Published online Dec Albrecht , 1 Peter V. Dicpinigaitis , 2 and Eric P. Guenin 3. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received May 3; Accepted Nov This article has been cited by other articles in PMC.
Abstract Guaifenesin, a mucoactive drug, acts by loosening mucus in the airways and making coughs more productive. Background Respiratory conditions have been known throughout most of recorded medical history, and today mortality and morbidity associated with respiratory conditions represent a substantial global health burden. Table 1 Brief history of guaifenesin and its regulatory path in the US.
Time Key events Pres Used as natural remedy by Native Americans s Guaiac extract used as stimulant remedies, e. From , the FDA removed all marketed, but unapproved, timed-release guaifenesin products from the market.
Open in a separate window. Mucus in airway function and disease The respiratory tract is covered with a layer of mucus, which maintains airway humidification and acts as a protective barrier to inhaled particles and microorganisms. Guaifenesin: multiple effects on pathological mucus Therapy with mucoactive drugs is an important factor in the treatment of respiratory conditions in which mucus hypersecretion is prevalent.
Table 2 Main classes of mucoactive drugs. N-acetylcysteine Mucokinetics Increase mucus transportability by mucociliary transport and cough mechanisms e. Pharmacology Pharmacokinetics Guaifenesin [3- 2- methoxyphenoxy -1,2-propanediol] has been well characterized chemically [ 17 ]. In vitro and animal studies investigating the mechanism of action To date, several mechanisms of action have been described for guaifenesin.
Human studies investigating the mechanism of action of guaifenesin Studies in patients with chronic bronchitis demonstrated that guaifenesin increases MCC [ 29 ] and reduces sputum viscosity [ 30 ]. Table 3 Pharmacology studies. Clinical efficacy studies in respiratory diseases Clinical uses of guaifenesin Despite the large number of clinical studies on different clinical aspects of guaifenesin therapy, its expectorant indication is currently the only one that the FDA considers to be supported by sufficient medical evidence.
Table 4 Clinical efficacy studies: Chronic bronchitis and chronic respiratory conditions. Table 5 Clinical efficacy studies: Upper respiratory tract infections. Table 6 Clinical efficacy studies: Rhinosinusitis. Chronic bronchitis and chronic respiratory conditions The inclusion of guaifenesin in the Final OTC Monograph was essentially supported by four clinical studies in patients with chronic bronchitis [ 36 — 39 ]. Rhinosinusitis Guaifenesin was reported to be effective for improving symptomatic rhinitis and sinusitis by decreasing nasal congestion and postnasal discharge in immunocompromised HIV positive patients [ 45 , 46 ].
Clinical safety As a single agent, guaifenesin has a well-established and favorable safety and tolerability profile. Guaifenesin drug products and dosing Immediate-release IR and extended-release ER guaifenesin are available in single-agent formulations Table 7. Table 7 Examples of currently available over-the-counter guaifenesin formulations and recommended doses in the US and Canada. Conclusions This review provides an updated and comprehensive perspective on the use of guaifenesin in treating respiratory disorders in which excessive mucus is an important clinical feature.
Acknowledgements The authors would like to thank the subjects, clinicians, and scientists who participated in the design, conduct, and analysis of the studies described in this review paper.
Funding Medical writing and editorial support in the preparation of this review article was funded by Reckitt Benckiser, LLC. Availability of data and materials Not applicable. Notes Ethics approval and consent to participate Not applicable.
Consent for publication Not applicable. Contributor Information Helmut H. References 1. Ferkol T, Schraufnagel D. The global burden of respiratory disease. Ann Am Thorac Soc. Accessed 21 Mar Federal Register 54 p. Airway mucus function and dysfunction. N Engl J Med. Rogers DF. Physiology of airway mucus secretion and pathophysiology of hypersecretion. Respir Care. Mucins, mucus, and sputum. Mucus Hyperconcentration as a unifying aspect of the chronic Bronchitic phenotype. Mucoactive drugs. Eur Respir Rev.
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Glyceryl guaiacolate; a controlled laboratory and clinical study. Am Rev Respir Dis. For instance, Mucinex DM has a cough suppressant, when you should be trying to thin your secretions and get rid of the excess mucus by coughing. Caution should always be used when taking combinations of medications that may reduce the efficacy of the other medication.
Staying properly hydrated with water is an important factor in helping to reduce the frequency of having thick secretions which are then difficult to cough up. There are many other medications that can help, but they are typically reserved for chronic issues related to cystic fibrosis, chronic COPD, and other respiratory conditions.
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Updated November 14, Medline Plus website. Updated July 15, Guaifenesin Oral Route. PubMed Health website. Updated October 1, Rubin, BK. Shop for Mucinex. Mucinex and Mucinex DM tablets also both come in maximum-strength versions. These medicines contain double the amount of active ingredients.
You should take no more than one maximum-strength tablet every 12 hours. Do not take more than two tablets in 24 hours. Shop for Mucinex DM. The packaging for the regular-strength and maximum-strength products is similar. There is also a liquid version of Mucinex DM available, but only in the maximum-strength form. Talk to your doctor or pharmacist to decide which form is right for you. Mucinex DM liquid is only for people 12 years or older. Shop for liquid Mucinex DM.
There are Mucinex liquid products that are made especially for children 4 to 11 years of age. Most people tolerate these medications very well. However, at higher dosages, the likelihood of side effects from the drugs in Mucinex and Mucinex DM increases. The chart below lists examples of possible side effects of Mucinex and Mucinex DM. These drugs are called monoamine oxidase inhibitors, or MAOIs.
Examples of these drugs include:. The interaction between these drugs and Mucinex DM can cause a serious reaction known as serotonin syndrome. This reaction can be life threatening. Symptoms of serotonin syndrome include:. Keep reading: Serotonin syndrome symptoms, treatment, and more ». Also, dextromethorphan, one of the ingredients in Mucinex DM, is a commonly misused drug.
It can cause a high or euphoria when used in high doses. It can even cause hallucinations. For the best results:.
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