Ambroxol releases cough symptoms based on its secretagogue, anti-inflammatory, anti-oxidant, anti-bacterial, anti-viral, immunomodulatory and local anesthetic effects.

Ambroxol is listed for secretolytic treatment of acute and chronic bronchopulmonary diseases related with a disturbance of mucus formation and transport in adults and children. 

The goal of a study published in BMC Pharmacology and Toxicology was to explore differential patient profiles and efficacy against acute respiratory symptoms of four formulations registered as over-the-counter medicines.

In the present study, 965 pharmacy customers purchasing one of four branded ambroxol formulations – extended release capsules, adult syrup, pediatric syrup and soft pastilles, participated in a questionnaire. Data on pediatric syrup users were entered by their parents.

The results revealed that the users of the pediatric syrup and the pastilles had less severe baseline symptoms. The patient-adapted Bronchitis Severity Scale (BSS) proved feasible as a self-administered tool. While among BSS items, ambroxol formulations improved chest pain while coughing to the largest and sputum to smallest degree. Reported efficacy was comparable among formulations with minor differences in favor of the pediatric syrup. Additionally, the time to onset of symptom relief was less than 60 mins in more than 90% of patients and occurred prior to known systemic tmax. Time to onset was the parameter with the greatest differences between formulations—reported as being the fastest with pastilles and pediatric syrup and the slowest with extended release capsules. All ambroxol formulations were well tolerated.

It was concluded that over-the-counter formulations of ambroxol exhibit comparable efficacy. Meanwhile, differences between pediatric and adult syrup may reflect reporting bias.

Source: BMC Pharmacology & Toxicology. 2018 Jul 4;19(1):40. doi: 10.1186/s40360-018-0229-y.