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Other Treatments Global Adoption
Bromhexine for COVID-19
7 studies from 110 scientists
875 patients in 4 countries
Statistically significant improvement for ventilation and ICU.
78%, 12% improvement for early and late treatment CI [30-93%], [-20-36%]
Bromhexine may be less effective for omicron due to the entry process moving towards TMPRSS2-independent fusion.
COVID-19 Bromhexine studies. Jun 2023.
0 0.5 1 1.5+ All studies 43% Mortality 77% Hospitalization 10% Recovery 46% Cases 62% Viral clearance 7% RCTs 43% RCT mortality 77% Prophylaxis 65% Early 78% Late 12% Favorsbromhexine Favorscontrol
Bromhexine COVID-19 studies. Bromhexine efficacy may vary depending on the degree of TMPRSS-dependent fusion for different variants [Peacock, Willett]. Recent:
Vila Méndez.
Bromhexine has been officially adopted in 1 country. Submit updates/corrections.
Jun 3
Covid Analysis (Preprint) (meta analysis) Bromhexine for COVID-19: real-time meta analysis of 7 studies
Statistically significant improvements are seen for ventilation and ICU admission. 3 studies from 3 independent teams in 2 different countries show statistically significant improvements in isolation (not for the most serious outcome). ..
Jan 3
Ghayour et al., Research Square, doi:10.21203/ (Preprint) Evaluation of the recovery rate and prevention of hospitalization among covid-19 outpatients: a randomized clinical trial comparing N-acetylcysteine with Bromhexine
93% lower mortality [p=0.01], 88% lower hospitalization [p<0.0001], and 28% faster recovery [p<0.0001]. RCT 225 outpatients in Iran showing lower mortality and hospitalization, and faster recovery with N-acetylcysteine and bromhexine. Baseline information per group is not provided, Figure 1 has the control group hospitalization status switc..
Dec 24
Vila Méndez et al., Journal of Clinical Medicine, doi:10.3390/jcm12010142 Efficacy of Bromhexine versus Standard of Care in Reducing Viral Load in Patients with Mild-to-Moderate COVID-19 Disease Attended in Primary Care: A Randomized Open-Label Trial
67% lower hospitalization [p=0.49] and 7% worse viral clearance [p=0.82]. RCT 191 low risk (no mortality) outpatients in Spain, showing no significant differences with bromhexine. Authors note that "statistical differences between the study groups were observed in the percentage of patients treated with..
Oct 18
Cosentino et al., Journal of Clinical Medicine, doi:10.3390/jcm11206138 Early Outpatient Treatment of COVID-19: A Retrospective Analysis of 392 Cases in Italy
Retrospective 392 outpatients in Italy showing 0.2% mortality with early treatment, compared with >3% in Italy at the time. Treatment varied for individual patients and included HCQ, vitamin D, vitamin C, vitamin A, zinc, quercetin, bromh..
Jan 3
Peacock et al., bioRxiv, doi:10.1101/2021.12.31.474653 (Preprint) (In Vitro) The SARS-CoV-2 variant, Omicron, shows rapid replication in human primary nasal epithelial cultures and efficiently uses the endosomal route of entry
In Vitro study showing that omicron can efficiently enter cells via the endosomal route, independent of TMPRSS2.
Jan 3
Willett et al., medRxiv, doi:10.1101/2022.01.03.21268111 (Preprint) (In Vitro) The hyper-transmissible SARS-CoV-2 Omicron variant exhibits significant antigenic change, vaccine escape and a switch in cell entry mechanism
In Vitro study showing that the entry process for omicron has moved towards TMPRSS2-independent fusion, indicating that TMPRSS2 inhibitors may be less effective for omicron.
Dec 20
Tolouian et al., SSRN, doi:10.2139/ssrn.3989 (Preprint) Bromhexine, for Post Exposure COVID-19 Prophylaxis: A Randomized, Double-Blind, Placebo Control Trial
70% lower hospitalization [p=0.15], 53% fewer symptomatic cases [p=0.007], and 50% fewer cases [p=0.03]. PEP RCT with 372 close contacts of COVID+ patients, 187 treated with bromhexine, showing significantly lower cases with treatment. IRCT20120703010178N22.
Apr 30
Sgrignani et al., Frontiers in Molecular Biosciences, doi:10.3389/fmolb.2021.666626 Computational Identification of a Putative Allosteric Binding Pocket in TMPRSS2
In Silico study of TMPRSS2 inhibition by camostat, nafamostat, and bromhexine, suggesting allosteric binding for bromhexine, compared to camostat and nafamostat which bind to the active site of TMPRSS2 forming covalent adducts.
Mar 15
Tolouian et al., J. Investig. Med., doi:10.1136/jim-2020-001747 Effect of bromhexine in hospitalized patients with COVID-19
76% lower mortality [p=0.43], 76% greater improvement [p=0.43], and 75% worse viral clearance [p=0.02]. Small RCT with 100 patients, 48 with bromhexine added to SOC, showing slower viral- conversion but lower mortality and greater clinical improvement with bromhexine (not statistically significant with few deaths and very high recovery). Th..
Mar 8
Mikhaylov et al., medRxiv, doi:10.1101/2021.03.03.21252855 (Preprint) Bromhexine Hydrochloride Prophylaxis of COVID-19 for Medical Personnel: A Randomized Open-Label Study
91% fewer symptomatic cases [p=0.05] and 71% improved viral clearance [p=0.14]. Small prophylaxis RCT with 25 treatment and 25 control health care worker, showing lower PCR+, symptomatic cases, and hospitalization with treatment, although not statistically significant with the small sample size.
Jan 31
Carpinteiro et al., Journal of Biological Chemistry, doi:10.1016/j.jbc.2021.100701 (In Vitro) Inhibition of acid sphingomyelinase by ambroxol prevents SARS-CoV-2 entry into epithelial cells
In Vitro study showing that ambroxol (a metabolite of bromhexine) inhibits SARS-CoV-2 infection.
Dec 31
Al-Kuraishy et al., Current Medical and Drug Research (Review) (Preprint) The potential role of Bromhexine in the management of COVID-19: Decipher and a real game-changer
Review article noting that bromhexine is a TMPRSS2 inhibitor with greater effect in lung tissue and attenuates the entry and proliferation of SARS-CoV-2.
Dec 3
Mareev et al., Кардиология, doi:10.18087/cardio.2020.11.n1440 Results of Open-Label non-Randomized Comparative Clinical Trial: “BromhexIne and Spironolactone for CoronаvirUs Infection requiring hospiTalization (BISCUIT)
11% improved recovery [p=0.47], 8% shorter hospitalization [p=0.35], and 87% improved viral clearance [p=0.08]. Prospective 103 PCR+ patients in Russia, 33 treated with bromexhine+spironolactone, showing lower PCR+ at day 10 or hospitalization >10 days with treatment. Bromhexine 8mg 4 times daily, spironolactone 25-50 mg/day for 10 days.
Sep 3
Li et al., Clinical and Translational Science, doi:10.1111/cts.12881 Bromhexine Hydrochloride Tablets for the Treatment of Moderate COVID-19: An Open-Label Randomized Controlled Pilot Study
75% higher hospital discharge [p=0.11] and 3% slower recovery. Tiny RCT with 12 bromhexine and 6 control patients showing non-statistically significant improvements in chest CT, need for oxygen therapy, and discharge rate within 20 days. Authors recommend a larger scale trial.
Jul 19
Ansarin et al., Bioimpacts, doi:10.34172/bi.2020.27 Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial
91% lower mortality [p=0.05], 89% lower ventilation [p=0.01], and 82% lower ICU admission [p=0.01]. RCT with 39 bromhexine and 39 control patients showing lower mortality, intubation, and ICU admission with treatment. The treatment group received bromhexine hydrochloride 8 mg three times a day for two weeks. All patients received SOC in..
May 26
Depfenhart et al., Internal and Emergency Medicine, doi:10.1007/s11739-020-02383-3 (Theory) Potential new treatment strategies for COVID-19: is there a role for bromhexine as add-on therapy?
Proposal to use bromhexine to inhibit TMPRSS2-specific viral entry for prophylaxis and treatment of COVID-19.
Apr 30
Habtemariam et al., Pharmacol. Res., doi:10.1016/j.phrs.2020.104853 (Theory) Possible use of the mucolytic drug, bromhexine hydrochloride, as a prophylactic agent against SARS-CoV-2 infection based on its action on the Transmembrane Serine Protease 2
Note on the potential use of bromhexine hydrochloride for prophylaxis of SARS-CoV-2, based on the role of TMPRSS2 in SARS-CoV-2 infection, and the TMPRSS2 inhibition of bromhexine hydrochloride.
Apr 22
Maggio et al., Pharmacol Res., doi:10.1016/j.phrs.2020.104837 (Review) Repurposing the mucolytic cough suppressant and TMPRSS2 protease inhibitor bromhexine for the prevention and management of SARS-CoV-2 infection
Proposal to use bromhexine for prophylaxis and treatment of COVID-19 based on TMPRSS2 inhibition, widespread clinical use, and supporting pharmacokinetic and safety data.
Mar 5
Hoffman et al., Cell, doi:10.1016/j.cell.2020.02.052 (In Vitro) SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibito
In Vitro study showing that SARS-CoV-2 uses ACE2 for entry and TMPRSS2 for S protein priming, and that TMPRSS2 inhibitor camostat blocked entry and may be an effective treaetment.
Please send us corrections, updates, or comments. Vaccines and treatments are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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