When a cough gets nasty, many head to the pharmacy to buy cough syrup. The active ingredient in many pharmaceutical cough syrups is bromhexine hydrochloride.
Bromhexine hydrochloride is found in such prominent cough medicine brands including Robitussin®, Benadryl®, Bromex®, Brofentol®, Dysolvon® and many others. Many of these have some derivative of “brom” in their names, such as Bromexina®, Bromexidril® and so on. Some brands contain the metabolite of bromhexin, which is ambroxol.
Some of these brands and their advertising seem awfully cozy – with cherry or other syrupy flavors and slick marketing. But make no mistake: These syrups are full of synthesized chemicals.
The full chemical name for bromhexine is:
benzenemetanamine, 2-amino-3,5-dibromo-N-cyclohexyl-N-metyl-
What does bromhexine do and are there side effects?
Bromhexine is a mucolytic agent. This means that it loosens up mucus by liquefying mucous membranes. This all sounds great. But bromhexine can also produce gastrointestinal adverse side effects. These include nausea, diarrhea, indigestion and bloating.
These are typically reported as mild. And changing the mucus content within the respiratory system might seem innocent enough. But changing mucus content within the respiratory system doesn’t happen in a vacuum. There are mucous membranes throughout the body, and mucus is critical to protecting those membranes.
An example is the digestive tract. When the mucus content of the respiratory system is changed, the mucus content in the digestive system will also be changed. And this can harm the intestinal tract.
A paper from the UK’s Brighton Polytechnic discussed the issue more than two decades ago:
“The agents which have been claimed to affect the quality and quantity of mucus secreted by the respiratory epithelium during conditions like chronic obstructive airways disease have been poorly understood. Recent studies have shown that compounds like bromhexine and S-carboxymethylcysteine can block the activity of mucus secretagogues in the rat. Furthermore, it has also been demonstrated that such compounds can prevent the inflammatory response to cigarette smoke. However, their activity is not restricted to the respiratory epithelium and the cervical mucus barrier has also been shown to be compromised following systemic administration.”
Mucus secretagogues are important to our intestinal system because they manage immunity along with digestion. They provide a gate-keeping system, which smartly allows healthy foods in and screens out toxins.
The “poorly understood” mention in Dr. Marriot’s paper also points out the unknown factor of messing around with our mucosal systems through chemical interactions. We may not fully understand the long-term effects of these interactions.
What about cough syrup abuse?
Cough syrup abuse and even addiction are serious issues today. Children and teenagers have been found abusing the sometimes-psychoactive ingredients in some pharmaceutical cough syrups.
The ingredients in these include dextromethorphan and promethazine and codeine. I have not investigated the labels of all the various bromhexine cough syrups enough to say whether or not some of these cough syrups also contain these or other psychoactive ingredients.
Herbal cough medicine beats bromhexine cough syrup in clinical trial
In a study published in the journal Phytomedicine, researchers from the Yerevan State Medical University of Armenia put bromhexine to the test against a traditional herbal cough medicine from Scandinavia. This was a randomized, double-blind and placebo-controlled clinical trial.
The herbal cough medicine tested is called Kan Jang®. Kan Jang contains the following herbs:
• Malabar nut leaf (Justicia adhatoda) – also called Vasa and Vasaka.
• Echinacea Moench root (Echinacea purpurea)
• Eleuthero ginseng root (Eleutherococcus senticosus (Rupr. & Maxim.) Harms)
We’ll discuss some of the properties of these medicinal herbs below.
The researchers tested 177 patients who had acute upper respiratory infections. These included coughs resulting from the common cold. The researchers divided the patients into three groups.
For five days, one group was given bromhexine hydrochloride at a daily dose of 30 milliliters (24 milligrams). Another group was given the Kan Jang herbal medicine formula, also at a daily dose of 30 milliliters. The third group was given a placebo.
The researchers analyzed the efficacy of each treatment by measuring coughing frequency. They also measured the change in coughing frequency in each patient compared with the beginning of their treatment.
By the third and fourth days of treatment, the patients treated with the Kan Jang cough herbal medicine showed the most improvement in cough symptoms compared to both the bromhexine hydrochloride treatment and the placebo. Yes, the bromhexine hydrochloride was better than the placebo. But the herbal medicine clearly beat out the pharmaceutical cough syrup by acting faster and more completely to reduce coughing.
The researchers also noted that the herbal medicine had no adverse effects and was tolerated well by the patients.
In their conclusion, the researchers stated:
“KJ exerted significant antitussive effects in URI. The present data further support the therapeutic use of KJ in upper respiratory tract infections.”
Cough medicine herbal formulary
As mentioned above, the Kan Jang herbal formula contains three herbs. Each of these has been used for thousands of years in formulations or individually for respiratory issues.
Today, standardized herbal extracts allow us to assure potency of the particular herb and formulation. The Kan Jang formula used in the research above was standardized at 0.2 milligrams per milliliter of vasicine (Justicia adhatoda), 0.8 milligrams per milliliter of chicoric acid (Echinacea purpurea), and 0.03 milligrams per milliliter of eleutherosides B and E (Eleutherococcus senticosus).
Such standardization can help an herbalist put together a similar formula by matching the standardization and dose. The 30 milliliters of the liquid extract was 762 milligrams of total herb formula extracts using the standardization above.
Why this formula works
Let’s quickly review these three herbs and why they are antitussive (reduce coughing).
Malabar nut leaf (Justicia adhatoda): Vasaka has been used in Ayurvedic medicine, Chinese medicine, Unani medicine and other forms of ancient herbalism for thousands of years for respiratory conditions, including asthma and COPD-type issues. It contains a variety of flavonoids, phenolics, alkaloids and other biochemicals.
Echinacea Moench root (Echinacea purpurea): Echinacea is also referred to as the purple coneflower. It is an ancient herbal medicine among the North American Indians, Europeans, Greeks and elsewhere through the centuries. This herb has been shown to increase immunity through the stimulation of T-cells, as well as cytokines such as interferon and TNF (tumor necrosis factor). The herb has been shown to increase the killing of viruses and bacteria through the process called phagocytosis. For this reason, Echinacea has proven a useful remedy to reduce colds and coughs.
Eleuthero ginseng root (Eleutherococcus senticosus (Rupr. & Maxim.) Harms): Eleuthero isn’t a true ginseng, but it still has been in use for thousands of years in numerous traditional medicines, including those from Russia, China, Japan and Korea. Eleuthero is considered an adaptogen and general tonic in that it stimulates the immune system and decreases the tendency for inflammation. For this reason, modern herbalism has utilized Eleuthero to increase athletic performance and stamina.
One of the benefits of combining herbs such as these is they often will have a synergistic effect. This contrasts with combining pharmaceutical chemicals, which can burden the liver and contribute to a variety of adverse effects – some that may not be realized until decades after the medication was prescribed and distributed to the public.
Traditional herbal formulations can be synergistic and safe because they utilize the wisdom of Nature. They come with generations of safety as they’ve been passed down from herbalist to herbalist.
REFERENCES:
Barth A, Hovhannisyan A, Jamalyan K, Narimanyan M. Antitussive effect of a fixed combination of Justicia adhatoda, Echinacea purpurea and Eleutherococcus senticosus extracts in patients with acute upper respiratory tract infection: A comparative, randomized, double-blind, placebo-controlled study. Phytomedicine. 2015 Dec 1;22(13):1195-200. doi: 10.1016/j.phymed.2015.10.001.
Siberian Ginseng: A Review of the Literature. The research behind this popular adaptogen. Natural Medicine Journal March 2012 Vol. 4 Issue 3. Natural Standard Research Collaboration.
Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Austin, TX: American Botanical Council; Newton, MA: Integrative Medicine Communications; 2000.
Upton R, Graff A, Joliffe G, Langer R, Williamson E eds. American Herbal Pharmacopoeia: Botanical Pharmacognosy – Microscopic Characterization of Botanical Medicines. CRC Press, 2011.
Barnes J, Anderson LA, Gibbons S, Phillipson JD. Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt.,Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties. J Pharm Pharmacol. 2005 Aug;57(8):929-54.
A. K. Nadkarni, ed. Indian Materia Medica, Volume 1, Popular Prakashan, Bombay, 1976.