Carbocisteine is a mucolytic agent for the adjunctive therapy of respiratory tract disorders characterised by excessive, viscous mucus, including chronic obstructive airways disease.

Posology

Adults including the elderly and adolescents over 12 years: Dosage is based upon an initial daily dosage of 2250 mg Carbocisteine in divided doses, reducing to 1500 mg daily in divided doses when a satisfactory response is obtained e.g. for oral solution 15 ml three times a day reducing to 10 ml three times a day.

Children 2-5 years: The usual dose is 1.25 - 2.5 ml four times a day.

Children 5-12 years: The usual dose is 5ml three times a day.

Method of administration

This medicine is for oral use.

This medicine, due to its composition (does not contain sugar), is suitable for administration to diabetics.

An oral dosing syringe is provided for use for dosing.

How to use the oral dosing syringe

The syringe end should be placed into the neck of the bottle below the liquid fill line.

To fill the syringe whilst holding the syringe in place, gently pull the plunger down drawing the medicine to the correct mark on the syringe. Remove the syringe from the bottle neck carefully. Place the end of the syringe into the mouth against the cheek and gently press the plunger down slowly to gently release the medicine. After use replace the bottle cap. Wash the syringe in warm water and allow to dry. Store out of the reach of children.

Hypersensitivity to the active substance (Carbocisteine) or to any of the excipients referred to in section 6.1.

Active peptic ulcer.

Children less than 2 years of age.

- Asthmatic patients with a history of bronchospasm;

- Severe respiratory failure;

- Debilitated patients. By decreasing the cough reflex there is a risk of obstruction of the airways as a consequence of the secretions amount increase.

The use of Carbocisteine will result in less viscous mucus, requiring clearance via epithelial ciliary action and an intact cough reflex. The concomitant use of antitussives is therefore not recommended (see section 4.5).

Caution is recommended in the elderly and in patients with a history of gastroduodenal ulcers, or those who are receiving concomitant medications that are known to cause gastrointestinal bleeding. If gastrointestinal bleeding occurs, patients should discontinue medication immediately.

This medicine contains sodium methyl parahydroxybenzoate (E219), which can cause allergic reactions (possibly delayed).

This medicine contains 12.7 mg sodium per ml. It should be taken into account by patients in controlled sodium diet.

No drug interactions have been identified

Pregnancy

There are no available data on carbocisteine use in pregnant women. No conclusions can be drawn regarding whether or not carbocisteine is safe for use during pregnancy. The use of carbocisteine in pregnant women is not recommended, especially during the first trimester.

Breast-feeding

There are no available data on the presence of carbocisteine in human milk, milk production, or the effects on the breastfed infant. No conclusions can be drawn regarding whether or not carbocisteine is safe for use during breastfeeding. The use of carbocisteine in breastfeeding women is not recommended.

Fertility

There is no consistent evidence on the effects of carbocisteine on fertility.

Carbocisteine has no or negligible influence on the ability to drive or use machines.

Adverse reactions are listed by System Organ Class. Frequencies are defined using the following convention: very common (≥ 1/10); common ( ≥ 1/100 to <1/10); uncommon (≥ 1/1,000 to ≤ 1/100); rare (≥ 1 / 10,000 to ≤ 1 / 1,000); very rare (≤ 1 / 10,000); not known (cannot be estimated from the available data).

* Special attention in patients with compromised thyroid function due to the risk of transient hypothyroidism occurrence.

** Special attention in asthmatic to the risk of bronchoconstriction occurrence (contraction of a muscle of the bronchial wall that leads to a reduction in airflow). In these cases, treatment discontinuation is recommended.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme, website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Gastric lavage may be beneficial, followed by observation. Gastrointestinal disorders is the most likely symptom of overdosage. In such cases, it is advised to reduce the dosage.

Pharmacotherapeutic group: Mucolytic, ATC code: R05CB03

Carbocisteine (S-carboxymethyl L-cysteine) has been shown in normal and bronchitic animal models to affect the nature and amount of mucus glycoprotein which is secreted by the respiratory tract. An increase in the acid:neutral glycoprotein ratio of the mucus and a transformation of serous cells to mucus cells is known to be the initial response to irritation and will normally be followed by hypersecretion. The administration of carbocisteine to animals exposed to irritants indicates that the glycoprotein that is secreted remains normal; administration after exposure indicates that return to the normal state is accelerated. Several studies have demonstrated that carbocisteine reduces goblet cell hyperplasia. Carbocisteine can therefore be demonstrated to have a role in the management of disorders characterised by abnormal mucus.

Carbocisteine is rapidly absorbed from the gastrointestinal tract. In a study, at steady state (7 days). Carbocisteine capsules 375mg given as 2 capsules three times daily to healthy volunteers gave the following pharmacokinetic parameters:

There are no preclinical data of relevance to the prescriber, which are additional to those already included in other sections of the SmPC.

Glycerol

Sodium Methyl Parahydroxybenzoate

Saccharin Sodium,

Sodium Hydroxide

Hydrochloric acid

Hydroxyethyl cellulose

Purified Water

Strawberry Flavour

Caramel Colorant

Not applicable

30 months

After opening, use within 6 months

Do not store above 25° C.

300ml type III amber glass bottles, with a polypropylene Safety Screw Cap with a measuring device in the form of a 2.5-15 mL measuring dosing plastic cup graduated to 2.5 ml and an oral dosing syringe which is marked per 0.25ml.

Any unused medicinal product or waste material should be disposed of in accordance with local requirements