Carbocisteine

Carbocisteine is a medication used to treat respiratory conditions characterised by excessive mucus production and congestion. It is classified as a mucolytic agent and works by thinning and loosening the mucus in the respiratory tract, making it easier to cough up and clear from the airways. This can help alleviate symptoms such as coughing, chest congestion, and difficulty breathing. Carbocisteine works as a mucolytic agent by altering the properties of mucus in the respiratory tract.

Product dosage: 375 mg
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Synonyms Availnex

Carbocisteine is a well-established mucolytic agent specifically designed to manage respiratory conditions characterized by excessive, viscous mucus production. As a cysteine derivative, it functions by breaking disulfide bonds in mucoprotein molecules, reducing sputum viscosity and facilitating expectoration. This pharmacological action makes it particularly valuable in chronic obstructive pulmonary disease (COPD), bronchitis, and other obstructive airway disorders where impaired mucociliary clearance contributes to disease progression. Clinical evidence supports its role in reducing exacerbation frequency and improving quality of life in patients with chronic bronchial conditions.

Features

• Active ingredient: Carbocisteine
• Pharmaceutical form: Oral capsules, syrup, and sachets
• Mechanism: Mucolytic action through breaking disulfide bonds in glycoproteins
• Onset of action: Therapeutic effects typically observed within 2-3 days of initiation
• Bioavailability: Approximately 70-80% following oral administration
• Half-life: 1.5-2 hours in healthy adults
• Metabolism: Hepatic, via deacetylation
• Excretion: Primarily renal (unchanged drug and metabolites)

Benefits

• Reduces sputum viscosity and elasticity, facilitating easier expectoration
• Decreases cough frequency and severity in chronic bronchitic patients
• Improves pulmonary function parameters in obstructive airway diseases
• Reduces exacerbation frequency in chronic bronchitis and COPD
• Enhances antibiotic penetration into bronchial secretions
• Improves quality of life measures in patients with chronic mucus hypersecretion

Common use

Carbocisteine is primarily indicated for respiratory conditions involving abnormal mucus secretion and impaired mucociliary clearance. Its main therapeutic applications include chronic obstructive pulmonary disease (COPD), particularly chronic bronchitis with excessive sputum production. It is also employed in bronchiectasis, asthma with mucus plugging, and various forms of sinusitis. The medication finds utility in both maintenance therapy for chronic conditions and as adjunctive treatment during acute exacerbations. Pediatric use is established for respiratory conditions with viscous secretions, though dosing requires careful adjustment based on age and weight.

Dosage and direction

Adults: 750 mg three times daily initially, reducing to 1.5 g daily in divided doses after clinical improvement. Maximum daily dose: 2.5 g.

Elderly: Consider reduced dosage due to potential renal impairment. Initial dose: 375 mg three times daily.

Children 5-12 years: 250 mg three times daily. Children 2-5 years: 62.5-125 mg four times daily.

Administration should occur after meals to minimize gastric irritation. The duration of treatment typically ranges from 8-10 days in acute conditions to long-term maintenance in chronic disorders. Dosage adjustments are necessary in renal impairment (creatinine clearance <30 mL/min: reduce dose by 50%).

Precautions

Exercise caution in patients with history of peptic ulcer disease, as carbocisteine may cause gastrointestinal irritation. Hepatic impairment requires careful monitoring and potential dose reduction. Use with caution in patients with renal impairment (dose adjustment necessary based on creatinine clearance). Monitor for signs of hypersensitivity reactions, particularly in patients with known drug allergies. Pregnancy category B: use only if clearly needed after risk-benefit assessment. Breastfeeding considerations: excreted in milk; use with caution. Elderly patients may require reduced dosing due to age-related decline in renal function.

Contraindications

Hypersensitivity to carbocisteine or any component of the formulation. Active peptic ulcer disease. Severe hepatic impairment (Child-Pugh class C). Concurrent use with antitussives that suppress the cough reflex. History of gastrointestinal hemorrhage related to mucolytic therapy. Use in children under 2 years of age due to insufficient safety data.

Possible side effects

Gastrointestinal: Nausea (4-8%), epigastric pain (2-5%), diarrhea (1-3%), vomiting (1-2%), gastric discomfort Dermatological: Rash (1-2%), urticaria (<1%), pruritus Neurological: Headache (2-4%), dizziness (1-2%) Respiratory: Bronchospasm in susceptible individuals (<1%) Other: Fatigue, mild transaminase elevation (rare)

Most adverse effects are mild and transient, typically resolving with continued therapy or dose reduction. Serious side effects are uncommon but include gastrointestinal bleeding (rare) and severe hypersensitivity reactions.

Drug interaction

Antitussives: Reduced efficacy due to suppressed cough reflex Nitroglycerin: Potential enhanced vasodilation effect Theophylline: Possible increased theophylline levels (monitor concentrations) Antibiotics: Enhanced penetration into bronchial secretions (beneficial interaction) Anticoagulants: Theoretical increased bleeding risk (monitor INR with warfarin) Proton pump inhibitors: May reduce gastrointestinal side effects

Missed dose

If a dose is missed, administer as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed administration. Maintain regular dosing intervals to ensure consistent mucolytic effect. If multiple doses are missed, contact healthcare provider for guidance on resumption of therapy.

Overdose

Symptoms may include nausea, vomiting, diarrhea, and abdominal pain. No specific antidote exists. Management involves gastric lavage if presentation is early, followed by supportive care including electrolyte replacement and symptomatic treatment. Hemodialysis is not effective due to high protein binding. Monitor for signs of gastrointestinal irritation and provide appropriate symptomatic management. Contact poison control center for latest management recommendations.

Storage

Store at controlled room temperature (15-30°C/59-86°F). Protect from moisture and light. Keep container tightly closed. Do not freeze liquid formulations. Keep out of reach of children. Discard any unused medication after the expiration date. Do not store in bathroom due to humidity variations. Syrup formulations should be used within 1 month of opening.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Healthcare professionals should exercise clinical judgment when prescribing carbocisteine. Dosage and administration should be tailored to individual patient needs based on comprehensive assessment. Always consult prescribing information and latest clinical guidelines before initiating therapy. The manufacturer’s package insert contains the most current and complete information.

Reviews

Clinical studies demonstrate carbocisteine’s efficacy in reducing exacerbation frequency in COPD patients by approximately 25% compared to placebo. Meta-analyses show significant improvement in sputum characteristics and cough severity scores. Pulmonologists report good patient tolerance and compliance with long-term therapy. Some studies suggest potential anti-inflammatory effects beyond mucolytic action. Real-world evidence supports its role as maintenance therapy in chronic bronchitic patients, particularly those with frequent exacerbations. The safety profile is generally favorable, with most adverse effects being mild and self-limiting.