ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Cystic Fibrosis Pregnancy: Can be used in pregnancy — non-systemic; risk/benefit discussion with specialist

Sodium Chloride 7% (Hypertonic Saline)

Brand names: HyperSal, MucoClear 7%

Adult dose

Dose: 4 mL of 7% solution inhaled twice daily
Route: Nebulised
Frequency: Twice daily
Max: 4 mL BD
Use PARI LC SPRINT or eFlow nebuliser. Pre-treat with salbutamol 15-30 min before first dose to prevent bronchospasm. Administer after chest physiotherapy or 30-60 min before dornase alfa. Rinse mouth after inhalation.

Paediatric dose

Route: Nebulised
Frequency: Twice daily
Max: 4 mL BD
Licensed from 12 months of age (MucoClear 7%). Same adult dose 4 mL BD. Pre-treat with salbutamol. Monitor for bronchoconstriction especially on first use.

Dose adjustments

Renal

No adjustment required

Hepatic

No adjustment required

Clinical pearls

  • Hypertonic saline works by osmotically drawing water into the airway lumen, restoring periciliary liquid layer depth and improving mucociliary clearance — the same mechanism impaired by CFTR dysfunction
  • CFFT trial (Elkins et al. NEJM 2006): 7% hypertonic saline vs 0.9% normal saline — 56% reduction in exacerbation rate; improved FEV1 by 3.2% from baseline
  • Sequencing: hypertonic saline before or after physiotherapy is common practice; dornase alfa and hypertonic saline are both used but timing varies per local protocol
  • Pre-salbutamol is mandatory before first dose; ongoing pre-treatment recommended
  • Used as adjunct even in patients on CFTR modulators (Kaftrio) — provides additive mucociliary benefit

Contraindications

  • Known hypersensitivity to sodium chloride

Side effects

  • Bronchoconstriction (prevent with pre-treatment salbutamol)
  • Cough
  • Throat irritation
  • Chest tightness
  • Salty taste

Interactions

  • None clinically significant

Monitoring

  • FEV1 and FVC
  • Exacerbation frequency
  • Bronchospasm on first use
  • Sputum culture

Reference: BNFc; BNF 90; BNFc; CFFT Trial (Elkins et al. NEJM 2006); NICE NG78 CF Guidelines; SPC MucoClear 7%. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways