The volume of distribution for oral administration is 552 liters. In the blood plasma in the therapeutic range, about 90% of the preparation binds to blood proteins.
Metabolism and excretion. About 30% of the dose after oral administration is excreted by presystemic metabolism. Ambroxol hydrochloride is metabolized in the liver by glucuronidation and cleavage to dibromoanthranilic acid (about 10% of the dose). Clinical studies in human liver microsomes have shown that CYP 3A4 is responsible for the metabolism of ambroxol hydrochloride to dibromoanthranilic acid.
For 3 days of oral administration, about 6% of the dose is excreted unchanged, while about 26% of the dose is in the conjugated form in the urine.
T½ from blood plasma is about 10 hours. The total clearance is in the range of 660 ml / min together with renal clearance, which is about 8% of the total clearance.
Syrup. Absorption. The absorption of ambroxol hydrochloride from oral forms of non-prolonged action is fast and fairly complete, with a linear dependence in the therapeutic range. Cmax in blood plasma is achieved after 1–2.5 hours with oral administration of rapid-release dosage forms and, on average, after 6.5 hours with the use of slow-release forms.
Distribution. When taken orally, the distribution of ambroxol hydrochloride from the blood to the tissues is rapid and pronounced, with a high concentration of the active substance in the lungs. The volume of distribution for oral administration is 552 liters. In blood plasma in the therapeutic range, approximately 90% of the preparation binds to proteins.
Metabolism and excretion. Approximately 30% of the dose after oral administration is excreted through the first pass metabolism. Ambroxol hydrochloride is metabolized mainly in the liver by glucuronidation and cleavage to dibromantranilic acid (about 10% of the dose). It has been reported that CYP 3A4 is responsible for the metabolism of ambroxol hydrochloride to dibromantranilic acid.
About 6% of the dose is excreted unchanged, while about 26% of the dose is excreted in the conjugated form in the urine.
T½ from blood plasma is about 10 hours. The total clearance is in the range of 660 ml / min together with renal clearance, which is approximately 8% of the total clearance.
Pharmacokinetics in special groups of patients. In patients with impaired liver function, the excretion of ambroxol hydrochloride is reduced, which causes its level in the blood plasma to be 1.3–2 times higher. Since the therapeutic range of ambroxol hydrochloride is quite wide, the dose should not be changed.
Age and gender do not have a clinically significant effect on the pharmacokinetics of ambroxol hydrochloride, so no dose adjustment is required.
Food intake does not affect the bioavailability of Ambroxol hydrochloride.
Secretolytic therapy for acute and chronic bronchopulmonary diseases associated with disorders of bronchial secretion and weakening of mucus movement.
The mucolytic effect of Ambroxol is enhanced when a large amount of liquid is consumed.
Pills. Ambrobene tablets 30 mg are taken orally after meals with a sufficient amount of warm liquid (for example, tea or broth).
Children aged 6-12 years: As a rule, a dose of ½ tablet 2-3 times a day is prescribed (equivalent to 30-45 mg of ambroxol hydrochloride per day).
Children over the age of 12 and adults: as a rule, the dose is 1 tablet 3 times a day for the first 2-3 days (equivalent to 90 mg of ambroxol hydrochloride per day). Treatment should be continued by taking 1 tablet 2 times a day (equivalent to 60 mg of ambroxol hydrochloride per day).
If necessary, the therapeutic effect for adults and children over the age of 12 can be increased by using 2 tablets 2 times a day (equivalent to 120 mg of ambroxol hydrochloride per day).
Retard capsules. Ambrobene capsules of prolonged action of 75 mg can be used regardless of food intake with a sufficient amount of warm liquid.
Adults: 1 capsule per day.
Solution for oral administration. Ambrobene oral solution is used after meals. The preparation is dispensed using a measuring cup. Take the drops after meals, dissolved in a liquid (for example, water, tea or juice).
The mucolytic effect of Ambroxol is enhanced when a large amount of liquid is consumed.
Children over the age of 12 and adults: in the first 2-3 days - 4 ml 3 times a day, then - 4 ml 2 times or 2 ml 3 times a day.
Children aged 2–5 years: 1 ml 3 times a day.
Children aged 6-12 years: 2 ml 2-3 times a day.
The duration of treatment depends on the characteristics of the course of the disease.
Ambrobene solution should not be used longer than 4–5 days without consulting a doctor.
In case of impaired renal function and severe liver disease, the preparation can be taken only under the supervision of a doctor. In this case, it is recommended to reduce the dose and increase the time between doses of the preparation.
In acute illness, you should consult your doctor if symptoms persist and / or worsen despite taking Ambrobene.
Syrup. Ambrobene syrup is taken orally after meals. It is recommended to drink 1 glass of water after use. The mucolytic effect of Ambroxol is enhanced when a large amount of liquid is consumed.
Adults and children over the age of 12 years: in the first 2-3 days - 10 ml 3 times a day, then - 10 ml 2 times a day. If necessary, the therapeutic effect for adults and children over the age of 12 can be enhanced by increasing the dose to 20 ml 2 times a day.
In adults and children over the age of 12, it is advisable to use a dosage form containing a high concentration of ambroxol hydrochloride (for example, Ambrobene solution, 37.5 mg / 5 ml).
Children aged 2–6 years: 2.5 ml 3 times a day.
Children aged 6-12 years: 5 ml 2-3 times a day.
The duration of treatment depends on the characteristics of the course of the disease.
Ambrobene syrup should not be used for more than 4-5 days without consulting a doctor.
Contraindications
Hypersensitivity to ambroxol and / or to other components of the preparation.
For tablets and syrup also: rare hereditary conditions, due to which incompatibility with the excipients of the preparation is possible (see SPECIAL INSTRUCTIONS).
Side effects
From the immune system: hypersensitivity reactions, including rash, reactions from the mucous membranes, angioedema, dyspnea, itching, allergic reactions. anaphylactic reactions, including anaphylactic shock, urticaria.
From the nervous system: dysgeusia.
From the respiratory system: rhinorrhea, dry airways, hypesthesia of the pharynx.
From the gastrointestinal tract: gastrointestinal disorders (for example, nausea, vomiting, dyspepsia, heartburn, abdominal pain and discomfort, constipation, diarrhea), dry mouth, taste disturbances, hypersalivation, oral hypoesthesia.
On the part of the skin and subcutaneous tissue: erythema, rash, contact dermatitis. Cases of severe skin lesions have been reported: Stevens-Johnson syndrome, Lyell's syndrome, associated with the use of mucolytic agents such as ambroxol. Basically, they could be explained by the severity of the underlying disease or the simultaneous use of another preparation.
On the part of the kidneys and urinary system: dysuria.
General disorders: headache, fainting, fever, chills.
Special instructions
A small number of cases of severe skin reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis (Lyell's syndrome)) have been reported associated with the use of expectorants such as ambroxol hydrochloride. basically they could be explained by the severity of the underlying disease and / or the simultaneous use of another preparation. therefore, if new lesions of the skin or mucous membranes appear, you should immediately seek medical attention and stop treatment with ambroxol hydrochloride.
During the early stages of Stevens-Johnson syndrome or Lyell's syndrome, the patient may develop non-specific, flu-like symptoms such as fever, body aches, rhinitis, cough, and sore throat. Mistakenly, with such nonspecific, like signs of the onset of influenza symptoms, symptomatic treatment with preparations for cough and cold is used.
Since ambroxol can increase mucus secretion, Ambrobene syrup should be used with caution in case of impaired bronchial motility and increased mucus secretion (for example, in such a rare disease as primary ciliary dyskinesia).
In patients with severe renal failure, the accumulation of hepatic metabolites of ambroxol is possible. In patients with impaired renal function and severe liver disease, Ambroxol should be used only after consulting a doctor. In this case, it is recommended to reduce the dose and increase the time between doses of the preparation.
Caution is needed in patients with gastric or duodenal ulcers.
In patients with asthma and severe asthmatic attacks, ambroxol syrup should be used with caution.
Ambrobene syrup contains sorbitol. 5 ml of syrup contains 2.1 g of sorbitol (which corresponds to 0.18 XE) and is a source of 0.53 g of fructose. Patients with rare hereditary forms of fructose intolerance should not take this preparation.
Ambrobene syrup contains sodium saccharin, which should be taken into account in patients with diabetes mellitus.
Patients with rare hereditary forms and intolerance to galactose, Lapp lactase deficiency or malabsorption of glucose and galactose should not take the preparation in tablet form.
The ability to influence the reaction rate when driving or working with other mechanisms. There is no data on the effect on the reaction rate when driving or operating other mechanisms. Studies of the effect on the reaction rate when driving vehicles or working with other mechanisms have not been carried out.
Use during pregnancy and lactation. Pregnancy. There is insufficient data on the use of ambroxol in pregnant women, especially for the period up to the 28th week of pregnancy. Ambroxol has not shown any teratogenic effects in animal studies.
However, you should follow the usual precautions when taking medications during pregnancy. Especially in the first trimester of pregnancy, it is not recommended to use this preparation.
Lactation. Ambroxol hydrochloride passes into breast milk. Although not expected to have adverse effects on infants, Ambroxol is not recommended for use during breastfeeding.
Children. Syrup and solution are used in children aged 2 years and older.
The preparation in the form of prolonged-release capsules should not be used in children. For children, it is recommended to use the preparation in the form of a syrup and solution. Tablets are used in children aged 6 years and older who do not tolerate syrup or solution for inhalation and ingestion.
In children under 6 years of age, apply Ambrobene in the form of syrup and drops.
Interactions
Ambrobene is not recommended to be taken simultaneously with preparations with antitussive activity (for example, codeine), as this will lead to difficulty in removing sputum from the bronchi against the background of a decrease in the severity of cough.
The use of Ambrobene in combination with antibiotics (amoxicillin, cefuroxime, erythromycin, doxycycline) can improve the flow of antibiotics into the lung tissue. This interaction with doxycycline is widely used for therapeutic purposes.
Overdose
There are currently no reports of specific overdose symptoms in humans. symptoms known from rare reports of overdose and / or in case of misuse of preparations correspond to the known side effects of Ambroxol in recommended doses and require symptomatic treatment. the most common were short-term anxiety and diarrhea.
According to preclinical studies, with a significant overdose, increased salivation, nausea, vomiting and arterial hypotension may occur.
Storage conditions
Capsules - at temperatures up to 30 ° c; tablets, syrup, solution do not require special storage conditions.