions that young children are unable to cough up on their own, which leads to a significant violation of the drainage function of the lungs and reinfection.

MUCOLYTIC (OR SECRETOLYTIC) DRUGS

In the vast majority of cases, this group of drugs is optimal in the treatment of respiratory diseases in children. Mucolytic drugs (bromhexine, ambroxol, acetylcysteine, carbocysteine, etc.) affect the gel phase of bronchial secretions and effectively thin sputum without significantly increasing its amount. Some of the drugs in this group have several dosage forms that provide various methods of drug delivery (oral, inhalation, endobronchial), which is extremely important in the complex therapy of respiratory diseases in children, both acute (tracheitis, bronchitis, pneumonia) and chronic ( chronic bronchitis, bronchial asthma, congenital and hereditary bronchopulmonary diseases, including cystic fibrosis). Also, the appointment of mucolytics is indicated for diseases of the upper respiratory tract, accompanied by the release of mucous and mucopurulent secretions (rhinitis, sinusitis). Mucolytics are most often the drugs of choice in children in the first 3 years of life. At the same time, the mechanism of action of individual representatives of this group is different.

Acetylcysteine(ACC, N-AC-ratiopharm, Fluimucil) is one of the most active mucolytic drugs. Its mechanism of action is based on the effect of breaking the disulfide bonds of sputum acid mucopolysaccharides. This leads to depolarization of mucoproteins, helps to reduce the viscosity of mucus, thin it and facilitate excretion from the bronchial tract, without significantly increasing the volume of sputum. Restoration of normal parameters of mucociliary clearance helps to reduce inflammation in the bronchial mucosa. The mucolytic effect of acetylcysteine ​​is pronounced and fast. It is extremely important that the drug also contributes to the liquefaction of pus and thereby increases its evacuation from the respiratory tract.

The high efficiency of acetylcysteine ​​is due to its unique triple action: mucolytic, antioxidant and antitoxic. The antioxidant effect is associated with the presence of a nucleophilic thiol SH-group in acetylcysteine, which easily gives up hydrogen, neutralizing oxidative radicals. The drug promotes the synthesis of glutathione, the main antioxidant system of the body, which increases the protection of cells from the damaging effects of free radical oxidation, which is characteristic of an intense inflammatory reaction.

Acetylcysteine ​​has a pronounced non-specific antitoxic activity - the drug is effective in poisoning with various organic and inorganic compounds. So, acetylcysteine ​​is the main antidote for paracetamol overdose.

There are literature data on the immunomodulatory W. Droge] and antimutagenic properties of acetylcysteine, as well as the results of still few experiments indicating its antitumor activity [M.N. Ostroumova et al.]. In this regard, it has been suggested that acetylcysteine ​​seems to be the most promising in the treatment of not only acute and chronic bronchopulmonary diseases, but also to prevent the adverse effects of xenobiotics, industrial dust, and smoking. It is noted that the properties of acetylcysteine ​​are potentially important, associated with its ability to influence several metabolic processes, including glucose utilization, lipid peroxidation and stimulate phagocytosis.

Also, acetylcysteine ​​is prescribed during intratracheal anesthesia in order to prevent complications from the respiratory tract.

Acetylcysteine ​​is effective when administered orally, parenterally, with endobronchial and combined administration.

In many years of clinical practice, both in adults and in children, acetylcysteine ​​\u200b\u200b-ACC has proven itself well. The high safety of ACC is associated with its composition - the drug is an amino acid derivative. However, acetylcysteine ​​is recommended to be used with caution in patients with bronchial asthma, tk. some authors sometimes noted an increase in bronchospasm in adult asthmatics. According to the approved instructions, acetylcysteine ​​should be used with caution in peptic ulcer disease (there are no absolute contraindications).

ACC can be used in children from 2 years of age. ACC is produced in granules and effervescent tablets for the preparation of a drink, incl. hot, in dosages of 100, 200 and 600 mg, applied 2-3 times a day. Doses depend on the age of the patient. Usually, children from 2 to 5 years old are recommended 100 mg of the drug per reception, over 5 years old - 200 mg each, always after meals. ACC 600 (Long) is prescribed 1 time per day, but only for children over 12 years old. The duration of the course depends on the nature and course of the disease and ranges from 3 to 14 days for acute bronchitis and tracheobronchitis, and 2-3 weeks for chronic diseases. If necessary, courses of treatment can be repeated. Injectable forms of ACC can be used for intravenous, intramuscular, inhalation and endobronchial administration.

Carbocysteine(Bronkatar, Mukodin, Mukopront) not only has a mucolytic effect, but also restores the normal activity of secretory cells. There is evidence of an increase in the level of secretory IgA against the background of taking carbocysteine. The drug is available for oral administration (capsules, syrup).

Bromhexine is a derivative of the vizine alkaloid and has a mucolytic, mucokinetic and expectorant effect. Almost all researchers note a lower pharmacological effect of bromhexine compared to the new generation drug, which is an active metabolite of bromhexine - ambroxol. However, the relatively low cost of bromhexine, the absence of side effects, and the convenience of packaging explain the fairly widespread use of the drug. Bromhexine is used for acute and chronic bronchitis of various etiologies, acute pneumonia, chronic broncho-obstructive diseases. Children from 3 to 5 years of age are shown 4 mg 3 times a day, from 6 to 12 years 8 mg 3 times a day, adolescents - 12 mg 3 times a day.

Ambroxol(Ambrogexal, Ambrobene, Lazolvan) belongs to the new generation of mucolytic drugs, is a metabolite of bromhexine and gives a more pronounced expectorant effect. In pediatric practice, it is preferable to use ambroxol preparations that have several dosage forms: tablets, syrup, solutions for inhalation, for oral administration, for injection and endobronchial administration.

Ambroxol affects the synthesis of bronchial secretions secreted by the cells of the bronchial mucosa. The secret is liquefied by the breakdown of acid mucopolysaccharides and deoxyribonucleic acids, while secretion is improved.

An important feature of Ambroxol is its ability to increase the content of surfactant in the lungs, blocking the breakdown and enhancing the synthesis and secretion of surfactant in type 2 alveolar pneumocytes. There are indications of stimulation of surfactant synthesis in the fetus if ambroxol is taken by the mother.

Ambroxol does not provoke bronchial obstruction. Moreover, K. Weissman et al. proved a statistically significant improvement in respiratory function in patients with bronchial obstruction and a decrease in hypoxemia while taking ambroxol. The combination of ambroxol with antibiotics certainly has an advantage over the use of a single antibiotic. Ambroxol helps to increase the concentration of the antibiotic in the alveoli and bronchial mucosa, which improves the course of the disease in bacterial infections of the lungs.

Ambroxol is used for acute and chronic respiratory diseases, including bronchial asthma, bronchiectasis, respiratory distress syndrome in newborns. You can use the drug in children of any age, even in premature babies.

Thus, in the complex therapy of respiratory diseases in children, mucolytic drugs are the most commonly used, but their choice should be strictly individual and take into account the mechanism of the pharmacological action of the drug, the nature of the pathological process, the premorbid background and the age of the child.

Phlegm increases inflammation in the bronchi and lungs - expectorants are needed to remove it from the respiratory tract. With a dry cough, such drugs are usually not prescribed so as not to worsen the patient's condition.

Expectorants are needed to expel mucus

Action of expectorants

Reflex cough turns on when the normal process of mucus excretion is disturbed in the body. In case of illness, it helps to remove mucus, pus, sputum from the tracheobronchial tree.

Expectorants are prescribed to help the human body cope with sputum that is difficult to separate.

They have different actions:

1. Reflex-stimulating expectoration. Irritates cough and gag reflexes. The action of drugs in this group is short and strong. Overdose causes nausea with vomiting.
2. resorptive action. They make sputum with a wet cough more liquid, which accelerates its removal from the respiratory tract. May cause tearing and nasal congestion.
3. proteolytic enzymes. Reduce the viscosity of sputum by breaking peptide bonds. Medicines in this group can lead to a severe allergic reaction and bronchospasm.
4. Cysteine ​​derivatives. It breaks down disulfide bonds, which thins the sputum. Should not be administered to debilitated patients.
5. Mucoregulators. Increases the amount of pulmonary sufactant - a substance that is located on the surface of the alveoli. The medicine evens out the mucous and liquid parts of the sputum.

Overview of expectorants

Before using expectorant drugs, it is important to consider their contraindications and follow the instructions for use.

Herbion with ivy extract helps with cough with phlegm, respiratory diseases.

When not to take:

• isolmatase deficiency;
• age up to 2 years;
• bearing a child;
• fructose intolerance;
• lactation.

Gerbion - syrup to improve expectoration

Admission rules:

• children under 5 years old drink syrup twice a day before meals, ½ tsp;
• for people over 12 years old, the doctor will prescribe 5-7.5 ml of the drug on an empty stomach 2 times a day.

How it can hurt:

• allergy;
• diarrhea;
• rash;
• nausea.

Price - from 250 rubles.

Mucolytic tablets ACC thin sputum due to the action of acetylcysteine.

Indications:

• pneumonia;
• cystic fibrosis;
• lung abscess;
• tracheitis.

When not to take:

• pregnancy;
• hemoptysis;
• lactation period;
• stomach ulcer;
• lactase deficiency and lactose intolerance;
• should not be used simultaneously with any antitussive drugs.

ACC tablets contain acetylcysteine ​​in their basis

Admission rules:

• babies 2-6 years old are given half a tablet twice a day;
• children 6-14 years old should drink 1 tablet 2 times in 24 hours;
• For adults, the doctor will prescribe 1 pill three times a day.

How it can hurt:

• nausea;
• dyspnea;
• rash;
• noise in ears.

Price - from 200 rubles.

An effective remedy that helps to cope with sputum in adults thanks to the active substance - ambroxol hydrochloride.

Indications:

• bronchial asthma;
• bronchitis;
• pneumonia.

Ambrobene is an effective expectorant

When not to take:

• epilepsy;
• peptic ulcer;
• impaired motility of the bronchi;
• age up to 12 years;

Admission rules:

• 1 capsule per day.

How it can hurt:

• increased cough;
• allergy;
• nausea;
• stomach ache.

Ambrobene capsules can be bought at a price of 250 rubles.

Thanks to bromhexine, chloride has a mucolytic effect. Bromgeskin refers to a children's medicine, but can also be prescribed to adults.

Indications:

• cystic fibrosis;
• bronchitis;
• bronchial asthma;
• tracheobronchitis;
• pneumonia.

Bromgeskin syrup is suitable for children and adults

When not to take:

• ulcer;
• first trimester of pregnancy;
• fructose intolerance;
• lactation.

Admission rules:

• two-year-olds drink 2.5 ml of syrup twice a day;
• for children from 3 to 6 years old, parents give 2.5-5 ml 3 times in 24 hours;
• those who are 6 to 14 years old drink 5-10 ml of syrup three times a day.

How it can hurt:

• headache;
• nausea;
• increased sweating;
• bronchospasm.

Price - from 85 rubles.

Used for wet coughs. The active ingredient of the drug is ivy leaf extract. Prospan is made on a plant basis, so it is often prescribed for children.

Indications:

• pneumonia;
• bronchitis;
• tracheobronchitis.

When not to take:

• children up to a year;
• sensitivity to alcohol;
• allergy to the components of the drops.

Prospan drops contain ivy leaf extract

Admission rules:

• babies under 3 years old are prescribed 10 drops 3-5 times a day;
• children 3-7 years old are prescribed 15 drops 3-5 times a day;
• schoolchildren and adults drink 20 drops 3-5 times a day.

How it can hurt:

• small rash;
• nausea.

Price - from 340 rubles.

A medicine that removes phlegm from the bronchi, diluting it. The active substance of Pertussin is an extract of thyme herb. This tool is inexpensive, but quite good.

Indications:

• whooping cough;
• tracheitis;
• bronchitis.

When not to take:

• lactation;
• heart failure;
• pregnancy.

Pertussin helps to remove phlegm

Admission rules:

• children drink 2.5 ml 3 times a day;
• adults take 1 tbsp. l. three times a day.

How it can hurt:

• heartburn;
• allergy.

Price - from 23 rubles. for a bottle.

Assign to the child when it is required to improve sputum discharge. The active substance is carbocysteine.

Fludetec is a mucolytic and has an anti-inflammatory effect.

Indications:

• bronchopulmonary diseases;
• diseases of the nasal cavity and nasopharynx;
• diseases of the middle ear.

When not to take:

• pregnancy - first trimester;
• intolerance to the components of the syrup;
• peptic ulcer;
• cystitis.

Fluditec - syrup for the treatment of cough in children

Admission rules:

• newborns do not exceed a dose of 100 mg per day.
• children 2-5 years old, 2.5 ml twice a day;
• children over 5 years old, 5 ml twice a day.

How it can hurt:

• nausea;
• hives;
• weakness.

Price - from 370 rubles.

Cheap tablets with herbal active ingredient - marshmallow extract. Mucoltin is prescribed for sputum discharge from the respiratory tract.

Indications:

• laryngitis;
• bronchitis;
• tracheitis.

When not to take:

• intolerance to medicinal components.

Mukaltin - affordable cough tablets

Admission rules:

• three times a day, 1 tablet;
• children dissolve the tablet in 30 ml of warm water.

How it can hurt:

• allergy;
• rash;

Price - from 12 rubles.

The active ingredients of Broncholitin syrup are glaucine hydrobromide, ephedrine hydrochloride.

Indications:

• pneumonia;
• bronchitis;
• bronchiectasis.

When not to take:

• ischemic disease;
• thyrotoxicosis;
• glaucoma;
• insomnia;
• myocardial infarction.

Broncholitin is an effective expectorant.

Admission rules:

• for babies from 3 years old, 5 ml, diluted in 10 ml of water, the drug three times a day;
• children who have reached 5-10 years old, 5 ml 3 times a day.
• adults 10 ml three times a day.

How it can hurt:

• tremor;
• violation of the rhythm of the heartbeat;
• visual impairment;
• dyspnea;
• feeling of dryness in the mouth;
• difficult urination.

Price - from 250 rubles.

Sputum thinning tablets Lazolvan contain the active substance - amboxol hydrochloride.

Indications:

• pneumonia;
• bronchitis;
• obstructive pulmonary disease;
• bronchial asthma.

When not to take:

• lactation period;
• sensitivity to components;
• pregnancy in the first trimester.

Lazolvan tablets dilute sputum

Admission rules:

• on a tablet 3 times a day.

How it can hurt:

• anaphylactic shock;
• hives;
• nausea.

Price - from 153 rubles.

The list of active ingredients is as follows: thermopsis extract, ambroxol, sodium bicarbonate, sodium glycyrrhizinate.

Indications:

• COPD;
• various bronchitis;
• bronchiectasis;
• pneumonia.

When not to take:

• ulcer;
• bonchial asthma;
• children under 12;
• kidney and liver failure.

Codelac broncho - a combination drug for the treatment of cough

Admission rules:

• adults 1 tablet three times a day.

How it can hurt:

• headache;
• allergic manifestations;
• diarrhea;
• nausea.

Price - from 180 rubles.

Expectorant folk remedies

There are many folk remedies for other diseases accompanied by a wet cough. Take after consulting a doctor. Usually, a home-prepared medicine must be used along with medications.

The following recipes are popular:

1. Take 10 g of crushed licorice root and pour 200 ml of boiling water. The product is kept in a water bath for 20 minutes. The broth is filtered, its volume is brought to 200 ml and drunk 1 tbsp. l. 4-5 times a day.
2. Take 1 tbsp. l. chopped elecampane and pour 400 ml of warm water. The medicine is boiled over medium heat for 15 minutes. The broth is filtered and taken 2 tbsp. l. every hour.
3. Chopped marshmallow root (15 g) is poured with water (500 ml). The remedy is insisted for a day, after which it is filtered. Drink it 4-5 times a day for a dessert spoon.
4. Cut off the upper part of the black radish and remove a third of its pulp. Inside put 1 tsp. honey, cover with a cut "lid" and put in a dark place. Drink the resulting juice 3 times a day, 1 tbsp. l.
5. Juice is squeezed out of a scalded lemon. Add honey to taste. Drink the remedy three times a day for 1 tbsp. l.

Lemon juice with honey is a simple and effective remedy for expectoration.

What's better?

Mukaltin or Bromhexine

Mukaltin has a herbal composition and fewer contraindications. The doctor may think that this remedy is the best.

Ambroxol or Mukaltin

Mukaltin cannot replace Ambroxol. Therefore, if the doctor has prescribed a second drug, then it is worth buying it. Syrup is often prescribed to children with pneumonia in complex therapy.

Ambrobene or ACC

Children are more often prescribed Ambroxol. It acts softer and harms the child's body less.

Ambroxol or ACC

For an adult, ACC is the best. Children are more likely to be prescribed Ambroxol because it is sold as a syrup and is easier to give to a child.

Mukaltin or Pertussin

They have the same effect. If it is more convenient for the patient to drink syrup, then Pertussin will be prescribed to him. During pregnancy, Mukaltin will be prescribed.

Codelac broncho or ACC

If the medicine is prescribed to a child, then ACC is a priority. Codelac broncho should not be taken by children under 12 years of age. For smokers, Codelac will be prescribed, because it can relieve the cough of a smoking person.