ACC release form and dosage. Indications for use acc. Description of the dosage form

The composition of the medicine ACC 200 includes the active ingredient acetylcysteine (200 mg), as well as additional components: sodium bicarbonate, citric anhydride, ascorbic acid, mannitol, sodium citrate, saccharin, lactose anhydride, flavor.

Release form

ACC 200 is produced in effervescent tablets, white, round, flat, with a line on one side. They have a blackberry aroma. Contained in packs of 4, 20, 25 pcs.

pharmachologic effect

The drug has a mucolytic effect. Due to the fact that the structure of the molecule contains acetylcysteine of sulfhydryl groups, the disulfide bonds of sputum acid mucopolysaccharides break. As a result of this process, the viscosity of the mucus decreases. ACC 200 also shows activity in patients with purulent sputum.

If acetylcysteine is used prophylactically, in patients with cystic fibrosis and chronic , the severity and frequency of exacerbations decreases.

Pharmacokinetics and pharmacodynamics

After internal administration, the drug is rapidly absorbed. Metabolism, in which the metabolite is formed - and other metabolites, passes in the human liver.

Bioavailability with internal administration is 10%, the connection with plasma proteins is 50%. The highest concentration is observed after 1-3 hours. It is excreted in the urine, the half-life is 1 hour.

Indications for use

The use of ACC 200 is indicated in such cases:

in diseases of the respiratory system, if the formation of viscous sputum occurs, which is difficult to separate (acute / chronic / obstructive bronchitis, bronchiectasis, cystic fibrosis, pneumonia, , );

Contraindications

It is contraindicated to take pills in the following cases:

high sensitivity to acetylcysteine or other ingredients of drugs;
period of exacerbation ;
pulmonary bleeding;
hemoptysis;
lactose intolerance, lack of lactase;
glucose-galactose malabsorption;
child under 2 years of age.

Use this remedy with caution in duodenal ulcers and history of histamine intolerance. Also, the medicine is carefully prescribed to people with varicose veins of the esophagus, obstructive bronchitis, adrenal diseases, liver failure and, arterial hypertension .

Side effects

There may be such side effects in the process of taking the drug:

nervous system: noise in ears, ;
the cardiovascular system: lowering , ;
digestion: , nausea, vomiting, ;
allergic reactions: single manifestations - bronchospasm , skin rash;
other reactions: single manifestations - bleeding.

Effervescent tablets ACC 200, instructions for use (Method and dosage)

Instructions for use ACC 200 provides that the drug, like the powder, is prescribed to patients after 14 years of age, 200 mg two to three times a day.

Patients from 6 to 14 years old use 1 tablet twice a day.

Children aged 2 to 5 years should take half an ACC 200 tablet two to three times a day.

Patients with cystic fibrosis after 6 years are shown taking 1 table. 3 times a day, children under 6 years of age are prescribed a remedy at the rate of 400 mg of acetylcysteine per day. If the patient's weight exceeds 30 kg, the dose, if necessary, is increased to 800 mg per day.

If colds are being treated, the course of admission lasts 5-7 days.

Before taking the medicine, and after that, you need to drink plenty of fluids to enhance the mucolytic effect of the drug. You need to drink the drug after a meal.

The method of diluting the tablets is the same as the method of using the powder. They need to be dissolved in half a glass of water, drink the solution immediately.

Overdose

If an overdose of the drug occurs, nausea, stomach pain, , . Dangerous and severe manifestations have not yet been noted.

Interaction

It should be borne in mind that while taking ACC 200 and other cough suppressants, dangerous mucus stagnation may develop due to the fact that the cough reflex is suppressed. Therefore, such drugs must be combined carefully.

Acetylcysteine may enhance vasodilatory effects if these drugs are taken at the same time.

Synergism of acetylcysteine with bronchodilators is observed.

Acetylcysteine is not pharmaceutically compatible with (penicillins, cephalosporins, , ) and proteolytic .

When taken simultaneously, acetylcysteine reduces the absorption of tetracycline, cephalosporins, penicillins. Therefore, you need to take such drugs with an interval of at least two hours.

If acetylcysteine is in contact with rubber, metals, the formation of sulfides occurs, which have a characteristic odor.

Terms of sale

ACC 200 can be bought without a prescription.

Storage conditions

Keep away from children, away from moisture and light, store at a temperature not exceeding 30 degrees. Close the tube tightly after removing the tablet.

Best before date

Keep 3 years.

special instructions

If ACC 200 is prescribed to patients with bronchial asthma and obstructive bronchitis, it is necessary to do this carefully and constantly monitor bronchial patency.

If any side effects develop, stop treatment and consult a doctor.

If necessary, dissolve the drug should use glassware.

Patients with should take into account that ACC 200 contains sucrose.

The tool does not affect the ability to concentrate, drive vehicles.

Analogues

Coincidence in the ATX code of the 4th level:

Means that are analogues of ACC 200 are drugs ACC Long , , , N-acetylcysteine , Mukomist , Acestine , Mukonex etc. Which of these means is the most optimal, the doctor determines on an individual basis.

children

Not intended for children under two years of age.

During pregnancy and lactation

Since there are no clear data on the effect of the drug during pregnancy, it is not prescribed during pregnancy, as well as during breastfeeding.

Description of the dosage form

Effervescent tablets, 100 mg: round flat-cylindrical white, with a smell of blackberry. There may be a slight sulfur odor. Reconstituted Solution: colorless transparent with blackberry smell. There may be a slight sulfur odor.

Granules for oral solution preparation (orange): homogeneous, white, without agglomerates, with an orange smell.

Syrup: clear, colorless, slightly viscous solution with a cherry smell.

pharmachologic effect

pharmachologic effect- mucolytic.

Pharmacodynamics

Acetylcysteine is a derivative of the amino acid cysteine. It has a mucolytic effect, facilitates sputum discharge due to a direct effect on the rheological properties of sputum. The action is due to the ability to break the disulfide bonds of mucopolysaccharide chains and cause depolymerization of sputum mucoproteins, which leads to a decrease in its viscosity. The drug remains active in the presence of purulent sputum.

It has an antioxidant effect based on the ability of its reactive sulfhydryl groups (SH-groups) to bind to oxidizing radicals and thus neutralize them.

In addition, acetylcysteine promotes the synthesis of glutathione, an important component of the antioxidant system and chemical detoxification of the body. The antioxidant effect of acetylcysteine increases the protection of cells from the damaging effects of free radical oxidation, which is characteristic of an intense inflammatory reaction.

With the prophylactic use of acetylcysteine, there is a decrease in the frequency and severity of exacerbations of bacterial etiology in patients with chronic bronchitis and cystic fibrosis.

Pharmacokinetics

Absorption is high. It is rapidly metabolized in the liver with the formation of a pharmacologically active metabolite - cysteine, as well as diacetylcysteine, cystine and mixed disulfides. Bioavailability when taken orally is 10% (due to the presence of a pronounced effect of the first passage through the liver). Tmax in plasma is 1-3 hours. Communication with plasma proteins is 50%. It is excreted by the kidneys in the form of inactive metabolites (inorganic sulfates, diacetylcysteine). T 1 / 2 is about 1 hour, liver dysfunction leads to an extension of T 1 / 2 to 8 hours. Penetrates through the placental barrier. There are no data on the ability of acetylcysteine to penetrate the BBB and be excreted in breast milk.

Indications for ACC ®

For all dosage forms

diseases of the respiratory system, accompanied by the formation of viscous sputum difficult to separate:

Acute and chronic bronchitis;

Obstructive bronchitis;

Tracheitis;

laryngotracheitis;

Pneumonia;

lung abscess;

bronchiectasis;

Bronchial asthma;

Chronic obstructive pulmonary disease;

bronchiolitis;

cystic fibrosis;

acute and chronic sinusitis;

inflammation of the middle ear (otitis media).

Contraindications

For all dosage forms

hypersensitivity to acetylcysteine or other components of the drug;

peptic ulcer of the stomach and duodenum in the acute stage;

hemoptysis, pulmonary bleeding;

pregnancy;

breastfeeding period;

children's age up to 2 years.

For effervescent tablets, 100 mg, optional

lactase deficiency, lactose intolerance, glucose-galactose malabsorption.

Carefully: peptic ulcer of the stomach and duodenum in history; bronchial asthma; obstructive bronchitis; hepatic and / or renal failure; histamine intolerance (long-term use of the drug should be avoided, since acetylcysteine affects the metabolism of histamine and can lead to signs of intolerance, such as headache, vasomotor rhinitis, itching); varicose veins of the esophagus; diseases of the adrenal glands; arterial hypertension.

For mortar pellets optional

sucrase/isomaltase deficiency, fructose intolerance, glucose-galactose deficiency.

Carefully: peptic ulcer of the stomach and duodenum in history; arterial hypertension; varicose veins of the esophagus; bronchial asthma; obstructive bronchitis; diseases of the adrenal glands; hepatic and / or renal failure; histamine intolerance (long-term use of the drug should be avoided, because acetylcysteine affects the metabolism of histamine and can lead to signs of intolerance, such as headache, vasomotor rhinitis, itching).

extra for syrup

Carefully: peptic ulcer of the stomach and duodenum in history; bronchial asthma; hepatic and / or renal failure; histamine intolerance (long-term use of the drug should be avoided, since acetylcysteine affects the metabolism of histamine and can lead to signs of intolerance, such as headache, vasomotor rhinitis, itching); varicose veins of the esophagus; diseases of the adrenal glands; arterial hypertension.

Use during pregnancy and lactation

Data on the use of acetylcysteine during pregnancy and breastfeeding are limited. The use of the drug during pregnancy is possible only if the intended benefit to the mother outweighs the potential risk to the fetus.

If necessary, the use of the drug during lactation should decide on the termination of breastfeeding.

Side effects

According to WHO, adverse reactions are classified according to their frequency of development as follows: very often (≥1 / 10); often (≥1/100,<1/10); нечасто (≥1/1000, <1/100); редко (≥1/10000, <1/1000); очень редко (<1/10000); частота неизвестна — по имеющимся данным установить частоту возникновения не представлялось возможным.

Allergic reactions: infrequently - pruritus, rash, exanthema, urticaria, angioedema, decreased blood pressure, tachycardia; very rarely - anaphylactic reactions up to shock, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome).

From the respiratory system: rarely - shortness of breath, bronchospasm (mainly in patients with bronchial hyperreactivity in bronchial asthma).

From the gastrointestinal tract: infrequently - stomatitis, abdominal pain, nausea, vomiting, diarrhea; heartburn, dyspepsia (except syrup).

From the sense organs: infrequently - tinnitus.

Others: very rarely - headache, fever, isolated reports of the development of bleeding due to the presence of a hypersensitivity reaction, a decrease in platelet aggregation.

Interaction

For all dosage forms

With the simultaneous use of acetylcysteine and antitussives, due to the suppression of the cough reflex, sputum stagnation may occur. Therefore, such combinations should be chosen with caution.

Simultaneous administration of acetylcysteine with vasodilators and nitroglycerin may lead to increased vasodilating action.

With simultaneous use with antibiotics for oral administration (including penicillins, tetracyclines, cephalosporins), their interaction with the thiol group of acetylcysteine is possible, which can lead to a decrease in their antibacterial activity. Therefore, the interval between taking antibiotics and acetylcysteine should be at least 2 hours (except for cefixime and loracarbene).

In contact with metals, rubber, sulfides are formed with a characteristic odor.

Dosage and administration

inside, after meal.

Mucolytic therapy

Adults and children over 14 years of age: 2 tab. effervescent 100 mg 2-3 times a day or 2 packs. ACC ® granules for the preparation of a solution of 100 mg 2-3 times a day, or 10 ml of syrup 2-3 times a day (400-600 mg of acetylcysteine per day).

Children from 6 to 14 years old: 1 tab. effervescent 100 mg 3 times a day or 2 tablets. effervescent 2 times a day, or 1 pack. ACC ® granules for solution 3 times a day or 2 packs. 2 times a day, or 5 ml of syrup 3-4 times a day or 10 ml of syrup 2 times a day (300-400 mg of acetylcysteine per day).

Children from 2 to 6 years old: 1 tab. effervescent 100 mg or 1 pack. ACC ® granules for the preparation of a solution of 100 mg 2-3 times a day, or 5 ml of syrup 2-3 times a day (200-300 mg of acetylcysteine per day).

cystic fibrosis

For patients with cystic fibrosis (a congenital metabolic disorder with frequent infections of the bronchial tract) and weighing more than 30 kg, if necessary, it is possible to increase the dose to 800 mg of acetylcysteine per day.

Children over 6 years old: 2 tab. effervescent 100 mg or 2 pak. ACC ® granules 100 mg for solution 3 times a day, or 10 ml syrup 3 times a day (600 mg acetylcysteine per day).

Children from 2 to 6 years old: 1 tab. effervescent 100 mg or 1 pack. ACC ® granules 100 mg for solution, or 5 ml syrup 4 times a day (400 mg acetylcysteine per day).

Effervescent tablets should be dissolved in 1 glass of water and taken immediately after dissolution, in exceptional cases, you can leave the solution ready for use for 2 hours.

Granules for oral solution (orange) should be dissolved in water, juice or iced tea and taken after meals.

Additional fluid intake enhances the mucolytic effect of the drug. With short-term colds, the duration of admission is 5-7 days.

In chronic bronchitis and cystic fibrosis, the drug should be taken for a longer time to achieve a preventive effect against infections.

ACC ® syrup is taken with a measuring syringe or a measuring cup, which is in the package. 10 ml of syrup corresponds to 1/2 measuring cup or 2 filled syringes.

Using a measuring syringe

1. Open the vial cap by pushing it in and turning it counterclockwise.

2. Remove the plug with a hole from the syringe, insert it into the neck of the vial and press it in until it stops. The stopper is designed to connect the syringe to the vial and remains in the neck of the vial.

3. Insert the syringe firmly into the stopper. Carefully turn the bottle upside down, pull the syringe plunger down and draw up the required amount of syrup. If air bubbles are visible in the syrup, press the plunger all the way down, then refill the syringe. Return the vial to its original position and remove the syringe.

4. Syrup from the syringe should be poured onto a spoon or directly into the child's mouth (into the buccal area, slowly, so that the child can swallow the syrup properly), while taking the syrup, the child should be in an upright position.

5. After use, rinse the syringe with clean water.

Note for diabetic patients: 1 effervescent tablet corresponds to 0.006 XE; 1 pack ACC ® granules for the preparation of a solution of 100 mg corresponds to 0.24 XE; 10 ml (2 measuring spoons) of ready-to-use syrup contain 3.7 g of D-glucitol (sorbitol), which corresponds to 0.31 XE.

Overdose

Symptoms: acetylcysteine at doses up to 500 mg/kg did not cause any symptoms of intoxication. With an erroneous or deliberate overdose, such phenomena as diarrhea, vomiting, stomach pain, heartburn and nausea can be observed. Children may experience hypersecretion of sputum.

Treatment: symptomatic.

special instructions

When working with the drug, it is necessary to use glassware, avoid contact with metals, rubber, oxygen, easily oxidized substances.

When using acetylcysteine, cases of severe allergic reactions such as Stevens-Johnson syndrome and Lyell's syndrome have been reported very rarely. If there are changes in the skin and mucous membranes, you should immediately consult a doctor, the drug should be stopped.

In patients with bronchial asthma and obstructive bronchitis, acetylcysteine should be administered with caution under the systemic control of bronchial patency.

Do not take the drug immediately before bedtime (it is recommended to take the drug before 18:00).

Influence on the ability to drive vehicles and work with mechanisms. There are no data on the negative effect of the drug in recommended doses on the ability to drive vehicles, mechanisms.

Special precautions for the disposal of unused medicinal product. There is no need for special precautions when destroying unused product.

extra for syrup

The use of the drug in patients with renal and / or hepatic insufficiency should be avoided in order to avoid additional formation of nitrogenous compounds.

1 ml of syrup contains 41.02 mg of sodium. This should be taken into account when using the drug in patients on a diet aimed at limiting sodium intake (with a reduced sodium / salt content).

Release form

Effervescent tablets, 100 mg.

When packing Hermes Pharma Ges.m.b.Kh., Austria: 20 tab. effervescent in a plastic or aluminum tube. 1 tube of 20 tab. effervescent in a cardboard box.

Granules for oral solution (orange), 100 mg. 3 g granules in bags of combined material (aluminum foil/paper/PE). 20 pack in a cardboard box.

Syrup, 20 mg/ml. In dark glass bottles, sealed with white caps with a sealing membrane, child-resistant, with a protective ring, 100 ml.

Dosing devices:

Transparent measuring cup (cap), graduated at 2.5; 5 and 10 ml;

Transparent dosing syringe, graduated at 2.5 and 5 ml, with white plunger and adapter ring for attaching to the vial.

1 vial together with dosing devices in a cardboard box.

Manufacturer

Effervescent tablets

1. Hermes Pharma Ges.m.b.H., Austria.

2. Hermes Artsnaimittel GmbH, Germany.

Granules for solution preparation

Marketing authorization holder: Sandoz d.d., Verovshkova 57, 1000 Ljubljana, Slovenia.

Produced by: Lindopharm GmbH, Neustraße 82, 40721 Hilden, Germany.

Syrup

Pharma Wernigerode GmbH, Germany.

Marketing authorization holder: Sandoz d.d. Verovshkova 57, Ljubljana, Slovenia.

A persistent cough in a child is a fairly common problem. Today, there are a lot of drugs on sale for the treatment of diseases, the symptom of which is a cough. However, parents who do not have a medical education do not always understand which of the medicines will help in a particular situation. Consider a popular drug that helps get rid of a cough - ACC for children - its composition, properties, indications and analogues.

The composition of the drug ACC and its action

There is only one active (medicinal) substance in the preparation - acetylcysteine. Its main property is mucolytic: the active ingredient “knows how” to liquefy sputum, changing its structure to less thick and viscous. Acetylcysteine uncouples the joints of mucopolysaccharide chains and separates the molecules of polymeric compounds, which include sputum mucoproteins.

Acetylcysteine is an antioxidant capable of neutralizing free radicals by establishing a bond with them using reactive thiol groups. This chemical is indicated for prophylactic use in patients diagnosed with cystic fibrosis and chronic bronchitis. Its use reduces the frequency of bacterial lesions of the respiratory system and the severity of their course.

The concentration of acetylcysteine in the blood reaches its maximum 60-180 minutes after ingestion. Then its level is reduced, and the drug is excreted by the kidneys.

Release forms

A medication is produced in the form of tablets intended for dissolution in water, sachets with granules to obtain a solution, as well as children's syrup. Let us consider in more detail the composition of each form of release.

ACC for children in the form of effervescent tablets contains:

100 mg aceticysteine;
citric acid;
food and soda ash;
D-Mannitol;
vitamin C;
milk sugar;
saccharin;
sodium salt of citric acid;
food flavoring.

The next form is syrup. Great for kids - it is sweet and children drink it with pleasure. However, it is worth considering the risk of allergic manifestations due to the presence of saccharin, lactose and flavoring in the composition.

Composition of 5 ml syrup ACC 100 for children:

100 mg aceticysteine;
methylparaben;
sodium salt of benzoic acid;
disodium salt of ethylenediaminetetraacetic acid;
cellulose gum;
saccharin;
caustic soda;
water;
flavoring.

Composition of granular powder for solution:

100 mg aceticysteine;
sucrose;
vitamin C;
saccharin;
flavoring.

What diseases are indicated for use?

Having studied the instructions for the use of all forms of release of the drug, it becomes clear that they have general indications. Among them:

cough with viscous sputum, which is difficult to pass;
all kinds of bronchitis, bronchial asthma (treatment is prescribed by a specialist);
inflammation of the larynx and / or trachea;
pneumonia, abscess;
chronic lung diseases (congenital or acquired);
cystic fibrosis;
inflammation of one or more paranasal sinuses;
otitis.

Dosage of ACC

All listed forms of the drug are intended for oral administration, preferably after a meal. The dosage of the drug depends on the type of disease and the age of the child:

children of preschool age (from 24 months) can receive from 0.2 to 0.4 g of aceticysteine per day;
for schoolchildren under 14 years of age, the maximum daily volume is 0.3-0.6 g of the active substance;
adolescents over the age of 14 and adults - 0.6 g per day.

Patients weighing more than 30 kg with a diagnosis of cystic fibrosis can consume up to 0.8 g of acetylcysteine per day. In addition, the course of taking the drug in such patients is calculated for a longer period.

Syrup use

To dilute sputum with a prolonged cough, the syrup is recommended to be given in the following dosage:

the younger group of patients (up to 6 years old) - 5 ml 2-3 times a day;
children aged 6-14 years - 5 ml 3-4 times or 10 ml 2 times a day;
from 14 years and older - 10 ml 2-3 times a day (maximum 0.6 g of active substance).

2-6 years - 5 ml 4 times a day;
older than six - 10 ml 3 times a day.

Selection of dosage and dilution of granules

Granules for the solution can be diluted not only in water. Suitable orange juice, tea. It is important that the dilution liquid remains cool. Usually ½ cup of water is used to dissolve the sachet, but more liquid can be taken.

for babies under 6 years old, a bag of granules is diluted in 60 ml of water twice a day;
children under 14 years of age are offered a similar dose of ACC three times a day or twice a day for a pair of sachets;
teenagers - 2 packets 2-3 times daily.

For children with cystic fibrosis:

children under 6 years old - 1 sachet (0.1 g) four times a day;
over 6 years old - 2 dosage sachets with powder after breakfast, lunch and dinner.

Application of effervescent tablets

One tablet is dissolved in 0.2 l of water. It is advisable to drink the resulting solution immediately after all the particles of the drug are completely dissolved. In extreme cases, the medicine can be drunk within 120 minutes after preparation. The dosage is as follows:

a young child (from 24 months) drink 1 tablet of ACC 2-3 times a day;
schoolchildren under 14 years old - 1 tablet dissolved in water three times a day or 2 tablets in the morning and late in the evening;
adolescents over 14 years old - 2 tablets 2-3 times a day.

For cystic fibrosis:

small patients (up to 6 years) - 1 dose 4 times a day;
children over 6 years old - 2 tablets 3 times a day.

Contraindications for use

Before using a drug based on acetylcysteine, contraindications should be studied. It is not recommended to take ACC in the following cases:

The patient's age is less than 24 months.
Exacerbation of diseases of the stomach (ulcers, gastritis) or duodenum. During the period of remission, before taking the remedy, you should consult with a gastroenterologist.
Throat bleeding.
Carrying a child, lactation.
Allergic reaction to acetylcysteine or additional components.

Effervescent tablets begin to act faster than syrup. However, they are not suitable for the treatment of patients with lactose intolerance or glucose-galactose malabsorption.

Possible side effects

Side effects are classified according to the following criteria:

Allergy: itchy skin rash, palpitations, angioedema.
Respiratory system: signs of suffocation, shortness of breath, bronchial obstruction.
Digestive system: burning sensation in the esophagus, bloating, loose stools, vomiting, pain.
Other manifestations: headache, lowering blood pressure, tinnitus, dizziness. The occurrence of hematomas and internal bleeding associated with a violation of platelet aggregation.

special instructions

ACC instantly oxidizes and changes its properties. In this regard, the solution should be prepared and the effervescent tablet should be dissolved in a glass or ceramic container, and the syrup should be measured with a special syringe. In addition, during therapy, the following factors should be considered:

The drug is not consumed at bedtime, it is desirable that the final dose be no later than 18 hours.
Acetylcysteine can cause a sharp bronchospasm, so people with asthma should take the remedy only under the supervision of their doctor.
During the period of therapy, severe allergic reactions may occur (in single cases). It is recommended that at the slightest change in the color of the skin, immediately consult a doctor.
Since the liver is involved in the breakdown and absorption of the drug, and its main volume is excreted by the kidneys, people with impaired functioning of these organs should take ACC on the recommendation of a doctor and under his supervision.
Antitussives are not used together with drugs based on acetylcysteine. This combination can aggravate sputum stasis due to a decrease in the cough reflex.

It is not used together with several groups of antibiotics, in order to avoid reducing the effectiveness of both drugs. If there is doubt about the possibility of combining antimicrobial agents with ACC, it is better to take a 2-hour break between doses.

The cost of ACC and analogues of the drug

The cost of the drug depends on the volume of the active substance in one dose and on the form of release. Consider average prices:

syrup with a volume of 200 ml - about 350 rubles;
effervescent tablets 200 mg, 20 pieces - about 300 rubles;
sachets of 200 mg, 20 pieces - from 120 rubles.

There is a different concentration of the active substance in the preparation. Tablets containing acetylcysteine from 100 to 600 mg are produced. In this regard, before buying, you should carefully study the packaging.

Acecex powder is one of the substitute analogues

Consider ACC analogues based on a similar active substance. For ease of perception, the information is summarized in a table.

Before buying an expectorant for a child, it is advisable to consult a doctor. Sometimes pediatricians do not recommend taking mucolytic drugs. This happens if the cough is allergic in nature or is a residual effect after a viral illness.

Update: October 2018

ACC (Acetylcysteine) is a drug with an expectorant and mucolytic effect, which is prescribed to thin the viscous secretion of the bronchi in diseases of the respiratory system that occur with the formation of thick, difficult to discharge sputum.

The history of the invention of the drug fell on the middle of the last century. It was then that Professor Ferrari, who worked at the Italian pharmaceutical company Zambon, discovered the similarity of acetylcysteine with the protein cysteine, which has the ability to break the mucopolysaccharide molecules that make up the bronchopulmonary secret. The first drug based on acetylcysteine was called Fluimucil.

Farmgroup: mucolytic drug.

Composition, physical and chemical properties, price

ACC is available in the form of tablets (effervescent, soluble), granules and powder for oral administration with different dosages of the active substance. Another dosage form is a solution for injection (intravenous and intramuscular).

	ACC effervescent tablets	Granules	Solution	Syrup
Base substance	Acetylcysteine 100, 200 or 600 mg		Acetylcysteine 300 mg	In 1 ml - 20 mg of acetylcysteine
Excipients	Citric and ascorbic acid, lactose, mannitol, citrate and sodium bicarbonate, aromatics	Ascorbic acid, aromatics, sucrose, saccharin.	Sodium hydroxide, disodium edetate, ascorbic acid, water for injection	Methyl parahydroxybenzoate, sodium benzoate, disodium edetate, carmellose and sodium saccharinate, sodium hydroxide, purified water, Cherry flavor
Physiochemical properties	Effervescent tablets are round and white, flat. Has a berry-fruity aroma	Homogeneous granules without agglomerated inclusions, white in color and with a fruity odor	Clear solution, liquid, colorless	The syrup is colorless, transparent, slightly viscous, with a cherry smell.
Package	In plastic tubes of 10 or 20 pieces	In moisture-proof bags, 6, 10, 20, 50 pieces per pack. 100 mg per vial (for suspension)	3 ml in ampoules, 5 ampoules in a carton box	100 ml in dark glass bottles, with measuring cup and syringe
Price	No. 20 for 200 mg: 150-180 rubles.	No. 20 for 100 mg: 120-130 rubles.	No. 5: 100-130 rubles.	Price 230 rubles.

pharmachologic effect

The mucolytic effect of the drug is provided by the active substance acetylcysteine, which is a derivative of cysteine (amino acid). The acetylcysteine molecule has sulfhydryl groups in its structure, which contributes to the disruption of the disulfide bonds of mucopolysaccharides in the sputum, which provide the viscosity of the secret. As a result, sputum softens and is easier to separate from the walls of the bronchi.

The drug has a direct effect on the density and rheological properties of sputum, maintaining proper activity even with purulent impurities in the bronchial secret. With the prophylactic use of acetylcysteine, patients with cystic fibrosis and chronic bronchitis note a decrease in the number and severity of exacerbations.

Another effect of acetylcysteine is an antioxidant pneumoprotective effect, which is realized by binding and neutralizing chemical radicals by sulfhydryl groups. The drug accelerates the synthesis of glutathione, an intracellular protection factor against a number of cytotoxic substances and oxidative toxins of internal and external origin, which allows the use of ACC in paracetamol overdose.

Pharmacokinetics

Rapidly and completely absorbed, being metabolized in the liver. In the course of metabolic reactions, the pharmacologically active cysteine and a number of other mixed disulfides are formed. Bioavailability is only about 10%. The maximum concentration is reached in the blood 1-3 hours after ingestion. Communication with fiery proteins reaches 50%. Acetylcysteine is excreted by the kidneys as inactive metabolites. The very fast half-life of about 1 hour is due to the biotransformation of the substance in the liver. With liver dysfunction, this period increases to 8 hours.

Indications for use

Diseases of the respiratory system, in which difficult-to-separate, viscous sputum is formed:

laryngotracheitis;
bronchitis (acute and chronic);
bronchiectasis;
pneumonia;
obstructive bronchitis;
lung abscesses;
bronchiolitis;
bronchial asthma;
cystic fibrosis.

Sinusitis (chronic and acute).
Otitis media.

Contraindications for taking ACC

Exacerbation of GU and duodenum;
Pulmonary bleeding, hemoptysis;
Pregnancy and lactation, ACC is prohibited during pregnancy at any time;
Individual intolerance;

The instructions for the use of ACC for children indicate that treatment is possible strictly according to medical prescription, it is contraindicated:

Children's age up to 2 years (except for granules for the preparation of the drug in a vial and injections).
Children's age up to 6 years (granules 200 mg);
Children's age up to 14 years (granules 600 mg).

It is prescribed with caution to people with pathological varicose veins in the esophagus, at the risk of bleeding from the lungs, bronchial asthma, insufficiency of the liver and kidneys.

Dosage

ACC effervescent tablets 100 and 200 mg

The tablet should be dissolved in water (100 ml) and taken immediately after preparation. In exceptional cases, it is permissible to store the solution for a maximum of 2 hours. Take after a meal, additionally drinking water.

Children 2-5 years old: One 100 mg tablet or half a 200 mg tablet three times or twice a day (200-300 mg per day).
Children 6-14 years: One 100 mg tablet or half a 200 mg tablet three times a day. 2nd scheme: two tablets of 100 mg or one tablet of 200 mg twice a day (300-400 mg per day).
Adolescents from 14 liters and adults: one tablet of 200 mg twice or thrice a day (400-600 mg per day).

In cases of cystic fibrosis, the dose and regimen are different.

Children 2-6 liters: one 100 mg tablet or half a 200 mg tablet four times a day (200 mg per day).
Children over 6 liters: two 100 mg tablets or one 200 mg tablet three times a day (600 mg per day).

Patients weighing more than 30 kg are given a daily dose of 800 mg, evenly distributed over doses.

Granules

The instructions for use of ACC powder indicate the method of preparation of the dosage form. Half a sachet or sachet is dissolved in juice, chilled tea or water and the composition is drunk after meals. To obtain a syrup, drinking water is added to the vial up to the mark and shaken.

Children under 2 liters: 50 mg (half a measuring spoon) twice or thrice a day (100-150 mg per day). Strictly prescribed by a doctor!
Children 2-5 liters: One scoop (100 mg) 2-3 times a day (200-300 mg per day).
Children 6-14 years: One scoop (100 mg) three times a day (300-400 mg per day).
Adolescents over 14 years of age and adults: Two scoops (200 mg) twice or thrice daily (400-600 mg per day).

The regimen for cystic fibrosis is similar to tablets.

Syrup

The syrup is taken after a meal, measuring out the proper amount with a syringe or a glass. 10 ml syrup = half cup or 2 full syringes. It should be taken with water to increase the mucolytic effect.
Children 2-5 liters: 5 ml of syrup 2-3 times a day (200-300 mg per day);
Children 6-14 liters: 5 ml of syrup 3 times a day or 10 ml twice a day (300-400 mg per day);
Children over 14 liters, adults: 10 ml of syrup 2-3 times a day (400-600 mg per day).

For cystic fibrosis:

Children 2-6 liters: 5 ml of syrup 4 times a day (400 mg per day);
Children over 6 liters: 10 ml of syrup 3 times a day (600 mg per day).

Injection

It is intended for intravenous or intramuscular administration only in a hospital setting.

IM: injected deep into the muscle. In / in: diluted with 0.9% NaCl in a ratio of 1: 1, slow administration.
Children 1-6 liters: 10 mg of solution per 1 kg of body weight.
Children 6-14 liters: 150 mg (one and a half ml) 1 or 2 r per day.
Children over 14 liters and adults: 300 mg (3 ml) 1-2 r per day.

Reception duration. Short-term colds: 5-7 days. More severe diseases - for a long time, as directed by a doctor.

Side effects when taking ACC

CNS: rarely - noise in the head, headache.
Digestive tract: diarrhea, stomatitis, vomiting, nausea, heartburn.
CCC: drop in blood pressure, tachycardia.
Allergies: bronchospasm, which is possible with hyperreactivity of the bronchial system, urticaria and skin rash.
Occasionally, pulmonary bleeding may develop in people with hypersensitivity to the drug.

special instructions

The drug should be diluted only in glassware. Upon contact with metals, sulfides are formed.
Patients with asthma and obstructive bronchitis should be monitored for bronchial patency.
With the development of any side effects, the drug is stopped.
Patients with diabetes should take into account the glucose content: in 100 mg ACC - 0.006 XE.
Does not affect the ability to drive a car and work with complex mechanisms.
Be wary appoint in the pathology of the kidneys, liver.

drug interaction

It is not recommended to combine acetylcysteine and cough medicines, as this is dangerous by suppressing the cough reflex and sputum stagnation.
With simultaneous use with nitroglycerin, the vasodilating effect of the latter is enhanced.
ACC reduces the adsorption of penicillins, cephalosporins and tetracyclines, so antibiotics are prescribed 2 hours after taking the mucolytic.

Analogues


Vicks Active (140-280 rubles)	Fluimucil (150-250 rubles)	Acetylcysteine	Rinofluimucil (nasal) 250 rub.

no temperature

With temperature

Massage

One of the very popular mucolytic drugs is ACC 200, so it is often prescribed for coughing with viscous sputum. But is this medicine suitable for children?

Release form

ACC 200 is produced in two forms:

Powder packaged in portion packs weighing 3 grams. It is represented by homogeneous white granules that smell like honey and lemon. Orange powder is also on sale. One pack contains 20 medicine packs.
Effervescent tablets. The manufacturer offers packs of 20 of these white round tablets with blackberry flavor.

Compound

The active substance in ACC 200 is acetylcysteine, which each tablet or each portion package contains, as the name implies, 200 mg. ACC 200 powder also includes sucrose, sodium saccharinate, ascorbic acid and flavors (lemon and honey). In addition to vitamin C and orange flavor, orange granules contain saccharin and sucrose for a sweet taste.

Additional substances in tablets are citric acid, milk sugar, bicarbonate, saccharinate, sodium citrate and carbonate, mannitol, ascorbic acid and blackberry flavor.

Operating principle

The main action of acetylcysteine, which is contained in ACC 200, is mucolytic. Such a substance directly affects sputum in the respiratory tract, changing its rheological properties. This is due to the ability to destroy the bonds of mucopolysaccharides in sputum, resulting in a decrease in the viscosity of the secret. In this case, the drug does not lose activity, even if pus is present in the sputum.

Acetylcysteine also has antioxidant properties, because it is able to neutralize oxidative radicals and stimulates the formation of glutathione. The result of this action will be an increase in cell protection and a decrease in the intensity of inflammation.

Video review of the drug ACC 200 in the form of a powder, see below.

Can it be given to children?

Instructions for use clarifies that the use of acetylcysteine is allowed from the age of two. In this case, a single dose for children under 6 years old is usually 100 mg of the active substance, so you have to divide the bag or tablet in half. The drug ACC 200 is designed for ages over 6 years.

Indications

Doctors prescribe ACC 200, if necessary, to improve sputum separation and thin it. The medicine is prescribed in childhood with:

Pneumonia.
bronchiolitis or bronchitis.
Chronic lung diseases, including obstructive ones.
bronchiectasis.
Otitis media.
sinusitis.
Cystic fibrosis.
Abscess in the lung.

Contraindications

The drug should not be taken in such situations:

If the child has intolerance to acetylcysteine or other components of the drug.
If the peptic ulcer worsened.
If blood is found in the sputum.
If the baby has glucose-galactose malabsorption.
When detecting pulmonary hemorrhage.

Prescribing a medicine requires increased attention from the doctor if the child has bronchial asthma, high blood pressure, diseases of the kidneys, adrenal glands or liver. Granules should not be given to children with fructose intolerance or sucrase deficiency.

Effervescent tablets are contraindicated in case of lactose intolerance or lack of lactase.

Side effects

ACC 200 can provoke allergies, which manifests itself in children with a skin rash, reduced blood pressure, itching, swelling, urticaria or tachycardia. An anaphylactic reaction is very rare.
The respiratory system of children may respond to ACC with shortness of breath, and in bronchial asthma, the drug causes bronchospasm.
In some children, under the influence of ACC, the digestive system may suffer, which is manifested by dyspepsia, heartburn, nausea, loose stools, stomatitis, vomiting or abdominal pain.
Occasionally, taking ACC provokes headaches., tinnitus, fever, or bleeding.

Instructions for use and dosage

ACC 200 powder should be diluted and given to the child to drink after meals. For one bag, take half a glass of liquid, which can be represented not only by water, but also by cool tea or juice. Effervescent tablets are diluted with water only.

The prepared solution should be drunk as soon as possible after preparation. Due to the presence of ascorbic acid in the composition, the diluted medicine can be stored for up to two hours after it is diluted with a liquid.

The dose of the medicine will depend on the age:

At 2-6 years of age, the child is given 200-300 mg of acetylcysteine per day. Since the daily dosage is divided into 2 times, a single dose will be 100-150 mg. In most cases, at one time, half a sachet of ACC 200. If tablets are used, then for a child under 6 years old, an effervescent tablet should be broken into halves and mixed with water only 1/2. However, at this age it is more convenient to use the medicine ACC 100.
At the age of 6-14 years, the daily dosage will be 300-400 mg of acetylcysteine, therefore, a single dosage is most often represented by a whole bag or a whole effervescent tablet of ACC 200, and the medicine is taken 2 times a day.
Children over 14 years old are given 400-600 mg of acetylcysteine per day, dividing this dosage into 1-3 doses. At this age, the use of ACC long is already acceptable.

The duration of treatment for ACC 200 should be determined by the doctor, but in acute pathologies without complications, the drug is often prescribed for 5-7 days.

Overdose

If the dosage of ACC for a child is too high, the baby's body will react to the drug with nausea, loose stools or vomiting. Help in this situation can be symptomatic therapy.

Interaction with other drugs

It is not recommended to dissolve ACC tablets or powder in the same glass with any other medicines.
When taking activated charcoal, the activity of acetylcysteine will decrease.
It is unacceptable to prescribe ACC 200 and any antitussive drugs, since an oppressed cough reflex can cause stagnation of mucus in the bronchi.
With the appointment of ACC and bronchodilators, their effectiveness increases.
Some antibiotics (cephalosporin, penicillin, tetracycline) when interacting with acetylcysteine lose their antimicrobial activity, so a pause should be made between such drugs, taking them at least 2 hours apart.
The simultaneous appointment of ACC 200 and nitroglycerin or other vasodilating drugs causes a more pronounced vasodilating effect.

Terms of sale

To purchase ACC 200 in a pharmacy, a prescription from a doctor is not required. The average cost of a package with 20 bags is 130 rubles.

Storage conditions and shelf life

The temperature at the place of storage of ACC 200 should not exceed +25°C. ACC 200 sachets have a shelf life of 4 years from the date of issue, and effervescent tablets - only 3 years. After removing the effervescent tablet from the tube, check the tightness of the closure of the package.