Carbocisteine

How it works

It alters the structure of bronchial mucus by affecting the sialomucin component, reducing its viscosity and aiding expectoration. This makes secretions easier to clear.

Prescribing in practice

• Contraindicated in active peptic ulceration because mucolytics may disrupt the protective gastric mucosal barrier; use cautiously in those with a history of peptic ulcer.
• Rare reports of severe cutaneous reactions mean treatment should be stopped at the first sign of rash or mucosal lesions.
• Initiate at a higher dose and reduce once a satisfactory response is achieved.

Monitoring

Review symptomatic benefit after a short trial and watch for gastrointestinal bleeding or skin reactions.

Counselling the patient

• This medicine thins phlegm to make coughing it up easier.
• Report black or bloodstained stools, indigestion, or any rash.
• Tell your prescriber if there is no improvement after a few weeks so treatment can be reviewed.

Evidence & guidelines

Mucolytic therapy is recognised in UK COPD guidance as an option for patients with a chronic productive cough who report symptomatic benefit.