Acetylcysteine ​​formula

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Acetylcysteine ​​- instructions for use, analogs, reviews and release forms (effervescent tablets, powder 100 mg, 200 mg and 600 mg, solution for inhalation and rinsing) medications for the treatment of cough with sputum in adults, children and pregnancy.

Table of contents:

Compound

In this article you can read the instructions for use of the drug Acetylcysteine. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Acetylcysteine ​​in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Acetylcysteine ​​analogues in the presence of existing structural analogues. Use for the treatment of bronchitis, pneumonia and other diseases accompanied by cough with sputum in adults, children, as well as during pregnancy and lactation. Composition of the drug.

Acetylcysteine ​​is a mucolytic agent and is a derivative of the amino acid cysteine. It has a mucolytic effect, facilitates the discharge of sputum due to a direct effect on the rheological properties of sputum. The action is due to the ability to break the disulfide bonds of mucopolysaccharide chains and cause depolymerization of sputum mucoproteins, which leads to a decrease in sputum viscosity. The drug remains active in the presence of purulent sputum.

It has an antioxidant effect due to the ability of its reactive sulfhydryl groups (SH groups) to bind to oxidative radicals and thus neutralize them.

In addition, acetylcysteine ​​promotes the synthesis of glutathione, an important component of the antioxidant system and chemical detoxification of the body. The antioxidant effect of acetylcysteine ​​increases the protection of cells from the damaging effects of free radical oxidation, which is characteristic of an intense inflammatory reaction.

With the prophylactic use of acetylcysteine, there is a decrease in the frequency and severity of exacerbations in patients with chronic bronchitis and cystic fibrosis.

Acetylcysteine ​​+ excipients.

When taken orally, it is well absorbed from the gastrointestinal tract. Substantially undergoes first pass effect through the liver, resulting in decreased bioavailability. Binding to plasma proteins up to 50% (4 hours after oral administration). Metabolized in the liver and possibly in the intestinal wall. In plasma it is determined unchanged, as well as in the form of metabolites - N-acetylcysteine, N,N-diacetylcysteine ​​and cysteine ​​ester. Renal clearance accounts for 30% of the total clearance.

Respiratory diseases and conditions accompanied by the formation of viscous and mucopurulent sputum:

  • acute and chronic bronchitis;
  • tracheitis due to bacterial and/or viral infection;
  • pneumonia;
  • bronchiectasis;
  • bronchial asthma;
  • atelectasis due to blockage of the bronchi by mucus plug;
  • sinusitis (to facilitate the passage of secretions);
  • cystic fibrosis (as part of combination therapy).

Removal of viscous secretions from the respiratory tract in post-traumatic and postoperative conditions.

Effervescent tablets 200 mg and 600 mg.

Powder for solution for oral administration 100 mg and 200 mg.

Solution for inhalation.

Instructions for use and dosage regimen

Inside. Adults - 200 mg 2-3 times a day in the form of granules, tablets or capsules.

Children 2-6 years old - 200 mg 2 times a day or 100 mg 3 times a day in the form of a water-soluble granulate; younger than 2 years mg 2 times a day; 6-14 years mg 2 times a day.

For chronic diseases for several weeks: adults mg per day in 1-2 doses; children 2-14 years old mg 3 times a day; for cystic fibrosis - children from 10 days to 2 years - 50 mg 3 times a day, 2-6 years mg 4 times a day, over 6 years mg 3 times a day in the form of a water-soluble granulate, effervescent tablet or in capsules.

Inhalation. For aerosol therapy, 20 ml of a 10% solution or 2-5 ml of a 20% solution are sprayed in ultrasound devices; in devices with a distribution valve - 6 ml of a 10% solution. Duration of inhalation minutes; frequency: once a day. When treating acute conditions, the average duration of therapy is days; for long-term therapy of chronic conditions, the course of treatment is up to 6 months. In the case of a strong secretolytic effect, the secretion is sucked out, and the frequency of inhalations and the daily dose are reduced.

Intratracheal. To wash the bronchial tree during therapeutic bronchoscopy, use a 5-10% solution.

Locally. Instill into the nasal passages (for 1 procedure).

Parenterally. Administer intravenously (preferably drip or slow stream over 5 minutes) or intramuscularly. Adults - 300 mg 1-2 times a day.

Children from 6 to 14 years old - 150 mg 1-2 times a day. For children under 6 years of age, oral administration is preferable; for children under 1 year of age, intravenous administration of acetylcysteine ​​is possible only for health reasons in a hospital setting. If there are still indications for parenteral therapy, the daily dose for children under 6 years of age should be 10 mg/kg body weight.

For intravenous administration, the solution is further diluted with 0.9% NaCl solution or 5% dextrose solution in a 1:1 ratio.

The duration of therapy is determined individually (no more than 10 days). In patients over 65 years of age, the minimum effective dose is used.

  • heartburn;
  • nausea, vomiting;
  • diarrhea;
  • feeling of fullness in the stomach;
  • skin rash;
  • itching;
  • hives;
  • bronchospasm;
  • with shallow intramuscular injection and in the presence of increased sensitivity, a slight and quickly passing burning sensation may appear, and therefore it is recommended to inject the drug deep into the muscle;
  • reflex cough;
  • local irritation of the respiratory tract;
  • stomatitis;
  • rhinitis;
  • nosebleeds;
  • noise in ears;
  • a decrease in prothrombin time due to the administration of large doses of acetylcysteine ​​(monitoring the state of the blood coagulation system is necessary);
  • changes in the results of the salicylate quantitation test (colorimetric test) and ketone quantitation test (sodium nitroprusside test).
  • peptic ulcer of the stomach and duodenum in the acute phase;
  • hemoptysis;
  • pulmonary hemorrhage;
  • pregnancy;
  • lactation period (breastfeeding);
  • hypersensitivity to acetylcysteine.

Use during pregnancy and breastfeeding

The use of Acetylcysteine ​​is contraindicated during pregnancy and lactation (breastfeeding).

When using acetylcysteine ​​in patients with bronchial asthma, it is necessary to ensure sputum drainage. In newborns, it is used only for health reasons at a dose of 10 mg/kg under the strict supervision of a physician.

Orally for children over 6 years old - 200 mg 2-3 times a day; children aged 2 to 6 years - 200 mg 2 times a day or 100 mg 3 times a day, up to 2 years - 100 mg 2 times a day.

Acetylcysteine ​​is used with caution in patients with bronchial asthma, diseases of the liver, kidneys, and adrenal glands.

A 1-2 hour interval should be observed between taking acetylcysteine ​​and antibiotics.

Acetylcysteine ​​reacts with some materials such as iron, copper and rubber used in the spray device. In places of possible contact with acetylcysteine ​​solution, parts made of the following materials should be used: glass, plastic, aluminum, chromed metal, tantalum, sterling silver or stainless steel. Silver may tarnish after contact, but this does not affect the effectiveness of acetylcysteine ​​and does not harm the patient.

The simultaneous use of acetylcysteine ​​with antitussives may increase sputum stagnation due to suppression of the cough reflex.

When used simultaneously with antibiotics (including tetracycline, ampicillin, amphotericin B), their interaction with the thiol group of acetylcysteine ​​is possible.

When taking acetylcysteine ​​and nitroglycerin simultaneously, the vasodilator and antiplatelet effects of the latter may be enhanced.

Acetylcysteine ​​reduces the hepatotoxic effect of paracetamol.

Pharmaceutically incompatible with solutions of other drugs. On contact with metals and rubber, it forms sulfides with a characteristic odor.

Analogues of the drug Acetylcysteine

Structural analogues of the active substance:

  • N-AC-ratiopharm;
  • N-acetylcysteine;
  • Acestine;
  • Acetylcysteine ​​Canon;
  • Acetylcysteine ​​Teva;
  • Acetylcysteine ​​solution for inhalation 20%;
  • Acetylcysteine ​​solution for injection 10%;
  • Acetylcysteine ​​PS;
  • ACC;
  • ACC injection;
  • ACC Long;
  • AC-FS;
  • Vicks Active ExpectoMed;
  • Mukobene;
  • Mucomist;
  • Mukonex;
  • Fluimucil;
  • Exomyuk 200;
  • Espa-Nat.

Analogs by pharmacological group (secretolytics):

  • Marshmallow syrup;
  • Ambrobene;
  • Ambroxol;
  • Ambrosan;
  • Ambrosol;
  • Ascoril;
  • Bromhexine;
  • Bronchicum;
  • Bronchicum inhalate;
  • Bronchicum cough lozenges;
  • Bronchicum cough syrup;
  • Bronchipret;
  • Bronchostop;
  • Bronchotil;
  • Gedelix;
  • Hexapneumin;
  • GeloMyrtol;
  • Herbion primrose syrup;
  • Herbion plantain syrup;
  • Glycyram;
  • Chest collection;
  • Breast Elixir;
  • Joset;
  • Dr. MOM;
  • Dr. Theiss syrup with plantain;
  • Zedex;
  • Insti;
  • Carbocysteine;
  • Cashnol;
  • Codelac Broncho;
  • Coldact Broncho;
  • Coldrex broncho;
  • Lazolvan;
  • Libexin Muco;
  • Linkas;
  • Mukaltin;
  • Mucosol;
  • Expectorant collection;
  • Pectosol;
  • Pectusin;
  • Pertussin;
  • overslept;
  • Rinicold Broncho;
  • Sinupret;
  • Mixture for inhalation;
  • Licorice syrup;
  • Solutan;
  • Stoptussin;
  • Cough tablets;
  • Terpinhydrate;
  • Travisil;
  • Tussamag;
  • Tussin;
  • Tussin Plus;
  • Fervex for cough;
  • Flavamed;
  • Flavamed forte;
  • Fluifort;
  • Fluditek;
  • Halixol;
  • Erdostein.

Source: http://instrukciya-otzyvy.ru/1467-acetilcistein-po-primeneniyu-analogi-tabletki-shipuchie-poroshok-rastvor-ingalyacii.html

Instructions for use of drugs, analogues, reviews

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Acetylcysteine*

PRESCRIPTION MEDICINES ARE PRESCRIBED TO THE PATIENT ONLY BY A DOCTOR. THIS INSTRUCTION IS FOR MEDICAL PROFESSIONALS ONLY.

Description of the active substance Acetylcysteine*/Acetylcysteine*.

Formula: C5H9NO3S, chemical name: N-Acetyl-L-cysteine ​​(and as sodium salt).

Pharmacological group: metabolic/detoxifying agents, including antidotes; organotropic agents / respiratory agents / secretolytics and stimulants of motor function of the respiratory tract.

Pharmacological action: expectorant, mucolytic, detoxifying.

Pharmacological properties

Acetylcysteine ​​breaks the disulfide bonds of acidic mucopolysaccharides of sputum, reduces the viscosity of mucus and slows down the polymerization of mucoproteins due to the fact that it has free sulfhydryl groups in its structure. Acetylcysteine ​​dilutes sputum and greatly increases its volume (in some cases, it is necessary to use suction to prevent “flooding” of the lungs). Acetylcysteine ​​stimulates mucosal cells, whose secretion lyses fibrin. Acetylcysteine ​​activates detoxification processes and increases glutathione production. Acetylcysteine ​​also has anti-inflammatory properties, which are due to the suppression of the production of reactive oxygen metabolites and free radicals, which are responsible for the development of chronic and acute inflammation in the airways and lung tissue.

After oral administration, acetylcysteine ​​is well absorbed, but its bioavailability is low (no more than 10%; during the “first pass” through the liver, the drug undergoes deacetylation to form cysteine). After an hour, the maximum concentration in plasma is reached. Acetylcysteine ​​is approximately 50% bound to plasma proteins. Acetylcysteine ​​passes through the placental barrier and is detected in the amniotic fluid. The half-life after oral administration is 1 hour, the half-life increases to 8 hours in case of liver cirrhosis. Acetylcysteine ​​is excreted in the form of inactive metabolites (diacetylcysteine, inorganic sulfates) mainly by the kidneys; a small part is excreted unchanged by the intestines.

Indications

Severe sputum production (with tracheitis, bronchitis, bronchiolitis, bronchiectasis, pneumonia), cystic fibrosis, emphysema, lung abscess, laryngotracheitis, bronchial asthma, interstitial lung diseases, purulent and catarrhal otitis, sinusitis (including sinusitis), pulmonary atelectasis (from -for blockage of the bronchi by mucous plug), removal of viscous secretions from the respiratory tract in postoperative and post-traumatic conditions, poisoning with paracetamol (as an antidote).

Method of administration of acetylcysteine ​​and dose

Acetylcysteine ​​is taken orally (after meals), administered intravenously, intramuscularly, endobronchially, inhaled, or taken topically. The regimen and dose are determined by the doctor individually. Orally, for adults - 400 - 600 mg per day in 2 - 3 doses. For children, the single dose depends on age. Intravenously or intramuscularly, for adults - 300 mg once a day, for children - 150 mg once a day, up to 6 years of age, oral treatment is preferable, but if parenteral administration is necessary and there are indications, the daily dose is 10 mg/kg body weight bodies. For children under 1 year of age, intravenous administration is possible only in a hospital setting for health reasons. Inhalation, 3 – 4 times a day, 2 – 5 ml of 20% solution (within 15 – 20 minutes). Locally, for rinsing the nasal passages and ear canals: 1.5 - 3 ml of a 10% solution is used for 1 procedure.

In patients who have bronchial obstruction syndrome (which can develop quite often with increased bronchospasm), it is necessary to combine acetylcysteine ​​with bronchodilators.

Contraindications for use

Hypersensitivity, exacerbation of peptic ulcer.

Restrictions on use

Peptic ulcer, hemoptysis, varicose veins of the esophagus, pulmonary hemorrhage, bronchial asthma without thickening of sputum, phenylketonuria, arterial hypertension, adrenal disease, renal and/or liver failure.

Use during pregnancy and breastfeeding

Acetylcysteine ​​may be used during pregnancy if the expected effects of treatment are higher than the possible risk to the fetus. During treatment with acetylcysteine, breastfeeding must be stopped.

Side effects of acetylcysteine

Digestive system: nausea, heartburn, vomiting, stomatitis, feeling of fullness in the stomach; allergic reactions: itching, skin rash, bronchospasm (mainly in patients who have bronchial hyperreactivity), urticaria; other: fever, drowsiness, rarely - reflex cough, tinnitus, rhinorrhea (with inhalation use), local irritation of the respiratory tract, burning at the injection site (with parenteral use).

Interaction of acetylcysteine ​​with other substances

The combined use of acetylcysteine ​​and antitussive drugs, due to suppression of the cough reflex, can increase sputum stagnation, so they should not be used together. When using acetylcysteine ​​and nitroglycerin together, it is possible to potentiate the antiplatelet and vasodilating effects of nitroglycerin. When acetylcysteine ​​is used simultaneously with antibiotics, such as ampicillin, tetracyclines (except doxycycline), amphotericin B, it is possible that they (antibiotics) interact with the thiol SH group contained in acetylcysteine, this process leads to a mutual decrease in activity (the interval between taking antibiotics and acetylcysteine ​​should be at least 2 hours). Acetylcysteine ​​reduces the hepatotoxic effects of paracetamol. Pharmaceutically, acetylcysteine ​​is incompatible with solutions of other drugs. When acetylcysteine ​​comes into contact with rubber or metals, sulfides are formed, which have a characteristic odor.

Overdose

In case of an overdose of acetylcysteine, diarrhea, stomach pain, vomiting, nausea, and heartburn develop. Symptomatic treatment is necessary.

Trade names of drugs with the active substance acetylcysteine

Acetylcysteine ​​solution for inhalation 20%

Acetylcysteine ​​injection solution 10%

Vicks Active ExpectoMed

Pharmgroup:

Reviews and comments

The child is 4 years old, he drank 5

Nadezhda Sat, 12/11/:01

The child is 4 years old, he drank 5 sachets of this drug while I was working with the youngest child. Is it worth going to the hospital now to have his stomach washed out?

You should immediately induce vomiting.

You should immediately induce vomiting. The stomach is washed out within the next hour after an overdose; later it is not effective. Symptomatic treatment is necessary.

Source: http://xn——8kceunaflgjrqyoqfbei8dxl.xn--p1ai/%D0%B0%D1%86%D0%B5%D1%82%D0%B8%D0%BB%D1%86%D0%B8%D1 %81%D1%82%D0%B5%D0%B8%D0%BD

Acetylcysteine

Content

Structural formula

Russian name

Latin name of the substance Acetylcysteine

Chemical name

N-Acetyl-L-cysteine ​​(as sodium salt)

Gross formula

Pharmacological group of the substance Acetylcysteine

Nosological classification (ICD-10)

CAS code

Characteristics of the substance Acetylcysteine

White or white with a slightly yellowish tint crystalline powder, with a slight specific odor. Easily soluble in water and alcohol; The pH of a 20% aqueous solution is 7–7.5.

Pharmacology

Due to the presence of a free sulfhydryl group, it breaks the disulfide bonds of acidic mucopolysaccharides of sputum, inhibits the polymerization of mucoproteins and reduces the viscosity of mucus.

It thins sputum and significantly increases its volume (in some cases, suction is required to prevent “flooding” of the lungs). It has a stimulating effect on mucosal cells, the secretion of which is lysed by fibrin. Increases glutathione synthesis and activates detoxification processes. It has anti-inflammatory properties due to the suppression of the formation of free radicals and reactive oxygen metabolites responsible for the development of acute and chronic inflammation in the lung tissue and airways.

When taken orally, it is well absorbed, but the bioavailability is low - no more than 10% (during the “first pass” through the liver it is deacetylated to form cysteine), Cmax is achieved after 1–3 hours. Plasma protein binding is about 50%. Penetrates the placental barrier and is found in amniotic fluid. T1 /2 when taken orally is 1 hour, with liver cirrhosis it increases to 8 hours. It is excreted mainly by the kidneys in the form of inactive metabolites (inorganic sulfates, diacetylcysteine), a small part is excreted unchanged by the intestines.

Application of the substance Acetylcysteine

Difficulty secreting sputum (bronchitis, tracheitis, bronchiolitis, pneumonia, bronchiectasis), cystic fibrosis, lung abscess, emphysema, laryngotracheitis, interstitial lung diseases, bronchial asthma, pulmonary atelectasis (due to blockage of the bronchi with a mucus plug), catarrhal and purulent otitis media, sinusitis, incl. sinusitis, removal of viscous secretions from the respiratory tract in post-traumatic and postoperative conditions, paracetamol poisoning (as an antidote).

Contraindications

Hypersensitivity, peptic ulcer of the stomach and duodenum in the acute stage.

Restrictions on use

Peptic ulcer of the stomach and duodenum, varicose veins of the esophagus, hemoptysis, pulmonary hemorrhage, phenylketonuria, bronchial asthma without thickening of sputum, diseases of the adrenal glands, arterial hypertension, liver and/or kidney failure.

Use during pregnancy and breastfeeding

During pregnancy, it is possible if the expected effect of therapy exceeds the potential risk to the fetus.

FDA category of effect on the fetus is B.

Breastfeeding should be stopped during treatment.

Side effects of the substance Acetylcysteine

From the gastrointestinal tract: nausea, vomiting, heartburn, feeling of fullness in the stomach, stomatitis.

Allergic reactions: skin rash, itching, urticaria, bronchospasm (mainly in patients with bronchial hyperreactivity).

Other: drowsiness, fever; rarely - tinnitus; reflex cough, local irritation of the respiratory tract, rhinorrhea (for inhalation use); burning at the injection site (for parenteral use).

Interaction

The simultaneous use of acetylcysteine ​​and antitussives may increase sputum stagnation due to suppression of the cough reflex (should not be used simultaneously). When used together with antibiotics, such as tetracyclines (excluding doxycycline), ampicillin, amphotericin B, they may interact with the thiol SH group of acetylcysteine, which leads to a decrease in the activity of both drugs (the interval between taking acetylcysteine ​​and antibiotics should be at least 2 hours) . When taking acetylcysteine ​​and nitroglycerin simultaneously, the vasodilator and antiplatelet effects of the latter may be enhanced. Acetylcysteine ​​reduces the hepatotoxic effect of paracetamol. Pharmaceutically incompatible with solutions of other drugs. On contact with metals and rubber, it forms sulfides with a characteristic odor.

Routes of administration

Inside, intravenously, intramuscularly, inhalation, endobronchially, locally.

Precautions for the substance Acetylcysteine

In patients with broncho-obstructive syndrome (develops quite often against the background of increased bronchospasm), acetylcysteine ​​must be combined with bronchodilators.

Interactions with other active ingredients

Trade names

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Acetylcysteine ​​- what is it, dosage form, instructions for use, indications and composition

A drug from the group of mucolytic, antitussive drugs Acetylcysteine ​​is used for the pharmacological treatment of inflammatory diseases of the bronchi. This drug belongs to the group of expectorants. Find out from the instructions for use Acetylcysteine ​​acetylcysteine ​​- what it is, features of use for different forms of release: tablets, drops, solutions for inhalation.

The drug Acetylcysteine

A mucolytic drug helps to liquefy and increase the volume of sputum, facilitating the separation of mucus. The effect is associated with the ability of free sulfhydryl groups of the main active substance to break the double sulfide bonds of sputum mucopolysaccharides and amino acids. The medication retains its activity in both catarrhal and purulent sputum. Does not affect immunity.

The medication also has a similar effect on the secretion formed during inflammatory lesions of the mucous membrane of the ENT organs. The drug has an antioxidant effect, which is due to the presence of a sulfate group with disulfide bonds (a specific antidote), which can reduce the concentration of electrophilic oxidative toxins and reduces the viscosity of mucus. The drug has mucolytic and anti-inflammatory effects.

Compound

The pharmaceutical composition of the drug depends on the form of release of the drug. Differences in composition are due to the need to use the drug on different organs and tissues, which differ in structure and ability to absorb the drug. In addition, the use of different forms of medication is necessary for certain types of infectious diseases.

Acetylcysteine ​​- 200 mg;

Additional components: ascorbic acid - 30 mg, anhydrous sodium carbonate - 93, sodium bicarbonate - 894 mg, dehydrogenated citric acid - 998, sorbitol - 695 mg, macrogol 6000 - 70, sodium citrate - 500 mg, sodium saccharinate - 5 mg, flavoring − 20 mg.

Acetylcysteine ​​- 20 mg; purified sterile water - 50 ml; sodium bicarbonate - 15 mg.

Powder for preparing solution

n-acetyl-l-cysteine ​​- 20 mg; additional components: aspartame - 20 mg; lactose monohydrate - 40 mg.

Solution for inhalation

n-acetylcysteine ​​- 200 mg.

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The drug is available in the forms of capsules, tablets and solutions. Pharmaceutical diversity is due to the need to comprehensively influence organs affected by the inflammatory process. ACC is available in the following forms:

  • granules for preparing solution and suspension;
  • solution for intravenous administration;
  • acetylcysteine ​​for inhalation 20%;
  • drops for topical use.

Indications for use

The medication is prescribed for inflammatory pathological processes of the respiratory and hearing organs, conditions that are accompanied by the formation of sputum of a viscous structure, mucopurulent in nature:

  • Chronical bronchitis,
  • tracheitis;
  • pneumonia of various etiologies;
  • bronchial asthma;
  • emphysema;
  • atelectasis;
  • catarrhal, purulent otitis;
  • cystic fibrosis.

Instructions for use of Acetylcysteine

Acetylcysteine ​​is prescribed for the pharmacological treatment of inflammatory diseases of the ENT organs in various dosage forms and dosages. The choice of the form of the drug depends on the severity of the disease, the location of the source of infection, the age of the patient and the presence of concomitant diseases. In addition, if side effects occur during therapy, another form of medication with a lower dosage should be considered.

For inhalations

For aerosol therapy in specialized devices, spray 20-30 ml of a 10% solution or 5-7 ml of a 20% solution. The duration of the inhalation procedure is minutes; multiplicity – from 2 to 5 rubles/day. For drug therapy of acute emergency conditions, the average duration of the course of inhalations should be at least 5-10 days; if necessary, the course of treatment is extended to six months.

Inside

For oral use, the contents of the package are dissolved in a glass of warm water, stirred thoroughly and drunk after preparing the solution, preferably minutes after eating:

  • adults – 1 package 2-3 rubles/day;
  • children 2-14 years old – 1 package 2 rubles/day.
  • for chronic pathologies: adults – 2-3 packets in 1-2 doses; children 2-14 years old – 1/2 package 3 times a day.

Local application

For topical use in chronic and acute inflammatory diseases of the mucous membrane of the middle ear, eardrum, drops are used as follows:

  • for adults with otitis media - 2-3 drops in the affected ear, 3-4 rubles/day;
  • adults with purulent otitis – 5-6 drops, 3-4 rubles/day;
  • small children (from 1 year to 6 years) – 1-2 drops 2 rubles/day;
  • older children (from 6 years old) – 1-2 drops 3-4 rubles/day.

Acetylcysteine ​​for children from 6 to 14 years of age is prescribed 150 mg 1-2 times a day for bronchitis and pneumonia to reduce the viscosity of sputum. Children under 6 years of age are recommended to take the medicine orally; For children under 1 year of age, intravenous administration of Acetylcysteine ​​should be carried out only for emergency indications in hospital treatment. If there are indications for drug therapy, the daily dose of the drug should not exceed 50 mg.

Interaction of Acetylcysteine ​​with other drugs

Acetylcysteine ​​significantly enhances the effect of bronchodilators in the treatment of bronchitis. The drug is pharmaceutically incompatible with solutions of tetracycline antibiotics and proteolytic enzymes. Acetylcysteine ​​reduces their absorption in the small intestine, so it should be used no earlier than one day after the last dose of antibiotics. Prescribe with caution the simultaneous use of the drug with paracetamol and nitroglycerin, because they enhance the hepatotoxic effect of each other in liver diseases.

Acetylcysteine ​​analogues

Among the drugs with a similar effect to Acetylcysteine, the following are distinguished:

  1. Glutathione. The drug in the form of tablets for the treatment of adults and syrup for the treatment of children is prescribed for acute and chronic bronchitis. The drug thins and removes mucus from the lungs, making breathing easier. In addition, Glutathione relieves swelling of the bronchial mucosa.
  2. Mukaltin. The drug in tablet form promotes easy separation and removal of sputum during respiratory viral infections.

Contraindications and side effects of Acetylcysteine

With long-term therapy with the drug, the following side effects of the drug are observed:

  1. From the gastrointestinal tract: nausea, vomiting, heartburn.
  2. Hypersensitivity reactions: urticaria, itching, bronchospasm, allergic cough.
  3. Others: drowsiness, low-grade fever, local irritation of the respiratory mucosa.

Among the contraindications, it is necessary to note individual intolerance to the drug, pregnancy and lactation. Caution should be taken in case of peptic ulcer (in the acute stage), varicose veins of the esophagus, phenylketonuria, tumor diseases of the adrenal glands, kidney or liver disease, arterial hypertension.

Acetylcysteine ​​price

The cost of the drug depends on the form of the drug, the degree of purification, the quality of the main active substance and auxiliary components. The price of the drug may be influenced by the region and pharmacy in which it is sold. In addition, the cost of the medicine can be set by the manufacturer. Approximate price of the medicine in Moscow:

Effervescent tablets, 10 pcs.

Solution for inhalation, 100 ml

Powder for preparing solution, 10 sachets

Video

The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.

Source: http://sovets.net/14875-acetilcistein-chto-eto-takoe.html

Acetylcysteine

Description current as of 01/06/2015

  • Latin name: Acetylcysteine
  • ATX code: R05CB01
  • Active ingredient: Acetylcysteine
  • Manufacturer: Marbiopharm (Russia)

Compound

Each package of powder, in addition to the main substance, contains the flavoring additive “Aromatic” Lemon, lactose monohydrate, aspartame.

Release form

The medicine is available in the form of a solution for internal use or capsules. In addition, such a release form is known as effervescent tablets.

pharmachologic effect

Pharmacodynamics and pharmacokinetics

It is important to know about acetylcysteine, what it is and what its mechanism of action is before using the drug. It is a derivative of the amino acid cysteine. The effect of the drug Acetylcysteine ​​is due to the fact that its sulfhydryl group cleaves the disulfide bonds of acidic mucopolysaccharides of sputum. This causes a mucolytic effect. Mucoregulatory activity depends on increased secretion of less viscous sialomucins by goblet cells. Bacterial adhesion on epithelial cells of the bronchial mucosa is reduced. This occurs due to a decrease in sputum viscosity and increased mucociliary clearance.

The disinfecting effect of the drug is due to the action of the free sulfhydryl group, which affects electrophilic oxidative toxins, neutralizing them.

This drug protects cells from free radicals both through direct interaction with them and through the transport of cysteine ​​for the synthesis of glutathione.

The drug is quickly broken down when used internally. But its bioavailability is approximately 10%. The degree of binding to plasma proteins is 50%. The maximum concentration in plasma is observed in minutes. The active substance can cross the placental barrier and accumulate in the amniotic fluid. The half-life is 60 minutes. For liver cirrhosis – up to 8 hours.

Excreted mainly by the kidneys as inactive metabolites. Some part is excreted unchanged by the intestines. In plasma it is determined unchanged and also as a metabolite of N-acetylcysteine, cysteine ​​ester and N,N-diacetylcysteine.

Indications for use

Contraindications

Side effects

The drug may cause adverse reactions such as:

In rare cases, tinnitus, burning at the injection site (if a solution is used), as well as reflex cough, rhinorrhea and local irritation of the respiratory tract when used in inhalation are possible.

Instructions for use of Acetylcysteine ​​(Method and dosage)

Dosages are selected depending on the age and nature of the patient’s disease.

Instructions for use of Acetylcysteine ​​indicate that for children 2–6 years old, a daily dosage of 100 mg 3 times or 200 mg 2 times is usually indicated. The medicine is used in the form of a water-soluble granule. And for children under 2 years of age, a daily dose of 2 times 100 mg is prescribed. In turn, children 6-14 years old are given 200 mg daily 2 times, in the case of cystic fibrosis - 200 mg 3 times. The medicine can be taken in the form of effervescent tablets, capsules or granules.

Adults take 200 mg of the drug 2-3 times every day in any possible form of release.

For aerosol therapy, 20 ml of a 10% solution is sprayed in ultrasonic devices, and 6 ml of a 10% solution is sprayed in devices with a distribution valve. Inhalation is done every day 2-4 times. For acute conditions, therapy lasts 5-10 days, for chronic conditions – up to six months.

With a strong secretolytic effect, it is necessary to suck out the secretion, as well as reduce the frequency of use and dosage of the drug.

Overdose

In case of overdose, the medicine can cause diarrhea, nausea, abdominal pain, heartburn, and vomiting.

Therapy is symptomatic. In case of severe symptoms of overdose, you should urgently consult a specialist.

Interaction

The combination of the drug with oral administration of semisynthetic penicillins, cephalosporins, tetracyclines (except for Doxycycline), aminoglycosides requires a two-hour interval. Acetylcysteine ​​with other antitussive medications can cause dangerous mucus stagnation. When combined with this drug, the vasodilating effect of Nitroglycerin may also increase.

Terms of sale

The drug is approved for over-the-counter release.

Storage conditions

Optimal storage conditions for Acetylcysteine: dry, dark place, out of reach of children, temperature not higher than 25 °C, sealed packaging.

Best before date

Acetylcysteine ​​analogues

The following common analogues of Acetylcysteine ​​are sold:

They are all similar in their action, but may have some application features.

Reviews

This drug receives a variety of reviews. Many of them are positive. Those who have tried this remedy report its effectiveness. However, there are also negative opinions about Acetylcysteine. They write that the drug did not help. Therefore, people often begin to look for other, more effective means.

Acetylcysteine ​​price, where to buy

The price of Acetylcysteine ​​depends on the form in which the drug is produced. Powder for diluting a solution of 200 mg (usually 20 sachets per package) costs about 630 rubles. The price of Acetylcysteine ​​in tablets is at least 60 rubles. In turn, some online stores sell capsules with the same name, the cost of which can be 770 rubles and more.

  • Online pharmacies in Russia Russia
  • Online pharmacies in Ukraine Ukraine

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Source: http://medside.ru/atsetiltsistein

What is the drug acetylcysteine?

For diseases of the respiratory tract, a wide range of medications are used that affect the cause, the mechanism of development of the pathology and its individual symptoms. A special place among them is given to expectorants, which facilitate the discharge of sputum. Acetylcysteine ​​is one of these medications. What it is, what effect it has, how and when it is used, whether it has contraindications and side effects - these are the main aspects that concern patients when prescribing treatment. Most of the information is reflected in the instructions, and the rest can be asked from your doctor.

Characteristics

Acetylcysteine ​​(N-acetylcysteine) is a white crystalline substance (sodium salt) with a slight specific odor. According to the structure of the molecule, it is a derivative of the amino acid L-cysteine. It dissolves easily in water and ethyl alcohol. At the same time, it gives a neutral reaction without shifting the acid-base balance. Dosage forms containing acetylcysteine ​​are presented as a solution for inhalation and injection (nebulas and ampoules), tablets and powder (granules) for oral administration.

Action

The drug is included in the list of essential medicines. N-acetylcysteine ​​helps reduce the viscosity of sputum by breaking disulfide bonds between mucopolysaccharide molecules and slowing down the polymerization of protein molecules. It stimulates the cells of the mucous membrane of the respiratory tract, causing them to produce more lytic enzymes that dissolve fibrin fibers. As a result, the volume of secretion increases and its removal from the respiratory tract increases.

The drug can reduce the adhesion of microbes to the epithelium, suppress oxidative processes (formation of reactive oxygen species), and thanks to the thiol group (-SH) it can inactivate various toxins. Taking into account all of the above, the effects of acetylcysteine ​​are considered to be:

  • Muco- and secretolytic.
  • Expectorant.
  • Anti-inflammatory.
  • Antioxidant.
  • Detoxifying.

It should be noted that the drug also prevents the destruction of alpha-1-antitrypsin by the corresponding enzymes (myeloperoxidase). Consequently, the drug has a complex effect on the organs of the respiratory system, which has a positive effect on the patient’s recovery.

The positive effects of acetylcysteine ​​lead to its widespread use among medical practitioners.

Distribution in the body

The drug is well absorbed from the gastrointestinal tract. However, when taken orally, bioavailability is low (about 10%). The maximum concentration in the blood is reached on average after 2 hours. Half of the N-acetylcysteine ​​released into the plasma is bound to protein. Metabolism occurs in the liver, where the substance is converted into the amino acid cysteine. Its half-life is 60 minutes. It is excreted from the body mainly by the kidneys with inactive metabolites or the intestines.

Indications

The main area of ​​application of acetylcysteine ​​is respiratory diseases accompanied by the formation of viscous and difficult to separate sputum. These include the following:

  • Laryngotracheitis.
  • Bronchitis and bronchiolitis.
  • Pneumonia.
  • Bronchial asthma.
  • Cystic fibrosis.
  • Bronchiectasis.
  • Pulmonary abscess.
  • Emphysema.

The drug can be successfully used as a preparation for diagnostic and therapeutic procedures on the respiratory tract (bronchoscopy or bronchography). In addition, it has found its niche in ENT pathology, when it is necessary to facilitate the passage of secretions (rhinosinusitis, otitis media). Acetylcysteine ​​solution is also used for rinsing the nasal passages and sinuses, treating cavities and fistulas. It is used as an antidote for paracetamol poisoning.

Application

Preparations based on N-acetylcysteine ​​are available in any pharmacy chain. But this does not mean that they can be used for self-medication. Whether this medication should be used, in what dose and for how long - this can only be determined by a doctor. First of all, it is necessary to understand what is wrong with the patient after making a diagnosis, and then deal with issues of therapy.

Method of administration

Based on the dosage forms and indications existing on the pharmaceutical market, we can conclude that the routes of administration of acetylcysteine ​​are very diverse. It is taken orally in the form of granules or tablets to prepare a solution, suspension or syrup. Adults can take the drug three times a day, and for children, twice a day is enough, although in some cases the frequency, dosage and course change (chronic inflammatory diseases and cystic fibrosis).

The medicine is administered by inhalation using a nebulizer, spraying the solution and inhaling the aerosol. The duration of the session is about 20 minutes, the frequency is up to 4 times a day. The course of therapy, depending on the severity of the pathological process, can range from 7 days to 6 months. Acetylcysteine ​​can be administered intravenously (drip or stream), diluting it with isotonic sodium chloride. But for children under 6 years of age, it would be more appropriate to give oral forms. Local therapy is carried out by instilling a solution into the nasal passages or ears.

The medicine should be taken in accordance with medical recommendations. The route of administration, dose and course of administration are determined only by a specialist.

Drugs

There are quite a lot of drugs containing acetylcysteine. Each pharmaceutical company comes up with its own trade name for them, but the active ingredient remains the same. Some of them can be noted:

Which drug is better to choose is a rather difficult task. You should always rely on your doctor’s recommendations and the results of clinical trials.

Side effects

In addition to its therapeutic effect, the medication also has some side effects. Among the most common are:

  • Dyspeptic: heartburn, nausea and vomiting, stomach discomfort.
  • Allergic: urticaria, itching, bronchospasm.
  • Others: drowsiness, fever, tinnitus, nosebleeds.

Long-term systemic therapy may result in hepatic or renal dysfunction. And during inhalations, a reflex cough sometimes occurs and watery discharge from the nose appears. If the drug is administered parenterally, there is a burning sensation at the injection site.

Restrictions

Before prescribing a medicine, the doctor is required to conduct a thorough examination to identify concomitant conditions and other restrictions for the use of acetylcysteine. Patients, in turn, should inform the specialist about any medications taken in parallel in order to exclude negative interactions.

Contraindications

Given the range of side effects of the drug and its effect on the body, the use of N-acetylcysteine ​​should be avoided in certain situations. The instructions indicate that the main contraindications will be:

  • Hypersensitivity to the drug.
  • Peptic ulcer disease.
  • Pulmonary hemorrhage.
  • Varicose veins of the esophagus.
  • liver and kidney failure.
  • Hypertension.
  • Pregnancy and breastfeeding.

It should also be taken into account that intravenous forms of the drug must be used with caution in bronchial asthma due to the risk of spasm of the smooth muscles of the respiratory tract (this does not apply to other dosage forms).

It must be remembered that acetylcysteine ​​has some contraindications that limit its use in some patients.

Interaction

When taking the drug simultaneously with antitussives, there is a possibility of sputum stagnation and worsening of the condition. Parallel use of an antibiotic (tetracycline, ampicillin, amphotericin) leads to inhibition of the activity of both medications due to interaction with the thiol group. Acetylcysteine ​​can enhance the effects of nitroglycerin (vasodilator and antiplatelet), as well as weaken the hepatotoxicity of paracetamol. Solutions should not be mixed with other medications (pharmacological incompatibility).

special instructions

In patients with obstructive syndrome, it is advisable to combine the drug with bronchodilators. Acetylcysteine ​​should not come into contact with rubber or metal products, as it can form sulfur compounds with a pungent odor. The intravenous injection should be administered slowly and injected deeper into the muscle to avoid burning.

Acetylcysteine ​​is a drug widely used in diseases of the respiratory tract to dilute viscous sputum (secret) and improve its discharge. It also has other positive effects that make it possible to obtain a complex effect on the pathological process in the bronchopulmonary system. By using the medicine in accordance with the doctor’s recommendations, you can be confident in the effectiveness of the treatment and its safety.

Source: http://elaxsir.ru/simptomy/kashel/acetilcistein-chto-eto-takoe.html

Acetylcysteine ​​(ACC / Fluimucil)

Pharmacological group: mucolytic drugs

Systematic (IUPAC) name: (2R)-2-acetamido-3-sulfanylpronic acid

Trade names: Acetadote, Fluimucil, Mucomyst, Parvolex

Application: oral, injection, inhalation

Bioavailability 4-10% (oral)

Protein binding 80-83%

Half-life 5.6 hours

Excretion: kidneys (22%), feces (3%)

Mol. weight 163.195

Acetylcysteine ​​(ACC/Fluimucil), also known as N-acetylcysteine ​​or N-acetyl-L-cysteine ​​(NAC), is a pharmaceutical drug and dietary supplement used primarily as a mucolytic agent and for the treatment of paracetamol (acetaminophen) overdose. The drug is also used for sulfate loading in diseases such as autism, when levels of cysteine ​​and related sulfur-containing amino acids are depleted. Acetylcysteine ​​is a derivative of cysteine; an acetyl group that is attached to a nitrogen atom. This compound is sold as a dietary supplement that manufacturers say acts as an antioxidant and liver protector. The drug is used as a cough suppressant because it breaks the disulfide bonds in mucus and thins it, easing coughing. Disruption of disulfide bonds serves to thin the supply of abnormally thick mucus in patients with cystic and pulmonary fibrosis. Also Known As: N-Acetyl-L-Cysteine, NAC, N-Ac

Not compatible with:

Description of the action of Acetylcysteine ​​(ACC / Fluimucil)

Acetylcysteine ​​(ACC / Fluimucil) is a derivative of the N-acetyl natural amino acid L-cysteine. The substance has a very powerful and fast-acting mucolytic effect. Thanks to free sulfhydryl groups, acetylcysteine ​​can cleave disulfide bonds in glycoprotein mucus with the simultaneous formation of hydrophilic complexes, which leads to liquefaction of the formation and a decrease in the viscosity of mucus in bronchial secretion. Acetylcysteine ​​exhibits antioxidant effects by neutralizing free radicals in inflamed or hypoxic cells. Acetylcysteine ​​acts as an antidote for paracetamol poisoning or overdose, as it inactivates the toxic metabolites of paracetamol and helps maintain proper glutathione levels, protecting the liver from damage. Acetylcysteine ​​is most effective within 8 hours after poisoning or overdose; however, cases of the drug’s effectiveness have also been described in case of poisoning lasting about 36 hours. Acetylcysteine ​​is well absorbed from the gastrointestinal tract, reaching maximum concentration in the respiratory tract after 0.5-3 hours. It is metabolized mainly in the liver and excreted in the urine.

Medical uses of Acetylcysteine ​​(ACC / Fluimucil)

Paracetamol overdose

Intravenous acetylcysteine ​​is used to treat overdose of paracetamol (acetaminophen). When paracetamol is taken in large quantities, a minor metabolite called N-acetyl-para-benzoquinone imine (NAPQI) accumulates in the body. It is usually combined with glutathione, but when used in excess, the body's supply of glutathione is insufficient to inactivate toxic NAPQI. This metabolite can freely react with key liver enzymes, thereby damaging hepatocytes. This can lead to severe liver damage and even death from acute liver failure. Acetylcysteine ​​acts by increasing the body's stores of glutathione and, along with glutathione, directly binding to toxic metabolites. These actions serve to protect hepatocytes in the liver from NAPQI toxicity. Although acetylcysteine ​​is equally effective when administered intravenously or orally, it may be poorly tolerated when administered orally due to low oral bioavailability (since very high doses of the drug are required), due to its very unpleasant taste and odor, and due to side effects, especially nausea and vomiting. In previous studies of the pharmacokinetics of acetylcysteine, acetylation was not considered as a reason for the low bioavailability of acetylcysteine. Oral acetylcysteine ​​is identical in bioavailability to cysteine ​​precursors. However, 3% to 6% of people taking acetylcysteine ​​intravenously experience a severe allergic reaction similar to anaphylaxis, which may include difficulty breathing (due to bronchospasm), decreased blood pressure, rash, angioedema, and sometimes nausea and vomiting. Repeated doses of intravenous acetylcysteine ​​will cause progressive worsening of these allergic reactions. Studies have shown that these anaphylaxis-like reactions occur most often in people taking acetylcysteine ​​intravenously, even though serum levels of acetaminophen are not high enough to be considered toxic. In some countries there are no specific intravenous formulas for the treatment of paracetamol overdose. In these cases, the inhalation drug can be used intravenously.

Mucolytic therapy

Acetylcysteine ​​is used by inhalation for its mucolytic effect (dissolving mucus) as an aid in respiratory conditions with excessive mucus production. Such diseases include emphysema, bronchitis, tuberculosis, bronchiectasis, amyloidosis, pneumonia, cystic fibrosis, chronic obstructive pulmonary disease and pulmonary fibrosis. The drug is also used after surgery, to perform diagnostics and in the care of patients with tracheotomy. The drug is ineffective for cystic fibrosis. However, recent work published in the Proceedings of the National Academy of Sciences reports that high-dose oral acetylcysteine ​​modulates inflammation in cystic fibrosis and that the drug has the potential to counter redox imbalance and inflammatory imbalance in cystic fibrosis. Oral acetylcysteine ​​may also be used as a mucolytic agent in less severe cases. Acetylcysteine ​​works by reducing the viscosity of mucus by cleaving disulfide bonds that link proteins present in mucus (mucoproteins).

Nephroprotective drug

Oral acetylcysteine ​​is used to prevent radiopaque nephropathy (a form of acute kidney failure). Some studies show that pre-administration of acetylcysteine ​​markedly reduces radiocontrast nephropathy, while others question its effectiveness. It was concluded that "N-acetylcysteine, administered intravenously and orally, may prevent nephropathy with a dose-dependent effect in patients undergoing primary angioplasty and may improve outcome." "Acetylcysteine ​​protects patients with moderate renal impairment from deterioration of renal function after coronary angiographic procedures." with minimal side effects." A 2010 clinical trial, however, found acetylcysteine ​​to be ineffective for the prevention of contrast-induced nephropathy. This study of 2,308 patients found that acetylcysteine ​​was not superior to placebo; Regardless of whether acetylcysteine ​​or placebo was used, the incidence of nephropathy was 13%. Acetylcysteine ​​is still widely used in people with kidney failure to prevent the development of acute kidney failure.

Treatment of hemorrhagic cystitis induced by cyclophosphamide

Acetylcysteine ​​is used to treat cyclophosphamide-induced haemorrhagic cystitis, although mesna is usually preferred in this case as acetylcysteine ​​may reduce the effectiveness of cyclophosphamide.

Microbiological use

Acetylcysteine ​​can be used in the Petrov method, i.e. in the liquefaction and decontamination of sputum, in preparation for the diagnosis of tuberculosis. It also displays significant antiviral activity against influenza A viruses.

Collagen lung disease

Acetylcysteine ​​is used in the treatment of interstitial lung disease to prevent the disease from progressing.

Psychiatry

Acetylcysteine ​​has been successfully used to treat a variety of mental disorders. In particular, it is used to treat schizophrenia, bipolar disorder, trichotillomania, dermatillomania, autism, obsessive-compulsive disorder, drug addiction (including nicotine, cannabis, methamphetamine, cocaine, etc.) and gambling addiction. The ability of acetylcysteine ​​to suppress p53-induced apoptosis and promote autophagy may be a factor in its effectiveness in the treatment of neuropsychiatric disorders.

Polycystic ovary syndrome

In a small prospective study comparing acetylcysteine ​​to metformin (which is the standard treatment for PCOS), it was shown that both treatments resulted in significant reductions in body mass index, hirsutism, insulin, HOMA index, free testosterone levels and menstrual irregularity compared with baseline values, and both procedures had equal effectiveness.

Traumatic brain injury

Acetylcysteine ​​has been shown to be effective in the treatment of mild to moderate traumatic brain injury, particularly in reducing neuronal loss and in reducing cognitive and neurological symptoms when administered immediately after injury.

Ischemia

Acetylcysteine ​​reduces the damage associated with ischemic brain injury when administered soon after a stroke.

Mechanism of action of Acetylcysteine ​​(ACC / Fluimucil)

Acetylcysteine ​​serves as a prodrug of L-cysteine, which is a precursor to the biological antioxidant, glutathione, and therefore, the use of acetylcysteine ​​replenishes glutathione stores. L-cysteine ​​also, in turn, serves as a cystine precursor and as a substrate for the cystine-glutamate antiporter in astrocytes, thereby increasing the release of glutamate into the extracellular space. This glutamate, in turn, acts on mGluR2/3 receptors, and at higher doses of acetylcysteine, on mGluR5. Glutathione also modulates the NMDA receptor by acting at the redox site. Acetylcysteine ​​also has some anti-inflammatory activity, possibly through inhibition of NF-kB and modulation of cytokine synthesis. It may also promote the release of dopamine in certain areas of the brain.

Complexing reagent

Acetylcysteine ​​is used to dissolve palladium in water. It helps separate palladium from drugs or precursors synthesized during palladium-catalyzed coupling reactions.

Chemistry

Acetylcysteine ​​is an N-acetyl derivative of [[amino acid|Amino acid|amino acid]] L-cysteine, and is a precursor in the formation of the antioxidant glutathione in the body. The thiol (sulfhydryl) group has an antioxidant effect and can reduce free radicals.

Sources and structure

Biological significance

Cysteine ​​is the limiting factor in the synthesis of glutathione.

Modification and wording

N-acetylcysteine ​​is similar to L-cysteine ​​(it is its acetylated form) and to the glutathione enzyme itself (it is a precursor to glutathione synthesis); Research has been conducted on the use of L-cysteine ​​and glutathione as a supplement. Glutathione has limited therapeutic use because it is rapidly hydrolyzed in the intestinal tract, so increases in glutathione levels when taken orally as a supplement are not clinically significant. 1)

Pharmacology

Blood serum

mg of N-acetylcholine reach a peak concentration of μg/ml at Tmax of 1-2 hours.

Excretion from the body

Up to 70% of N-acetylcysteine ​​is not excreted in the urine. 2) The main renal metabolite of N-acetylcysteine ​​taken orally is urinary sulfate.

Bioaccumulation of minerals

In rodents, decreased tissue accumulation and increased urinary lead excretion were observed. In humans, a decrease in lead levels in the blood was noted. 3) N-acetylcysteine ​​has chelating activity. Lead is a heavy mineral that has a toxic effect and blocks the activity of glutathione. The toxic effect of lead directly depends on the depletion of glutathione reserves in cells; this is due to the high affinity of lead for the thiol group. Cysteine ​​(via NAC) is thought to mitigate the toxic effects of lead by providing a substrate and reducing the interaction of lead with thiol groups. 4) Animal studies (based on blood biomarkers and histological examination) have revealed the beneficial effects of N-acetylcysteine ​​against the effects of lead on kidney, brain and liver tissue. 5) N-acetylcysteine ​​is believed to mitigate the toxic effects of lead, which has a high affinity for thiol groups that normally suppress glutathione concentrations in the body; the position of external thiols can maintain glutathione concentration. N-acetylcysteine ​​supplementation (dosage divided into two days) for 12 weeks by workers who are highly exposed to lead was able to reduce blood lead concentrations by 4.72+/-7.08% (no dose response found). Erythrocyte lipofuscin is reduced by 11% with N-acetylcysteine ​​(mg daily for more than 12 weeks). But this is secondary to reducing lead toxicity (cross-linking as a result of oxidative stress and increasing lipofucin) 6). When taken orally in a standard dose, it may have a protective effect against lead toxicity, likely reducing lead concentrations in the body and the effects caused by it.

Neurology

Kinetics

N-acetylcysteine ​​increases glutathione concentrations in rodent nerve tissue when taken orally, suggesting that NAC is able to cross the blood-brain barrier. When taking L-cysteine, such an increase in glutathione concentration is not observed, since acetylation of N-acetylcysteine ​​slows down its metabolism, it is believed that first-pass metabolism limits the distribution of cysteine ​​in the body. 7)

Glutamatergic neurotransmission

Cystine-glutamate antiporter in astrocytes mediates synaptic glutamate levels and also uptakes cystine (cysteine ​​dimer) in exchange for glutamate release, which engages inhibitory metabotropic glutamate receptors (group II) on glutamatergic nerve terminals and reduces subsequent synaptic glutamate release. It is believed that N-acetylcystiene supplementation provides a substrate for the reaction to reduce stimulation of the glutamatergic system. 8) When taking medications, the antiport may be reduced and its functions may be impaired; N-acetylcystine may reverse the decline observed with drugs and inhibit autoregulation of transporters. 9) It is believed that cysteine ​​may reduce glutamatergic neurotransmission by reducing neuronal release of glutamate into the synapse (primary action is to promote its release from astrocytes). During the study, cocaine addicts took 2,400 mg of N-acetylcysteine. Readings taken an hour later (via MRI and MRS) demonstrated that the drug addicts' high glutamate levels (which were higher than those in healthy people) had normalized. 10) Taking N-acetylcysteine ​​may reduce glutamate levels (in people with high levels) within an hour of taking it. Oxidized and reduced glutathione are ligands for NMDA and AMPA receptors. They suppress the activity of ligands of the glutamate binding site, and also increase the binding of the antagonist MK-801 (to NMDA receptors). Affects neurotransmission at the receptor level, reduces the signaling ability of ligands of the glutamate binding center, but increases the binding of the antagonist MK-801.

Dopaminergic neurotransmission

The release of dopamine from neurons increases in the presence of a low concentration of N-acetylcysteine, but a high concentration of the substance (10 mmol) inhibits the process. This may be due to the way glutathione increases the release of dopamine caused by glutamate. Intravenous administration of N-acetylcysteine ​​slowed the downregulation of dopamine transporters in monkeys administered methamphetamine. 11) 3.4. Stress and Anxiety N-acetylcysteine ​​has been reported to have beneficial effects in anxiety-related disorders in some cases. For example, several case studies have found beneficial effects against nail biting and dermatillomania. 12)

Nervous excitability

Two studies have been conducted on patients with autism. It was noted that excitability, a symptom of autism, is noticeably reduced (compared to placebo) with daily intake of the substance and standard therapy. 13)

Obsessive state

Research has been conducted on the use of N-acetylcysteine ​​for the treatment of obsessive-compulsive disorder, for example, certain areas of the brain (nucleus accumbens and rectus cingulate cortex) show a similar response in drug addiction and OCD, and taking N-acetylcysteine ​​is known to have beneficial effects in drug addiction . People with OCD have increased lipid peroxidation in the brain, 14) associated with low levels of vitamin E in the brain, and decreased activity of antioxidant enzymes (except for increased superoxide dismutase). These oxidative changes are directly related to worsening symptoms. The similarities between drug addiction (proven beneficial effects) and OCD, as well as the pro-oxidative properties of OCD, suggest that N-acetylcysteine ​​supplementation may have therapeutic benefits. In a mouse model of OCD, intraperitoneal administration of 150 mg/kg N-acetylcysteine ​​was observed to have beneficial effects (as assessed by the defensive ball burying test), whereas the mg/kg dose was ineffective. Vitamin E was also found to be ineffective at any dosage (mg/kg). No additive effect was observed with the use of N-acetylcysteine ​​and a small dose of the serotonin reuptake inhibitor, fluvoxamine. A beneficial effect of acetylcysteine ​​in animals has been noted, and another antioxidant does not have the same effect. The study noted that cocaine addicts have elevated levels of glutamate in the brain, and these elevated levels of glutamate are associated with impulsivity; N-acetylcysteine ​​lowers glutamate levels, but the degree of impulsivity was not determined at the end of the experiment. Impulsivity is associated with high cerebral glutamate concentrations. A case study was conducted on a patient who was refractory to standard therapy with selective serotonin reuptake inhibitors (SSRIs; observed in 20% of cases). After daily intake of 3000 mg of N-acetylcysteine, the therapy gave results. In a follow-up study, daily administration of 2400 mg N-acetylcysteine ​​for 12 weeks to SSRI treatment-resistant patients (and OCD sufferers) increased treatment response (more than 35% on the Yale-Brown Obsessive-Compulsive Scale) from 15% to 52. 6%. 15) Preliminary evidence suggests that N-acetylcysteine ​​may enhance the effectiveness of SSRI therapy for the treatment of OCD, but it is unknown whether N-acetylcysteine ​​can provide similar beneficial effects on its own (since it is an adjuvant therapy rather than a monotherapy). Another disease that is similar in symptoms and treatment to OCD (since it is an impulse control disorder) is trichotillomania, which involves tearing out and eating hair on the head or other parts of the body. There are many types of this disease, some of them are similar in symptoms and pathology to OCD, some are similar to addiction. Therefore, the use of N-acetylcysteine ​​for the treatment of this disease is being studied (as it has a beneficial effect in the treatment of OCD and addiction). Case studies have shown beneficial effects of N-acetylcysteine ​​at 1,800 mg and 1,200 mg (in one study) daily for 6 weeks followed by increasing doses (2,400 mg). Taking the substance has shown that people suffering from trichotillomania experience a reduction in overall symptoms (31-45%, depending on the rating scale), as well as symptoms of comorbidities such as anxiety (31% reduction) and depression (34% reduction). %). 16) Preliminary evidence suggests that N-acetylcysteine ​​has a beneficial effect in the treatment of trichotillomania, possibly due to its effectiveness in the treatment of addiction and OCD (diseases similar in pathology to trichotillomania).

Addiction

In an open-label study, adolescents who admitted to using marijuana took 2,400 mg (twice 1,200 mg) of N-acetylcysteine ​​orally for four weeks. The result was a reduction in symptoms of dependence (according to the survey), compulsivity, and emotionality, but not anxious anticipation. Attacks of “craving” for marijuana decreased by 25% (the effect is observed after 2 weeks and persists thereafter), but the level of cannabinoids in the urine remained the same. 17) Preliminary data suggest that taking N-acetylcysteine ​​only slightly weakens dependence on marijuana and exhibits an anti-addictive effect. Testing was carried out on cocaine addicts who abstained from drug use (assessing withdrawal symptoms). During the day they took 2400 mg of N-acetylcysteine ​​(600 mg every 6 hours), as a result, it was noted that two hours after the first dose (the peak concentration of NAC in the blood), the desire did not decrease, but it was less after 14 hours, the effect persisted within 24 hours after the last dose of the medicinal substance. N-acetylcysteine ​​may reduce the desire for cocaine during drug withdrawal. In a study in rats, it was noted that self-administration of nicotine for more than 21 days reduced the expression of GLT-1 and cystine-glutamate antiporter in the nucleus accumbens (prefrontal cortex and amygdala were not affected). 18) The results of the experiment showed that taking 2400 mg of N-acetylcysteine ​​for 4 weeks by smokers reduced the frequency of smoking (compared to placebo) two weeks after intake. Nicotine consumption may reduce the expression levels of cystine glutamate antiporter and GLT-1, and N-acetylcysteine ​​intake may have a beneficial effect in the treatment of nicotine dependence (reduces the number of cigarettes smoked, but does not reduce smoking cravings).

Impact on Cardiovascular Health

Blood

Daily intake of mg/kg N-acetylcysteine ​​for 12 weeks increases the concentration of glutathione in erythrocytes by 5-6% compared to the control group, as well as an increase in G6PD activity by 17% (based on the results of a survey of all groups).

Skeletal muscle tissue and physical performance

Aerobic exercise

Taking N-acetylcysteine ​​for 6 days before a sprint interval test, which was done three times a day, maintained the same performance on the following day, but had no effect on the isokinetic test; this study is duplicated in Pubmed. 19)

Fatigue

Taking 150 mg/kg N-acetylcysteine ​​(by injection) before repeated peak contractions of the lower leg muscles does not affect energy output at rest, but increases it by 15% compared to the control group, which indicates the anti-fatigue effect of the substance. The result was obtained through low electrical impulses (10Hz), which put the subjects into a state of fatigue. The sprint interval test showed a beneficial effect of N-acetylcysteine, but no effect was found before and after exercise in isokinetic dynamometry. Although N-acetylcysteine ​​has a beneficial anti-fatigue effect, large doses and therefore injections are required to produce this effect; but even in this case the effect of the substance is not pronounced.

Effect on oxidation

Glutathione

N-acetylcysteine ​​acts as a glutathione substrate. Glutathione (GSH) sequesters reactive oxygen and nitrogen species in a process that converts glutathione (to glutathione disulfide; GSSG), then glutathione disulfide is reduced to glutathione by glutathione S-transferase (GST) enzymes. The antioxidant cycle is repeated until glutathione is broken down by gamma-glutamyltransferase into free glutamates and the dipeptide glycine-cysteine. Ultimately, free amino acids can be used to reduce glutathione, first by glutamate cysteine ​​ligase (to re-create the dipeptide) and then by glutathione synthesis (to create glutathione itself); the first stage is rate-limiting due to the availability of L-cysteine. Glutathione takes part in the cycle to block oxygen- and nitrogen-containing radicals, after several cycles it breaks down. Glutathione can be easily reduced, but the limiting factor is the availability of L-cysteine; taking N-acetylcysteine ​​allows L-cysteine ​​to accelerate resynthesis.

Superoxide

Superoxide (O2-) is an anion and free radical that is blocked by the antioxidant enzyme superoxide dismutase (SOD). N-acetylcysteine, like both cysteine ​​and glutathione, 20) has a relatively slow in vitro reaction rate for blocking O2-; Moreover, N-acetylcysteine ​​exhibits less antioxidant properties than glutathione, which is also quite ineffective. N-acetylcysteine ​​does not exhibit protective effects against superoxides, either directly or through glutathione.

Hydrogen peroxide

Hydrogen peroxide (H2O2) is a free radical in the body. It interacts directly and slowly with N-acetylcysteine ​​in vitro. 21) N-acetylcysteine ​​is not a promising free radical scavenger.

Hydroxyl group

Thiol antioxidants such as glutathione and N-acetylcysteine ​​are quite good at scavenging hydroxyl radicals (OH-). N-acetylcysteine ​​effectively scavenges hydroxyl radicals (OH-) both directly and through the production of glutathione.

Hypochlorous acid

Hypochlorous acid (HClO) is an oxidant derived from myeloperoxidase (MPO) after combining chloride anion and hydrogen peroxide; The enzyme is most active in neutrophils (a type of immune cell) during an oxidative burst. 22) N-acetylcysteine ​​is a fairly potent HOCl scavenger in vitro. N-acetylcysteine ​​blocks hypochlorous acid quite effectively.

Inflammation and immunology

Leukocytes

Supplementation with N-acetylcysteine ​​for 12 weeks caused a slight decrease in glutathione S-transferase activity in white blood cells in workers exposed to lead.

Eosinophils

Supplementation with 600 mg N-acetylcysteine ​​for 10 weeks was associated with lower levels of eosinophil cationic protein (which is released when eosinophils degranulate) in individuals with COPD. 23)

Effect on organs

Stomach

Taking 600 mg of N-acetycysteine, in addition to standard therapy, helps to increase the eradication rate in patients with helicobacter pylori infection who also suffer from dyspepsia (heartburn), from 60.7% to 70%.

Liver

Reducing the toxic effects of paracetamol with N-acetylcysteine ​​was first reported in 1978, with 7 g taken orally every 216 minutes (17 doses). 24)

Kidneys

N-acetylcysteine ​​supplementation (100 mg/kg intraperitoneal injection) was able to reduce lead levels in the blood and tissues of rats (pre-exposed to lead for 8 weeks), resulting in less kidney damage.

Lungs

N-acetylcysteine ​​exhibits mucolytic properties in individuals suffering from COPD. N-acetylcysteine ​​reduces immune cell adhesion when taken daily for 10 months as a prophylactic agent, but was ineffective when taken for 8 weeks. 25)

Other diseases

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a disease associated with airflow limitation. The disease is completely irreversible and is associated with a pathological inflammatory and oxidative response to stress factors, in particular in lung tissue. Research is being conducted on the beneficial effects of acetylcysteine ​​in COPD, due to the oxidative and inflammatory nature of the disease. When taking 600 mg of N-acetylcysteine ​​twice a day, lower levels of hydrogen peroxide in exhaled air condensate were observed in people with COPD (22% after 15 days, 29% after a month and 35% after two months). This suggests lower levels of oxidative stress in lung tissue, particularly from immune cells such as activated neutrophils and macrophages. When taking placebo, an increase in H2O2 was noted, but there was no effect on lung function. 26) A decrease in hydrogen peroxide levels may be associated with an increase in glutathione peroxidase activity. Daily administration of 600 mg N-acetylcysteine ​​for 10 months reduces neutrophil adhesion, while administration for 8 weeks was ineffective. Corticosteroids have the opposite effect, as they inhibit adhesion by 31% after 8 months of use, but eventually increase adhesion after 10 months. The decrease in adhesion may be directly related to the increase in glutathione concentration. Since daily intake of 600 mg N-acetylcysteine ​​reduces the cell adhesion factor ICAM-1 and IL-8, a decrease in these two factors is negatively associated with an increase in glutathione peroxidase activity. 27) Short-term administration of N-acetylcysteine ​​may cause changes in respiratory biomarkers, suggesting suppression of oxidative stress in lung tissue. This suggests the possibility of therapeutic use of N-acetylcysteine ​​in COPD. Taking 600 mg N-acetylcysteine ​​twice daily for 3 years (BRONCUS study) did not reduce the rate of decline in lung function. The BRONCUS study noted that N-acetylcysteine ​​did not have a protective effect when taking corticosteroids. This suggests that adjuvant therapy was ineffective. Long-term administration of N-acetylcysteine ​​has demonstrated beneficial effects in the treatment of COPD, but N-acetylcysteine ​​does not have adjuvant properties when used with corticosteroids. This suggests that the beneficial effect of corticosteroids is similar in effect to that of N-acetylcysteine, but the combination of the two drugs improves this effect. Daily administration of 600 mg N-acetylcysteine ​​for one week (concomitantly with 40 mg prednisone and 5 mg salbutamol) did not show any effect of N-acetylcysteine ​​on lung function or symptoms of breathlessness in persons with acute exacerbation of COPD. N-acetylcysteine ​​is ineffective in the treatment of acute forms of COPD.

Autism

Autism is associated with increased rates of oxidation in the brain, 28) blood, 29) and urine. 30) N-acetylcysteine ​​has a therapeutic effect on people suffering from autism, since this condition is characterized by low levels of glutathione in the cerebellum (34.2%) and temporal cortex (44.6%) compared to healthy people. Autism is also characterized by genetic changes in the glutathione pathway. Additionally, elevated glutamate levels do not have a significant effect on autism pathology (glutamate antagonists alleviate autism symptoms in animals 31). Supplemental N-acetylcysteine ​​reduces elevated glutamate levels (a mechanism that underlines anti-addiction properties). N-acetylcystine improves autism symptoms due to its antioxidant properties, and it also reduces excessive levels of glutamate in the brain; Both oxidation and glutamate levels are abnormally elevated in individuals with autism compared to healthy controls. A case study demonstrated the promising effects of N-acetylcysteine. In a pilot study (double-blind), patients took 900 mg N-acetylcysteine ​​daily for the first 4 weeks, a double dose (1800 mg) for the next 4 weeks, and a triple dose (2700 mg) for the last four weeks. N-acetylcysteine ​​was found to be able to reduce feelings of excitability (as measured by the Deviant Behavior Test) after 12 weeks in patients with autism, but did not affect any of the ABC rating scales, a measure of social responsibility. (SRS scale) or response distortion scale (RBS scale). The experiment was later repeated on individuals with autism who were being treated with risperidone. Daily intake of 1200 g of the substance for 8 weeks reduced feelings of arousal only on the ABC scale. Preliminary evidence suggests that N-acetylcysteine ​​may reduce feelings of agitation in individuals with autism, especially when undergoing therapy. But N-acetylcysteine ​​does not affect any other symptom.

Sjögren's syndrome

One study noted that taking N-acetylcysteine ​​improved the eye symptoms of Sjögren's syndrome by reducing irritability and dry eyes, as well as reducing bad breath and thirst.

Interactions with nutrients

Activated carbon

It was noted that N-acetylcysteine ​​binds to charcoal in the intestine (96%). Studies have shown that the combined consumption of 100 g of activated carbon reduces the absorption of N-acetylcysteine ​​(140 mg/kg) by 39% and reduces peak plasma concentration levels by 26%. This statement is not fully confirmed, since there is evidence that 60 g of activated carbon does not affect the kinetics of 140 mg/kg N-acetylcysteine. It is possible that N-acetylcysteine ​​binds to activated charcoal in the intestines (activated charcoal binds to toxins and removes them from the body). Therefore, both substances should not be used together.

Ethanol

Oxidative stress is usually assessed by glutathione levels and activity. Taking N-acetylcysteine ​​and alcohol together suppresses the alcohol-induced decrease in glutathione levels after 4 weeks and after six months. Oxidative stress also affects the liver, blood and brain tissue. Before the start of the experiment, the rats were injected with ethyl alcohol, then ethyl alcohol was injected together with N-acetylcysteine. 15 days after starting N-acetylcysteine ​​supplementation, a protective effect of the substance was noted, as a decrease in oxidative stress in the liver was detected. But when taking N-acetylcysteine ​​after stopping ethyl alcohol, the protective effect was higher. 32) N-acetylcysteine ​​taken 30 minutes before a dose of ethyl alcohol shows a protective effect, while taking N-acetylcysteine ​​4 hours after a dose of ethyl alcohol aggravates the damage. This study also noted a reduction in the degree of histological damage in mice that were pretreated with N-acetylcysteine. Pre-administration (30 minutes) of N-acetylcysteine ​​before consuming ethyl alcohol reduces liver damage in rodents, whereas taking N-acetylcysteine ​​4 hours after consuming ethyl alcohol may worsen alcohol-induced damage. Mitochondrial biogenesis in rats (assessed by the activity of the PGC-1α gene), enhanced by ethyl alcohol, is suppressed by taking 1.7 g/kg N-acetylcysteine, while ethyl alcohol reduces the structural integrity and function of mitochondria, regardless of the effect of N-acetylcysteine. A study assessing the mitochondrial structure of rat liver tissue found that N-acetylcysteine ​​supplementation suppressed alcohol-induced increased mitochondrial biogenesis but did not appear to protect against other types of mitochondrial damage; this occurs simultaneously with the standard reduction in oxidative damage.

Acetylcysteine ​​(ACC / Fluimucil): instructions for use

Indications for use

Acute and chronic bronchitis and bronchiolitis, bronchiectasis, cystic fibrosis, emphysema and other respiratory diseases with large amounts of thick mucus or mucopurulent discharge. In toxicology it is used as an antidote for paracetamol overdose. It is also used for long-term artificial ventilation in the treatment of respiratory failure, acute and chronic sinusitis, exudative otitis media, as well as in preparation for bronchography.

Acetylcysteine ​​(ACC / Fluimucil): contraindications

Hypersensitivity to any of the components of the drug, severe asthma attack. Do not use or use caution when using the drug in patients with active peptic ulcers of the stomach and duodenum. Caution should also be exercised in elderly patients with severe respiratory failure, asthma or esophageal varices. Should not be used in patients with reduced expectoration ability in the absence of respiratory physiotherapy. Large doses of acetylcysteine ​​as an antidote can reduce prothrombin time; coagulation parameters should be monitored. The smell of sulfur does not indicate a change in the properties of the drug and is typical of the active substances contained in the drug.

Acetylcysteine ​​(ACC / Fluimucil): interaction with other drugs

The simultaneous use of cough medications may be associated with retention of thin mucus in the bronchi. Simultaneous use with nitroglycerin or nitrates increases their vasodilatory effect and platelet aggregation. Do not use the drug within two hours after taking antibiotics, especially semisynthetic penicillins, tetracyclines, cephalosporins and aminoglycosides (when using acetylcysteine ​​as an antidote, these precautions are unnecessary). Nothing is known about possible interactions of acetylcysteine ​​with amoxicillin, doxycycline, [[erythromycin|erythromycin]], thiamphenicol and cefuroxime (acetylcysteine ​​increases the penetration of cefuroxime into bronchial secretions). Solutions containing acetylcysteine ​​should not be mixed with other drugs.

Side effects of Acetylcysteine ​​(ACC / Fluimucil)

Nausea, vomiting, heartburn, diarrhea, headache, tinnitus, watery nasal discharge, stomatitis. Sometimes an allergic reaction manifests itself as a skin lesion in the form of an itchy rash. When taking large doses, dilation of blood vessels and sudden redness of the face, as well as excessive dilution of mucopurulent secretions (especially in patients with an inadequate cough reflex), may be observed. Very rarely, during the initial period of use of the drug, bronchoconstriction, hypersecretion of mucus, and a sharp dry cough may be observed. When taking the drug by inhalation, bronchospasms and shortness of breath may occur, especially in patients with asthma. Hypersensitivity to acetylcysteine ​​can lead to inflammation of the mucous membranes of the mouth and nose.

Pregnancy and lactation

Category B. Do not use during pregnancy or breastfeeding unless absolutely necessary.

Acetylcysteine ​​(ACC / Fluimucil): instructions

For respiratory diseases: Adults and children over 14 years of age: up to 600 mg per day once a day or divided into several doses. Children 6–14 years: up to 400 mg/day in 2–4 doses Children 2–6 years: up to 300 mg/day in 2–3 doses. For cystic fibrosis: Children 2-6 years old: up to 400 mg / day Children over 6 years old: up to 600 mg / day. Take the last dose no later than 4 hours before bedtime. Dissolve the drug in the form of effervescent tablets or granules in cold water. Take immediately after dissolution. Solutions should not have contact with metal (iron, nickel, copper) and rubber. In case of poisoning with paracetamol, acetylcysteine ​​should be taken as quickly as possible, no later than within the first 14 hours, or in extreme cases, up to 24 hours after poisoning; Preferably taken orally, initially at a dose of 150 mg/kg body weight with plenty of liquid, followed by 70 mg/kg body weight every 4 hours (for a total of 17 doses). Intravenous adults and children over 2 years of age: initial dose 150 mg/kg body weight over 15 minutes, then 50 mg/kg body weight over 4 hours, then 100 mg/kg body weight over 16 hours; the total dose is 300 mg/kg body weight over 24 hours.

Availability / Fluimucil)

Acetylcysteine ​​is used for diseases of the respiratory system and conditions accompanied by the formation of viscous and mucopurulent sputum: acute and chronic bronchitis, tracheitis due to bacterial and/or viral infection, pneumonia, bronchiectasis, bronchial asthma, atelectasis due to blockage of the bronchi by mucus plug, sinusitis (for facilitating the passage of secretions), cystic fibrosis (as part of combination therapy). It is also used to remove viscous secretions from the respiratory tract in post-traumatic and postoperative conditions. Effective in case of paracetamol overdose.

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