Ambroxol +Sulbutamol +Guaiphenesin +Menthol

INTRODUCTION

An understanding of the anatomic, physiologic, and pathophysiologic aspects of cough in necessary to appropriately diagnose and treat patients with cough. In the majority of persons, cough that is acute and self limiting is usually secondary to a viral upper respiratory tract infection; cough that is chronic and persistent is usually due to chronic bronchitis or postnasal drip.

The Rational

Definitive treatments of cough depends on determining its precise cause and then initiating specific therapy for the underlying disorder. Many combination cough preparation are available today. . Mucociliary clearance (MCC), The process inwhich airway mucus together with substance trapped with in are moved out of the lungs, is an important defence mechanism of the human body. . Indeed, agents (ambroxol )stimulating MCC may be used therapeutically in respiratory medicine, especially in patients suspected of having an impairment of their mucociliary transport system. . A combination of ambroxol, Sulbutamol, Guaiphenesin and Menthol has been recently introduced and promises high efficiency in treatment of cough

The Drugs

Ambroxol:::::

"Ambroxol scavenges oxidants ( e.g ..OH, HOCI reduce bronchial Hypersensitivity, and it is known to stimulate cellular surfactant production. In addition, ambroxol has anti-inflammatory properties owing to its inhibiting effect on the production of cellular cytokines and arachidonic acid metabolites. Ambroxol in habits the release of histamine , leukocytes and must cells. Unliken-acetylcystine , ambroxol is able to not only inhibit acute mediator release from must cells and leukocytes but also reduce immunomodulatory cytokines generation from basophils and may have beneficial effects in the treatment of allergic respiratory disease. In patients which chronic bronchitis, breathlessness while at rest and the rate of exacerbation is significantly improved by ambroxol."

SULBUTAMOL

"Sulbutamol ( albuterol) is a beta 2-selective adrenoceptor agonist which accounts for its pronounced bronchodilatory effects . It has become extensively used in the treatment of reversible obstructive airway disease. Numerouse studies in this disease ( including severe acute;,childhood and exercise induced asthma ) have confirmed the bronchodilatory efficacy of Sulbutamol , and it has been shown to be at least as most of the currently available bronchodilatory. Oral Sulbutamol affords clinically significant bronchodilatory and it is particularly useful in those patients unable to coordinate the use of inhalers ."

Guaiphenesin

" Guaiphenesin is an expectorant which increases respiratory tract fluid secretion and helps to loosen phlegm and bronchial secretion. By reducing the viscosity of secretions, Guaiphenesin increase the efficacy of the cough reflex and of ciliary action in removing accumulated secretion from the trachea and bronchi. Guaiphenesin is readily absorbed from the gastrointestinal tract and is rapidly mametabolised and excreted in the urine . Guaiphenesin has a plasma half -life of one hour. The urinary matabolite is B-(2-METHOXYPHENOXY) Lactic acid. "

Menthol

"The coolant action and carminative action of Menthol are important in the treatment of cough. Methol is very effective for blocked nose . "

Adersie effects

" Tremor, tachycardia and hypokalaemia are the most frequently reported adverse effects of Sulbutamol. Ambroxol and Guaiphenesin are generally well tolerated. "

Indication

Tamporary relief of coughs associated which respiratory tract infections and related conditions such as sinusitis, pharyngitis, bronchitis and asthma, when these conditions are complicated by tenacious mucus and /or mucus plungs and congestion. The Drugs is effective in productive as well non-productive cough, but is of particular value in dry , non productive cough which tends to ingure the mucous membrane of the air passage .

Dosage and administration

5-10 ml thirce /day

COMPOSITION

Each 5ml contains ambroxol 30mg , Sulbutamol 1mg, Guaiphenesin 50 mg and Menthol 0.5mg