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3.7 Mucolytics

Acetylcysteine injection for nebuliser, tablets
Carbocisteine capsules, oral liquid, sachets (sugar-free) 
Dornase alfa nebuliser solution (specialist use only in cystic fibrosis)
Mannitol dry powder inhalation - see NICE TA 266



1. Carbocisteine is restricted to use by respiratory physicians for patients with COPD or Bronchiectasis who have chronic cough productive of sputum. A three month trial may be offered to patients of mucolytics. Treatment should only continue is there is symptomatic improvement e.g. reduced cough, ease of expectoration or exacerbation.

2. Acetylcysteine tablets (unlicensed) are used for respiratory specialist initiation in patients with idiopathic pulmonary fibrosis (triple therapy with steroids and azathioprine in IPF is now no longer recommended following results from a NHLBI trial. The trial reported worse outcomes (greater mortality, more hospitalisations, and other serious events) in the 'triple drug' arm.

3. Mannitol dry powder inhalation is recommended by NICE for the treatment of cystic fibrosis in patients who cannot tolerate/use dornase alfa, whose lung function is declining, and for whom other osmotic agents are not appropriate.



For link to BNF section: 3.7 Mucolytics