Acebrophylline is a mucolytic, bronchodilator, and anti-inflammatory agent used primarily in the management of chronic obstructive pulmonary disease (COPD) and bronchial asthma. It is a complex of theophylline-7-acetate and ambroxol in a 2:1 molar ratio. The combination provides synergistic action: ambroxol enhances mucociliary clearance and sputum expectoration, while theophylline derivative provides bronchodilation and reduces airway inflammation. It is widely prescribed in India for chronic bronchitis and asthma with productive cough.
Adult: 100 mg (10 ml of 50mg/5ml syrup) twice daily, usually after meals. Maximum: 200 mg per day.
Note: Take after food to minimize gastric irritation. Use the measuring cup/syringe provided. Shake the bottle well before use. Maintain adequate hydration to aid mucus clearance.
Acebrophylline exerts a triple action: 1) Bronchodilation via non-selective phosphodiesterase (PDE) inhibition (mainly PDE3, PDE4), leading to increased intracellular cAMP and cGMP, causing relaxation of bronchial smooth muscle. 2) Mucolytic action via the ambroxol component, which stimulates surfactant production, breaks down acid mucopolysaccharide fibers in sputum, and activates the mucociliary transport system. 3) Anti-inflammatory action by inhibiting the release of inflammatory mediators (TNF-α, IL-1β, IL-8) from alveolar macrophages and neutrophils, and by reducing airway hyperresponsiveness.
Pregnancy: Category C: Animal studies show risk, human data insufficient. Use only if potential benefit justifies potential fetal risk. Theophylline crosses placenta. Avoid in first trimester.
Driving: May cause dizziness, nervousness, or blurred vision. Patients should not drive or operate machinery until their response is known.
| Ciprofloxacin/Enoxacin | Markedly decreases theophylline clearance, leading to toxicity (seizures, arrhythmias). | Major |
| Erythromycin, Clarithromycin | Decreases theophylline metabolism, increases serum levels. | Major |
| Phenytoin, Carbamazepine, Rifampicin | Induces CYP450 enzymes, increases theophylline clearance, reducing efficacy. | Major |
| Cimetidine | Inhibits metabolism, increases theophylline levels. | Moderate |
| Beta-2 Agonists (Salbutamol) | Additive hypokalemic and cardiac stimulant effects. | Moderate |
| Warfarin | Theophylline may potentiate anticoagulant effect. | Moderate |
| Lithium | Theophylline increases renal lithium excretion, decreasing lithium levels. | Moderate |
| Alcohol | Chronic use may increase clearance; acute intoxication may decrease clearance. | Moderate |