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Ammonium Chloride – Uses, Effects & Side Effects

Ammonium chloride (NH4Cl) is an inorganic salt used in medicine as an expectorant and urinary acidifier. It is commonly found in cough preparations and is also used to treat metabolic alkalosis.

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Things worth knowing about "Ammonium chloride"

Ammonium chloride (NH4Cl) is an inorganic salt used in medicine as an expectorant and urinary acidifier. It is commonly found in cough preparations and is also used to treat metabolic alkalosis.

What is Ammonium Chloride?

Ammonium chloride (chemical formula: NH4Cl) is an inorganic salt composed of ammonium ions (NH4+) and chloride ions (Cl-). It is also known historically as sal ammoniac and has a wide range of applications in medicine, food science, and industry. In medicine, it is primarily used as an expectorant (a substance that helps loosen mucus) and as a urinary acidifier.

Mechanism of Action

Ammonium chloride acts on several levels within the human body:

Expectorant effect: Ammonium chloride stimulates the mucous glands in the bronchial lining to produce more fluid secretions. This is partly achieved via a mild irritant effect on the gastric mucosa, triggering a reflex increase in bronchial secretion, which makes it easier to cough up mucus.
Acidifying effect: After absorption, ammonium chloride is metabolized in the liver into urea and hydrochloric acid (HCl). The released hydrochloric acid lowers the pH of the blood and urine, acidifying the urine. This is used therapeutically, for example in the treatment of metabolic alkalosis.
Electrolyte balance: As a source of chloride ions, ammonium chloride can help correct chloride deficits in the body.

Medical Uses

Cough and Respiratory Conditions

Ammonium chloride is an active ingredient in many cough syrups and cold preparations. It acts as an expectorant, helping to dissolve and clear thick mucus from the airways in conditions such as bronchitis and upper respiratory tract infections.

Metabolic Alkalosis

In cases of metabolic alkalosis – a condition in which the blood becomes too alkaline – ammonium chloride can be administered orally or intravenously to restore the acid-base balance. Its hepatic metabolism generates acid equivalents that lower the blood pH.

Urinary Acidification

By acidifying the urine, ammonium chloride can enhance the renal excretion of certain basic substances. Historically, it has been used to improve the effectiveness of urinary antiseptics such as methenamine, which works more effectively in an acidic environment.

Dosage and Usage Notes

The dosage of ammonium chloride depends on the indication and should always be followed according to medical advice or the product label:

As an expectorant: Typical adult doses range from 300 to 600 mg, taken several times daily, often in combination with other active ingredients.
For metabolic alkalosis: Dosage is calculated individually based on the degree of acid-base imbalance and requires medical supervision.
Ammonium chloride should not be taken for extended periods without medical oversight.

Side Effects and Risks

Ammonium chloride can cause adverse effects when misused or taken in excess:

Gastrointestinal complaints: Nausea, vomiting, stomach pain
Metabolic acidosis: Overdose can cause the blood pH to drop excessively, leading to dizziness, headache, and confusion.
Hyperammonaemia: In patients with impaired liver function, the conversion of ammonium may be compromised, potentially leading to a dangerous rise in blood ammonia levels.
Electrolyte disturbances: Changes in potassium and sodium levels are possible.

Contraindications

Ammonium chloride should not be used in patients with:

Severe liver or kidney insufficiency
Pre-existing metabolic acidosis
Pregnancy and breastfeeding (unless advised by a doctor)
Known hypersensitivity to the active substance

Ammonium Chloride in Food

Ammonium chloride is approved as a food additive under the designation E 510. It is used in some countries – particularly in Scandinavia and the Netherlands – as an ingredient in salty liquorice (salmiak liquorice), giving it its characteristic sharp, intense flavour. In larger quantities, regular consumption of salty liquorice may have health implications, and moderate intake is recommended.

References

Mutschler, E. et al. – Arzneimittelwirkungen: Pharmakologie, klinische Pharmakologie, Toxikologie. 10th Edition. Wissenschaftliche Verlagsgesellschaft Stuttgart, 2012.
European Food Safety Authority (EFSA) – Re-evaluation of ammonium chloride (E 510) as a food additive. EFSA Journal, 2018.
Lacy, C.F. et al. – Drug Information Handbook. 29th Edition. Lexi-Comp, 2021.

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