3.7 Mucolytics

ChoiceDrugDosage
1st choice (COPD)Carbocisteine capsules 375mg; oral solution 250mg/5ml; Dose:
750mg three times a day, reducing to 750mg twice daily if there is a clear benefit to the patient and longer term therapy is required
Or
NACSYS® (acetylcysteine) 600mg effervescent tabletsDose:
600mg once daily

Prescribing Notes

  • Mucolytic drug therapy should be considered in COPD patients with a chronic cough productive of sputum.
  • Mucolytic therapy should be continued if there is symptomatic improvement (for example reduction in frequency of cough and sputum production).
  • 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. Mucolytic therapy should be reviewed after 4 to 6 weeks and only continued in patients where there is clear symptomatic improvement.
  • Mucolytics should be used with caution in those with a history of peptic ulceration because they may disrupt the gastric mucosal barrier.