Mucolytic Pregnancy: Caution — limited data; avoid in first trimester

Carbocisteine

Brand names: Mucodyne

Adult dose

Dose: 750 mg TDS until improvement, then reduce to 375 mg TDS

Route: Oral

Frequency: Three times daily

Max: 2250 mg/day

For COPD with excessive/viscous mucus. Reduces sputum viscosity. BRONCHUS trial: reduced exacerbations in COPD. Also used in bronchiectasis.

Paediatric dose

Route: Oral syrup

Frequency: BD-TDS

Max: 750 mg/day

Concentration: 125 mg/5 mL or 250 mg/5 mL syrup mg/ml

Children 2–5 years: 62.5–125 mg TDS. Children 5–12 years: 250 mg TDS. Reduce to BD after improvement.

Dose adjustments

Renal

No dose adjustment required

Hepatic

Caution in severe hepatic impairment

Clinical pearls

Evidence from BRONCHUS trial (2008): 25% reduction in COPD exacerbations with 1500 mg/day in patients with chronic productive cough
Less evidence than erdosteine but widely used due to cost and availability
Often continued long-term in COPD and bronchiectasis patients with productive cough
NICE COPD guideline: consider mucolytic if sputum is tenacious (GOLD group C/D)

Contraindications

Active peptic ulcer disease

Side effects

Nausea
Gastrointestinal upset
Skin rash (rare)

Interactions

Minimal known interactions

Monitoring

Sputum viscosity and production
Exacerbation frequency
GI symptoms

Reference: BNFc; BRONCHUS Trial (Zheng et al, Lancet 2008); BNF; NICE NG115 COPD. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways