Clinical and pharmacological group: & nbsp

Mucolytics and stimulators of motor function of the respiratory tract

Included in the formulation
  • Acestin®
    pills inwards 
  • Acestin®
    pills inwards 
  • Acetylcysteine
    pills inwards 
    VERTEKS, AO     Russia
  • Acetylcysteine
    pills inwards 
    VERTEKS, AO     Russia
  • Acetylcysteine
    powder inwards 
    MARBIOFARM, OJSC     Russia
  • Acetylcysteine ​​Canon
    granules inwards 
  • Acetylcysteine-Teva
    pills inwards 
  • ACTS®
    syrup inwards 
    Sandoz d.     Slovenia
  • ACTS®
    granules inwards 
    Sandoz d.     Slovenia
  • ATSTS® 100
    pills inwards 
    Sandoz d.     Slovenia
  • ATSTS® 200
    pills inwards 
    Sandoz d.     Slovenia
  • ACTS® injection
    solution w / m in / in 
    Sandoz d.     Slovenia
  • ACTS® Long
    pills inwards 
    Sandoz d.     Slovenia
  • N-AC-Ratiopharm
    powder inwards 
    ratiofarm GmbH     Germany
  • Fluimucil®
    solution inwards 
    Zambon SpA     Italy
  • Fluimucil®
    pills
  • Fluimucil®
    granules inwards 
  • Fluimucil®
    solution locally d / inhal. in / in 
    Zambon SpA     Italy
  • ESPA-NATS®
    powder inwards 
    Esparma GmbH     Germany
  • Included in the list (Order of the Government of the Russian Federation No. 2782-r of 30.12.2014):

    VED

    ONLS

    Minimal chemist's assortment

    АТХ:

    S.01.X.A.08   Acetylcysteine

    R.05.C.B.01   Acetylcysteine

    Pharmacodynamics:
    Mucolytic, expectorant. Promotes liquefaction and excretion of sputum, reduces inflammation in the bronchi.

    The mucolytic action of acetylcysteine ​​is due to several mechanisms. The preparation contains sulfhydryl groups in the structure, which break the disulfide bonds of the proteoglycans of the sputum, which causes their depolymerization. This leads to a decrease in the viscosity and adhesiveness of the sputum.

    Acetylcysteine ​​stimulates the functioning of mucosal cells, the secret of which lysers fibrin, which also contributes to liquefaction of sputum. The amount of sputum secretion increases, this facilitates its separation. In addition, the drug inhibits the formation of free radicals, reducing the inflammatory response in the bronchi.

    Another useful function of acetylcysteine ​​is to restore the concentration of glutathione in the liver, spent on inactivating toxic metabolites of paracetamol, as well as direct inactivation of toxic metabolites of paracetamol.
    Pharmacokinetics:
    When ingested quickly and completely absorbed, but the bioavailability does not exceed 10%, because the first passage through the liver is deacetylated, turning into cysteine.

    The maximum concentration is achieved in 1-3 hours. The binding to plasma proteins is about 50%. The latent period is 30-90 minutes, the duration of the action is 2-4 hours.

    Penetrates through the placental barrier, is found in the amniotic fluid. Half-life with oral administration - 1 hour, with cirrhosis increases to 8 hours. It is excreted mainly by kidneys in the form of inactive metabolites (inorganic sulfates, diacetylcysteine), a small part is excreted unchanged in the intestine.

    Indications:
    Diseases of the respiratory system and condition, accompanied by the formation of viscous and mucopurulent sputum: bronchitis, tracheitis, bronchiolitis, pneumonia, bronchiectatic disease, cystic fibrosis, lung abscess, pulmonary emphysema, laryngotracheitis, interstitial lung diseases, bronchial asthma, lung atelectasis (due to congestion of bronchial mucosa cork), catarrhal and purulent otitis, sinusitis, including sinusitis.
    Removal of a viscous secretion from the respiratory tract in post-traumatic and postoperative conditions.
    Preparation for bronchoscopy, bronchography, aspiration drainage.
    Poisoning with paracetamol (as an antidote).

    VIII.H65-H75.H66.0   Acute suppurative otitis media

    VIII.H65-H75.H65.0   Acute middle serous otitis media

    IV.E70-E90.E84.0   Cystic fibrosis with pulmonary manifestations

    X.J00-J06.J04.1   Acute tracheitis

    X.J10-J18.J18   Pneumonia without clarification of the pathogen

    X.J20-J22.J21.9   Acute bronchiolitis, unspecified

    X.J30-J39.J32.9   Chronic sinusitis, unspecified

    X.J30-J39.J32.0   Chronic maxillary sinusitis

    X.J30-J39.J37.1   Chronic laryngotracheitis

    X.J40-J47.J40   Bronchitis, not specified as acute or chronic

    X.J40-J47.J43   Emphysema

    X.J40-J47.J45   Asthma

    X.J40-J47.J47   Bronchoectasia

    X.J80-J84.J84.8   Other specified interstitial lung diseases

    X.J85-J86.J85   Abscess of the lung and mediastinum

    X.J95-J99.J98.1   Pulmonary collapse

    XVIII.R00-R09.R09.3   Sputum

    XIX.T36-T50.T39   Poisoning by non-opioid analgesic, antipyretic and antirheumatic agents

    Contraindications:Peptic ulcer of the stomach and duodenum in the phase of exacerbation, hemoptysis, pulmonary hemorrhage, hypersensitivity to acetylcysteine.
    Carefully:
    Pregnancy, breast-feeding, liver and kidney disease. Varicose veins of the esophagus, phenylketonuria (for forms containing aspartame), adrenal diseases, arterial hypotension. When using acetylcysteine ​​in patients with bronchial asthma, it is necessary to provide sputum drainage.

    In patients with bronchoobstructive syndrome (it develops quite frequently against the background of bronchospasm enhancement), the drug must be combined with bronchodilators.

    Pregnancy and lactation:
    Action category for the fetus by Food and Drug Administration (US Food and Drug Administration) - B.

    In pregnant women and during lactation - it is possible only if the intended benefit to the mother exceeds the potential risk to the fetus or baby. For the duration of treatment, breastfeeding should be discontinued. Newborns - only for life indications in a dose of 10 mg / kg under the strict supervision of a doctor.

    Dosing and Administration:
    Inside bronchitis, bronchiectasis, bronchiolitis, laryngitis, bronchial asthma, sinusitis, average otitis adults and children over 6 years - 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 (recommended - in the form of effervescent tablets), up to 2 years - 100 mg 2 times a day.

    In cystic fibrosis, children over 6 years of age should take the drug 200 mg three times a day (600 mg per day). The dose should be increased gradually. Patients with a body weight of more than 30 kg with cystic fibrosis drug can be taken in a dose of up to 800 mg per day.

    In newborn infants are used only for vital indications in a dose of 10 mg / kg under the strict supervision of a doctor.

    Inside the initial dose of 140 mg / kg, then 70 mg / kg every 4 hours - up to 17 additional doses.

    Intramuscularly adults - 300 mg once a day, children - 150 mg once a day.

    Inhalation - 2-5 ml of 20% solution 3-4 times a day (for 15-20 minutes).

    Locally - to flush the auditory canals, nasal passages (for 1 procedure - 1.5-3 ml of 10% solution).

    It is recommended that after food intake.

    For use as an antidote, the combined use of acetylcysteine ​​and activated carbon, a loading dose of 140-235 mg / kg, followed by 70 mg / kg every 4 hours - up to 17 additional doses is recommended.
    Side effects:
    From the digestive system: rarely - heartburn, nausea, vomiting, diarrhea, sensation of stomach overflow.

    Allergic reactions: rarely - skin rash, itching, urticaria, bronchospasm.

    With a shallow intramuscular introduction and in the presence of hypersensitivity: there may be a light and rapid burning, so it is recommended to inject the drug deep into the muscle.

    For inhalation use: possible reflex cough, local irritation of the respiratory tract; rarely - stomatitis, rhinitis.

    Other: drowsiness, fever; rarely - nosebleeds, rarely - tinnitus.

    From the laboratory indicators: it is possible to decrease the prothrombin time when large doses of acetylcysteine ​​are administered (monitoring of the state of the blood clotting system is necessary), changing the results of the quantitative salicylate test (colorimetric test) and the ketone quantification test (sodium nitroprusside test).
    Overdose:It manifests itself with symptoms such as diarrhea, heartburn, nausea, vomiting, pain in the stomach. Treatment is symptomatic.
    Interaction:
    It is undesirable to mix solutions of acetylcysteine ​​with solutions of antibiotics and proteolytic enzymes to avoid inactivation of the drug.

    When used simultaneously with antibiotics (including tetracycline, ampicillin, amphotericin B), they may interact with the thiol group of acetylcysteine ​​and, as a consequence, reduce the absorption of antibiotics.

    Acetylcysteine ​​increases the antianginal effect of nitroglycerin (the interval between doses should be at least 2 hours).

    Simultaneous use of acetylcysteine ​​with antitussive drugs can increase sputum stagnation due tosuppression of cough reflex.

    M-holinoblokatory - weakening the effect of acetylcysteine.

    Theophylline - increased bronchodilator effect.

    Pharmaceutically incompatible with solutions of other drugs, but budesonide in the form of a suspension for inhalation can be mixed with a solution of acetylcysteine, intended for use with a nebulizer.

    Physically and chemically compatible for 60 minutes with a solution for inhalation of cromolyn sodium and isoproterenol.

    The combination glaucine + ephedrine + basil of common oil It is not recommended to apply simultaneously with acetylcysteine ​​- due to difficulty in coughing up phlegm.

    Special instructions:Acetylcysteine reacts with some materials, such as iron, copper and rubber, used in the spraying device. In the places of possible contact with the acetylcysteine ​​solution, parts made of the following materials should be used: glass, plastic, aluminum, chrome-plated metal, tantalum, silver of the sample or stainless steel. After contact, silver may fade, but this does not affect the effectiveness of acetylcysteine ​​and does not harm the patient.
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