Viscotin 200

Indications

Acetylcysteine is used:

• as a mucolytic, to thin thick, sticky phlegm (mucus) in chest conditions such as bronchitis, COPD, bronchiectasis and cystic fibrosis, so it is easier to cough up;
• as the antidote for Paracetamol (acetaminophen) overdose, given by drip in hospital to protect the liver;
• in some other situations decided by a specialist, given by inhaler, nebuliser or injection.

How It Works

Acetylcysteine breaks the chemical bonds that hold mucus together, so phlegm becomes thinner and easier to clear. In Paracetamol overdose it restores glutathione, a natural substance the liver uses to neutralise the harmful breakdown product of Paracetamol.

Dosage and Administration

• Mucolytic, adults and children over 12: usually 200 mg two or three times a day, or 600 mg once a day.
• Children under 12: as prescribed.
• Paracetamol overdose: given by a doctor or nurse in hospital as an infusion; the dose depends on body weight.
• Inhalation or nebuliser: as prescribed.

Dissolve effervescent tablets or granules completely in a glass of water before drinking. It can be taken with or after food. Drink plenty of fluids. A slight smell of sulphur is normal.

Interactions

Avoid taking it with cough suppressants (such as Codeine or Dextromethorphan) unless advised, because loosened mucus may build up if coughing is blocked. Take some oral antibiotics at least 2 hours apart from acetylcysteine. It may increase the headache and blood pressure-lowering effect of Glyceryl Trinitrate (Nitroglycerin). Activated charcoal reduces the effect of acetylcysteine taken by mouth. Tell your doctor about all medicines you take.

Contraindications

• Allergy to Acetylcysteine
• Children under 2 years for mucolytic use, unless prescribed
• Active stomach ulcer (oral use, unless the doctor decides otherwise)

In Paracetamol overdose, the antidote is given even when there are cautions, because the benefit is life-saving.

Side Effects

By mouth: nausea, vomiting, diarrhoea, heartburn, stomach pain and, less often, rash or itching. Inhaled: cough, runny nose and tightness of the chest. By drip in hospital: flushing, rash, itching, wheezing and low blood pressure, which staff will watch for.

Get medical help at once for: wheezing or trouble breathing, swelling of the face, lips or throat, a widespread or blistering rash, or vomiting blood or black stools.

Pregnancy and Lactation

Use in pregnancy only if the doctor advises it. Paracetamol overdose in pregnancy must still be treated with acetylcysteine. There is little information on breastfeeding; it is generally considered unlikely to harm the baby, but ask your doctor first.

Precautions and Warnings

• Take extra care if you have asthma (it can cause wheezing, especially when inhaled), or a past stomach ulcer.
• Effervescent forms may contain sodium; tell your doctor if you are on a low-salt diet.
• If you have a weak cough, the doctor may advise help to clear the loosened mucus.

Overdose

Too much by mouth may cause nausea, vomiting and diarrhoea. Contact a doctor if a large amount was taken; treatment is supportive.

Therapeutic Class

Mucolytic (expectorant); antidote for Paracetamol poisoning.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Keep effervescent tablets in their tightly closed tube. Store injections and inhalation solutions as directed on the pack.