Carbocisteine (ENT — Mucolytic)

How it works

It alters the composition of bronchial mucus, reducing its viscosity and improving clearance of secretions from the airways.

Prescribing in practice

• Avoid in active peptic ulcer disease, as it can affect the gastric mucosal barrier; use with caution in those with a history of peptic ulceration.
• Review the benefit after a defined trial period and stop if there is no symptomatic improvement.
• Gastrointestinal upset and, rarely, gastrointestinal bleeding have been reported.

Monitoring

Assess the response to treatment clinically by reduction in cough and ease of expectoration, and review whether continued use is justified. No routine laboratory monitoring is required.

Counselling the patient

• Stop and seek advice if you develop stomach pain, indigestion or signs of bleeding such as black stools.
• Tell your prescriber if you have ever had a stomach ulcer.
• Let your prescriber know if your symptoms do not improve so treatment can be reviewed.

Evidence & guidelines

Used as adjunctive symptomatic therapy in chronic productive cough and COPD where mucus clearance is problematic.