Work and Uses of Acetylcysteine

Generic Name
Acetylcysteine

Antidote preparations, Cough expectorants & mucolytics

Pharmacology :

Acetylcysteine may be a mucolytic agent that reduces the viscosity of secretions probably by the splitting of disulfide bonds in mucoproteins. Moreover, it gives an antisecretory effect. These lead to the clearing of respiratory ducts and facilitate breathing. Acetylcysteine also has anti-oxidant properties by reacting with free radicals and also by serving as a precursor to glutathione, which is a crucial intra and extra-cellular antioxidant. By providing anti-oxidant action, it neutralizes exogenous and endogenous oxidants, which actually act as pathogens in respiratory inflammations.

Indications :

As Mucolytic in pulmonary disease: tract disorders related to excessive viscous mucous such as-chronic bronchopulmonary disease (chronic emphysema, emphysema with bronchitis, chronic asthmatic bronchitis, tuberculosis) acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis), pulmonary complications of CF, pulmonary complications related to surgery.

Dosage & Administration :

Effervescent tablet or Dispersible table-

• Children above 6 years aged or adults: 1 tablet daily (preferably within the evening). Dissolve it in ½ glass of water and blend properly. After dissolving, take the entire content of the glass.

Granules-

• Adults and youngsters above 6 years: 1 sachet Acetylcysteine 200 mg or 2 sachets Acetylcysteine 100 mg, 2-3 times each day.
• Children (2-6 years of age): 1 sachet Acetylcysteine 100 mg from 2 to 4 times each day, consistent with the age.

The duration of treatment should be 5 to 10 days within the acute treatment, whereas it's going to be continued within the chronic states for several months, consistent with the recommendation of the physician.

Dissolve the contents of the sachets during a glass containing a little quantity of water; mixing it, if necessary, with a spoon. A palatable solution is thus obtained, which may be drunk directly from the glass.

Nebuliser Solution: The 20% solution could also be diluted to a lesser concentration with either common salt for injection, common salt for inhalation, sterile water for injection, or sterile water for inhalation.

• Adult: 5-10 ml of 10% or 20% solution by Nebuliser every 6-8 hr PRN.
• Children: 1-11 months: 1-2 ml of 20% or 2-4 ml of 10% solution by Nebuliser every 6-8 hr PRN.
• 12 months-11 years: 3-5 ml of 20% or 6-10 ml of 10% solution by Nebuliser every 6-8 hr PRN.
• Below 12 years: 5-10 ml of 10/20% solution by Nebuliser every 6-8 hr PRN.

Diagnostic Bronchograms: 1-2 ml of 20% or 2-4 ml of 10% solution 2-3 times by Nebulisation or by instillation intratracheally before the procedure.

Nebulisation tent or croupette: this type of administration requires very large volumes of the answer, occasionally the maximum amount as 300 ml during one treatment period. If a tent or croupette must be used, the recommended dose is that the volume of acetylcysteine (using 20%) which will maintain a really heavy mist within the tent or croupette: for the specified period. Administration for intermittent or continuous prolonged periods, including overnight, could also be desirable.

Direct Installation: When employed by direct instillation, 1-2 ml of a 20% solution could also be given as often as every hour. When used for the routine medical care of patients with tracheostomy, 1-2 ml of a 20% solution could also be given every 1-4 hours by instillation into the tracheostomy.

Interaction :
The thiol group of Acetylcysteine can reduce the efficacy of certain antibiotics like ampicillin, tetracycline, macrolides, cephalosporins, aminoglycosides,and amphotericin. Concomitant use of Acetylcysteine and amoxicillin will increase the extent of the antibiotic in tissues. It is, therefore, advisable to use the 2 medicines 2 hours aside from one another. Acetylcysteine can increase the inhibitory effect of thrombocyte aggregation and vasodilation by nitroglycerine.

Contraindications :
Allergic reaction to Acetylcysteine.

Side Effects :
Mild gastrointestinal disturbances like nausea, vomiting, diarrhea, itching, urticaria, headache, and fever could also be reported. Hypersensitivity reactions affecting the skin and respiratory organs.

Pregnancy & Lactation :
The US Food and Drug Administration has classified Acetylcysteine as category B medicine for pregnant women. Acetylcysteine should only be utilized in pregnant women when clearly needed.

Precautions & Warnings :
Acetylcysteine can't be used with antitussive medicines since it suppresses the cough reflex and therefore the physiologic self-cleaning mechanism of respiratory airways thus causes mucus stasis in bronchial ducts will increase the danger of infection, the occurrence of bronchospasm. Special attention must be paid to patients with asthma due to the danger of bronchospasm in these patients. Patients with gastrointestinal bleeding must use this medicine with caution since it increases nausea.

Storage :
keep in a dry place far away from light and warmth. exclude the reach of youngsters.