Download Mucomist ® DT Prescribing information

Mucomist®
Acetylcysteine
Respirator Solution, Dispersible Tablet
Description
Acetylcysteine is a derivative of the amino acid, cysteine. Mucomist® DT contains
Acetylcysteine 600 mg. Mucomist® DT (dispersible tablet) is a new pharmaceutical form that
ensures optimum stability, rapid dissolution, maximal absorption, high bioavailability in a
perfectly calibrated dosage. Mucomist® Respirator Solution contains 20% or 200 mg/ml
Acetylcysteine and available as sterile, unpreserved solution (not for injection). The 20%
inhalation solution is given by nebulization or by instillation intratracheally.
Pharmacology
Acetylcysteine has a mucolytic activity through its free sulfhydryl group. It acts directly on the
mucoproteins to open the disulfide bonds and thus lowers the viscosity of the mucous and
facilitates its removal by the muco-cillary action and expectoration. Acetylcysteine improves the
phagocytic capacity of the alveolar macrophages, thus protecting lungs from a variety of insults.
Acetylcysteine is a precursor to glutathione, the most important intra & extra-cellular antioxidant
(the safest & most convenient).
Indication and Use
As Mucolytic in pulmonary disease: Respiratory tract disorders associated with excessive
viscous mucous such as- chronic bronchopulmonary disease (chronic emphysema, emphysema
with bronchitis, chronic asthmatic bronchitis, tuberculosis, bronchiectasis and primary
amyloidosis of the lung), acute bronchopulmonary disease (pneumonia, bronchitis,
tracheobronchitis), pulmonary complications of cystic fibrosis, tracheostomy care, pulmonary
complications associated with surgery; post-traumatic chest conditions, atelectasis due to mucous
obstruction.
As an antidote for Paracetamol overdose: Acetylcysteine, administered orally, is indicated as an
antidote to prevent or lessen hepatic injury which may occur following the ingestion of a
potentially hepatotoxic quantity of Paracetamol.
As for diagnostic bronchial studies: Such as bronchograms, bronchospirometry, and bronchial
wedge catheterization.
Dosage and Administration
Mucomist ® DT: The dispersible tablet should be dissolved in 1/2 glass of water before use
(preferably in the evening). The duration of treatment should be 5 to 10 days in the acute phase.
It may be continued in the chronic state for up to 6 months or according to the advice of the
physician.
As a mucolytic:
Adults: 600 mg daily as a single dose.
In Paracetamol overdose: Initially 140 mg/kg, followed by 70 mg/kg every 4 hours for an
additional 17 doses. As an antidote, Acetylcysteine is reported to be very effective when
administered within 8 hours of Paracetamol overdose, with the protective effect diminishing after
this time. Initiation of treatment after a lapse of 15 hours has previously been thought to be
ineffective, but recent studies suggest that beneficial results may still be obtained.
Mucomist ® Respirator Solution: The 20% solution may be diluted to a lesser concentration with
either Sodium Chloride for injection, Sodium Chloride for inhalation, sterile water for injection,
or sterile water for inhalation.
As a mucolytic:
Adult: 5-10 ml of 10% or 20% solution by nebulizer every 6-8 hr PRN.
Children: 1-11 months: 1-2 ml of 20% or 2-4 ml of 10% solution by nebulizer every 6-8 hr PRN.
12 months-11 years: 3-5 ml of 20% or 6-10 ml of 10% solution by nebulizer every 6-8 hr PRN.
Below 12 years: 5-10 ml of 10/20% solution by nebulizer every 6-8 hr PRN.
Diagnostic Bronchograms:
1-2 ml of 20% or 2-4 ml of 10% solution 2-3 times by nebulization or by instillation
intratracheally prior to procedure. Nebulization tent or croupette: This form of administration
requires very large volumes of the solution, occasionally as much as 300 ml during a single
treatment period. If a tent or croupette must be used, the recommended dose is the volume of
acetylcysteine (using 20%) that will maintain a very heavy mist in the tent or croupette for the
desired period. Administration for intermittent or continuous prolonged periods, including
overnight, may be desirable. Direct Instillation: When used by direct instillation, 1-2 ml of a 20%
solution may be given as often as every hour. When used for the routine nursing care of patients
with tracheostomy, 1-2 ml of a 20% solution may be given every 1-4 hours by instillation into
the tracheostomy.
Pregnancy
Pregnancy Category- B (US FDA).
Lactation
It is not known if this drug is excreted in human milk.
Side Effects
Generally, Acetylcysteine is well tolerated. However, mild effects such as nausea, headache,
tinnitus, urticaria, stomatitis, rhinorrhoea, chills, fever, bronchospasm may be observed.
Occasional cases of nausea and dyspepsia, rare cases of urticaria may be observed.
Contraindications
Acetylcysteine is contraindicated in those patients who are sensitive to it.
Precaution
Acetylcysteine should be given in caution in asthma patients.
Drug interaction
After taking Acetylcysteine orally it increases the bioavailability of amoxicillin, but shows no
effect on doxycycline and reduces the absorption of cefalexine. Acetylcysteine seems to increase
the effects of nitroglycerin. Taking Acetylcysteine at the same time as activated charcoal might
decrease how well it works for preventing poisoning.
Pharmaceutical Precaution
Mucomist ® Respirator Solution:
The physical and chemical compatibility of acetylcysteine solutions with certain other drugs that
might be concomitantly administered by nebulization, direct instillation, or topical application
has been studied. Acetylcysteine should not be mixed with certain antibiotics. For example,
antibiotics like tetracycline hydrochloride, oxytetracycline hydrochloride, and erythromycin
lactobionate were found to be incompatible when mixed in the same solution. These agents may
be administered from separate solutions if administration of these agents is desirable. If it is
deemed advisable to prepare an admixture, it should be administered as soon as possible after
preparation. Do not store unused mixtures.
Storage and Handling Instructions
Mucomist ® Respirator Solution:
Do not contain an antimicrobial agent; hence, care must be taken to minimize contamination of
the sterile solution. Store below 25o C, away from light. Keep out of reach of children.
Mucomist ® DT:
Keep in a cool and dry place. Protect from light. Keep out of the reach of children.
Commercial Pack
Mucomist® DT: Box containing 30 dispersible tablets in 3x10’s Aluminium strips. Each
dispersible tablet contains Acetylcysteine USP 600 mg.
Mucomist® Respirator Solution: Box containing 1 x 5 ampoules of 3 ml in blister pack. Each 3
ml ampoule contains Acetylcysteine USP 600 mg i.e. 200 mg/ml or 20% solution.
Manufactured by
BEXIMCO PHARMACEUTICALS LTD.
TONGI, BANGLADESH
IL 9450
120214
® Mucomist is a registered trademark of Beximco Pharmaceuticals Ltd.