title: Ambroxol in the 21st century: pharmacological and clinical update.
abstract: BACKGROUND
  Belonging to the group of expectorants, ambroxol is an active substance with a long history that influences parameters considered to be the basis for the physiological production and the transport of the bronchial mucus. Therefore, ambroxol's indication is 'secretolytic therapy in acute and chronic bronchopulmonary diseases associated with abnormal mucus secretion and impaired mucus transport'.
  
  
  OBJECTIVE
  The aim of this review is to evaluate the pharmacological and clinical data on the mucokinetic compound ambroxol.
  
  
  METHODS
  The existing database that covers >40 years of pharmacological research and clinical development was analysed. Only studies with adequate study design were evaluated.
  
  
  CONCLUSIONS
  Ambroxol is shown to exert several activities: i) secretolytic activity (i.e., promotes mucus clearance, facilitates expectoration, and eases productive cough); ii) anti-inflammatory and antioxidant activity; and iii) a local anaesthetic effect through sodium channel blocking at the level of the cell membrane. The reduction on chronic obstructive pulmonary disease exacerbations is consistent and clinically relevant. The anaesthetic effect is a new pharmacological action that could be beneficial in the management of acute respiratory tract infections. The efficacy and safety of ambroxol is well established.
authors.affiliation: University of Brescia, Department of Internal Medicine, 1 degrees Divisione di Medicina, Spedali Civili di Brescia, Pzza Spedali Civili 1, 25100 Brescia, Italy. malerba@med.unibs.it
authors.forename: Mario
authors.initials: M
authors.lastname: Malerba
authors.forename: Beatrice
authors.initials: B
authors.lastname: Ragnoli
mesh_terms: D000328:Adult; D000551:Ambroxol / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000818:Animals; D002648:Child; D002986:Clinical Trials as Topic; D005100:Expectorants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D012140:Respiratory Tract Diseases / Q000188:drug therapy*
chemical_list: D000779:Anesthetics, Local; D005100:Expectorants; D000551:Ambroxol