ACC pills effervescent 200mg №20

Mechanism of action

Mucolytic agent, dilutes sputum, increases its volume, facilitates secretion, promotes expectoration. The action is related to the ability of free sulfhydryl groups of acetylcysteine ​​to break intra- and intermolecular disulfide bonds of acidic mucopolysaccharides of sputum, which leads to the depolymerization of mucoproteins and a decrease in the viscosity of mucus (in some cases this leads to a significant increase in sputum, which requires aspiration of the bronchial contents). Remains active in purulent sputum. Does not affect the body's defenses. Increases the secretion of less viscous sialomucins by goblet cells, reduces the adhesion of bacteria to epithelial cells of the bronchial mucosa. Stimulates mucosal cells of the bronchi, the secret of which lyses fibrin. It has a similar effect on the secret produced in inflammatory diseases of the upper respiratory tract. It has an antioxidant effect due to the presence of a SH group capable of neutralizing electrophilic oxidative toxins. Protects alpha1-antitrypsin (an elastase inhibitor) from the inactivating effect of HOCl, an oxidizing agent produced by myeloperoxidase of active phagocytes. It also has an anti-inflammatory effect (due to the suppression of the formation of free radicals and active oxygen-containing substances responsible for the development of inflammation in the lung tissue).

Absorption - high, bioavailability - 10% (due to the presence of a pronounced effect of the "first pass" through the liver - deacetylation with the formation of cysteine), TCmax in plasma - 1-3 hours after oral administration, communication with plasma proteins - 50%. T1 / 2 - about 1 h, with cirrhosis of the liver increases to 8 h. Excreted by the kidneys as inactive metabolites (inorganic sulfates, diacetylcysteine), a small part is excreted unchanged with feces. Gets through a placental barrier, accumulates in amniotic fluid.

Indications and usage

Disturbance of sputum discharge: bronchitis, tracheitis, bronchiolitis, pneumonia, bronchiectasis, cystic fibrosis, lung abscess, pulmonary emphysema, laryngotracheitis, bronchial asthma, lung atelectasis (due to blockage of bronchi by a mucous plug) Catarrhal and purulent otitis media, sinusitis, sinusitis (facilitating secretion of the secret). Removal of viscous secretions from the respiratory tract in post-traumatic and postoperative conditions. Preparation for bronchoscopy, bronchography, aspiration drainage. For washing abscesses, nasal passages, maxillary sinuses, middle ear; treatment of fistulas, surgical field during operations on the nasal cavity and the mastoid process.

Inside Adults - 200 mg 2-3 times a day in the form of granules, pills or capsules. Children 2-6 years old - 200 mg 2 times a day or 100 mg 3 times a day in the form of a water-soluble granulate; under 2 years old - 100 mg 2 times a day; 6-14 years - 200 mg 2 times a day.In chronic diseases for several weeks: adults - 400-600 mg / day in 1-2 doses; children 2-14 years old - 100 mg 3 times a day; with cystic fibrosis - children from 10 days to 2 years - 50 mg 3 times a day, 2-6 years - 100 mg 4 times a day, older than 6 years - 200 mg 3 times a day as a water-soluble granulate, effervescent pill or in capsules. Inhalation. For aerosol therapy, ultrasound devices are sprayed with 20 ml of a 10% solution or 2-5 ml each of a 20% solution, in devices with a control valve - 6 ml of a 10% solution. The duration of inhalation is 15-20 minutes; frequency rate - 2-4 times a day. In the treatment of acute conditions, the average duration of therapy is 5-10 days; with long-term treatment of chronic conditions, the course of treatment is up to 6 months. In the case of a strong secretolytic action, the secret is sucked off, and the frequency of inhalations and the daily dose are reduced. Intratracheal For washing the bronchial tree with therapeutic bronchoscopy use 5% or 10% solution. Locally. Buried in the external auditory canal and nasal passages 150-300 mg (1 procedure). Parenteral Enter in / in (preferably drip, or slowly jet - for 5 min) or in / m. Adults - 300 mg 1-2 times a day. Children from 6 to 14 years old - 150 mg 1-2 times a day. Oral administration is preferable for children under 6 years of age, children under 1 year of intravenous acetylcysteine ​​are possible only for health reasons in a hospital setting. In the event that there are still indications for parenteral therapy, the daily dose for children under the age of 6 years should be 10 mg / kg body weight.For iv administration, the solution is further diluted with a 0.9% solution of sodium chloride, or 5% dextrose solution in a 1: 1 ratio. The duration of therapy is determined individually (no more than 10 days). In patients over 65 years of age - use the minimum effective dose.

Adverse reactions

Nausea, vomiting, feeling of fullness in the stomach, nasal bleeding, urticaria, tinnitus, short-term appearance of unpleasant odor during administration, drowsiness, fever. Rarely - heartburn, dyspepsia. When aerosol therapy: reflex cough, irritation of the respiratory tract, rhinorrhea; rarely stomatitis. With the / m injection - a burning sensation at the injection site; with long-term treatment - a violation of the liver and / or kidneys.

Contraindications

Hypersensitivity, pregnancy, lactation. With caution - gastric ulcer and duodenal ulcer (in acute phase), esophageal varicose veins, hemoptysis, pulmonary hemorrhage, phenylketonuria (for forms containing aspartame), bronchial asthma (with a / in the introduction of the risk of developing bronchospasm), adrenal disease, hepatic and / or renal failure, arterial hypertension.

Special notes

When treating patients with diabetes, it is necessary to take into account that the granulate contains sucrose. When working with the drug it is necessary to use glassware, avoid contact with metals, rubber, oxygen, easily oxidized substances.With a shallow intramuscular injection and in the presence of hypersensitivity, a slight and fast burning sensation may appear, and therefore it is recommended to inject the drug deep into the muscle. In patients with broncho-obstructive syndrome, it is necessary to combine with bronchodilators.

Drug Interactions

When treating patients with diabetes, it is necessary to take into account that the granulate contains sucrose. When working with the drug it is necessary to use glassware, avoid contact with metals, rubber, oxygen, easily oxidized substances. With a shallow intramuscular injection and in the presence of hypersensitivity, a slight and fast burning sensation may appear, and therefore it is recommended to inject the drug deep into the muscle. In patients with broncho-obstructive syndrome, it is necessary to combine with bronchodilators. In connection with the possible reduction of prothrombin time on the background of the appointment of large doses of acetylcysteine, it is necessary to monitor the state of the blood coagulation system. May change the results of the test for the quantitative determination of salicylates (colorimetric test) and the test for the quantitative determination of ketones (test with sodium nitroprusside). The presence of sulfuric smell of the drug is not the result of poor product quality - this is the characteristic smell of the active ingredient.