Acetylcysteine is a substance that thins bronchial secretions. What are its benefits ? In what drugs is it found? Exomuc®? Can you get it without a prescription? What are the risks and contraindications?
What is acetylcysteine?
Acetylcysteine is a synthetic molecule derived from cysteine. Cysteine is one of the amino acids that the synthesis of proteins essential for the proper functioning of the body. After absorption, acetylcysteine is transformed into cysteine, this is its precursor.
Is it the same as N-acetylcysteine?
Terms “N-acetylcysteine” (or NAC) and “acetylcysteine” are equivalent. The name retained by the World Health Organization (WHO) and found in the INNs of medicinal products is “acetylcysteine“.
What are the benefits of acetylcysteine?
► Acetylcysteine exerts a mucolytic action: it breaks down and thins the mucus present in the bronchi to promote its elimination. Thus, it is indicated in the symptomatic treatment of acute bronchial affections and episodes of chronic bronchopneumopathies. Use is recommended when these conditions are associated with excess bronchial secretions and expectoration difficulties. It also reduces secretions for colds, sinusitis and otitis. In addition, this medicine may be of interest in the bronchial clearance in a tracheotomized patient. Acetylcysteine combined with a decongestant and an antiseptic is used in the treatment of nasopharyngitis.
► Acetylcysteine allows detoxification of the body. In hospitals, its use as an antidote is intended for the management of acute paracetamol poisoning.
► In ophthalmology, acetylcysteine promotes corneal healing by blocking the action of collagenase, an enzyme that degrades collagen after injury. Currently, eye drops containing it are no longer marketed in France.
► In addition, some scientific studies have highlighted other benefits of acetylcysteine: anti-inflammatory and cardiovascular propertiesa increased insulin sensitivity in diabetic patients, reduction in symptoms of depression, bipolar disorder and schizophrenia. However, these effects are not recognized by the French national health authorities, so they do not constitute indications for marketed drugs.
In which drugs is acetylcysteine found?
Acetylcysteine is present in several commercial specialties that can be administered orally:
- Fluimucil® in oral solution or in granules for oral solution. There is an adult form and a pediatric form.
- Fluimucil® expectorant in granules for oral solution, exclusively reserved for adults
- Exomuc® in sachet granules for oral use (from 7 years old) or granules for oral solution (from 2 years old)
- Mucomyst® in sachet of powder for oral solution, indicated for adults and children from 7 years old
- Mucodrill® tablets 600 mg sparkling
- Acetylcysteine® Arrow tablets 200 mg sparkling
In addition, powder for oral solution 200 mg is available in generics. Note that the 600 mg dosage forms are reserved for adults. Moreover, the drug Rhinofluimucil® is a nasal spray solution containing acetylcysteine associated with a decongestant vasoconstrictor and an antiseptic. The drug Istendo® contains acetylcysteine in the form of ampoules of solution for instillation intended to clear the airways of tracheotomized patients.
Is acetylcysteine good for the liver?
By its transformation into cysteine, acetylcysteine is a precursor of glutathione. Powerful antioxidant mainly present in the liver, glutathione eliminates harmful substances from this organ and limits harmful damage. Acetylcysteine therefore has a protective role for the liver.
Is acetylcysteine recommended in case of wet cough?
The use of an acetylcysteine-based drug is recommended in case of wet cough associated with difficulty in expectoration. This molecule does not exert a direct antitussive action, but allows relieve cough by clearing the airways by thinning mucus. This type of medicine should never be combined with an antitussive (indicated for a dry cough) at the risk of stopping the wet cough and causing superinfection in the respiratory tract by stagnation of mucus.
Is acetylcysteine without a prescription?
Acetylcysteine medicines for oral use are available over the counter. On the other hand, Istendo® and Rhinofluimucil® are only available with a prescription.
What are the side effects of acetylcysteine?
Adverse effects of acetylcysteine are uncommon. Digestive intolerance manifested by nausea, diarrhea and gastric pain may occur. A reduction in dosage helps to reduce these effects. Likewise, bronchospasm and breathing difficulties have been reported. Their occurrence should lead to an interruption of acetylcysteine. Other effects like headache, tinnitus, heart palpitations, or low blood pressure are possible. More rarely, a severe allergic reaction can be caused by the drug. Particular vigilance is therefore required in patients with history of peptic ulcer disease or stomach irritant treatment (anti-inflammatory) and those with history of asthma or bronchospasm.
“Administration should be avoided in the evening, the last dose is recommended around 4 p.m.”
What are the contraindications of acetylcysteine?
Specialties containing acetylcysteine have several contraindications:
- A allergy to one of the components
- A phenylketonuriafor specialties containing aspartame (Exomuc® in sachet for oral solution and Fluimucil® in granules for oral solution)
- A galactose or fructose intolerancelactase deficiency (enzyme used to digest milk) and intestinal absorption disorders: for Mucomyst, Exomuc® and Fluimucil® in granules for oral solution
- Child under 2 years old (7 years for Mucomyst® and Exomuc® granules for oral use). An infant is not able to expectorate effectively, this type of medication would expose him to bronchial overcrowding.
Additionally, a mucolytic should not be administered for more than 10 days without medical advice (5 days for Mucomyst® and Exomuc®). Administration should be avoided in the evening at the risk of inducing nocturnal coughs, the last dose is recommended around 4 p.m. Caution is required in patients with history of asthma, bronchospasm, or peptic ulcer disease because of the risk of worsening disorders. Note that acetylcysteine is not contraindicated during pregnancy and breastfeeding, it is possible if necessary.
Sources:
– Public drug database
– French Society of Emergency Medicine (SFMU)