Initially 2.25 g daily in 3 divided doses, then reduced to 1.5 g daily in 2–4 divided doses, dose to be reduced as condition improves
Or
Acetylcysteine 600mg effervescent tablets
NB: acetylcysteine 600mg capsules are very high cost - avoid where possible
600 mg once daily
Prescribing Notes
Mucolytic drug therapy can be considered in COPD patients with a chronic cough productive of sputum.
Mucolytic therapy should be discontinued after 4 weeks if there is no symptomatic improvement (for example, reduction in frequency of cough and sputum production). Do not put mucolytics on repeat prescription before this initial review.
The evidence that mucolytics can reduce the frequency of exacerbation is of very low quality. NICE NG115 does NOT recommend the use of mucolytics to prevent exacerbations in people with stable COPD.
Mucolytics should be used with caution in those with a history of peptic ulceration because they may disrupt the gastric mucosal barrier.
Note: other acetylcysteine preparations are very high cost: Acetylcysteine 600mg capsules (£101.90 for 30 caps); acetylcysteine 200mg oral powder sachets (£112.50 for 30 sachets) Jan 24 Drug Tariff
