What are the trade names for N-acetylcysteine (NAC) mucolytic agents and their administration routes?

Trade Names and Administration Routes for NAC Mucolytic Agents

N-acetylcysteine (NAC) is available in oral and inhaled formulations for mucolytic therapy, with oral administration being the most commonly recommended route at doses of 600 mg twice daily for patients with COPD and chronic bronchitis.

Available NAC Mucolytic Preparations

Oral Formulations

• N-acetylcysteine (NAC) - Generic name
  • Administered as tablets or oral solution
  • Typical therapeutic dose: 600 mg twice daily 1
  • Rapidly absorbed from GI tract and incorporated into lung tissue and respiratory secretions 2

Inhaled/Nebulized Formulations

• Acetylcysteine Solution, USP (20% solution)
  • Available in 10 mL or 30 mL rubber-stopped glass vials 3
  • Must be diluted to 5% concentration for nebulization
  • Can be diluted with sodium chloride for inhalation or sterile water for inhalation 3

Administration Routes and Dosing

Oral Administration

• Preferred route for chronic therapy in COPD and chronic bronchitis
• Dosage: 600 mg twice daily (high-dose therapy) 1
• Oral NAC has been shown to:
  • Reduce exacerbation rates in COPD patients 1
  • Improve quality of life measures 4
  • Act as a mucolytic, antioxidant, and anti-inflammatory agent 5, 6, 7

Nebulized/Inhaled Administration

• Used for direct mucolytic effect on respiratory secretions
• Preparation requires dilution of 20% solution to 5% with diluent 3
• Dilutions should be freshly prepared and used within one hour 3
• Unopened vials should be stored at room temperature (15-30°C) 3
• Opened vials can be refrigerated for up to 96 hours 3

Clinical Considerations

Patient Selection

• Most beneficial for patients with:
  • Moderate to severe COPD (FEV1/FVC < 0.70 and FEV1 30-79% predicted) 1
  • History of exacerbations despite optimal inhaled therapy 1
  • Chronic bronchitis with viscous secretions 1

Efficacy Evidence

• High-dose oral NAC (600 mg twice daily) has been shown to:
  • Reduce exacerbation rates (RR 0.78) 1
  • Extend time to second and third exacerbations 1
  • Be more effective in GOLD II COPD compared to GOLD III 1

Safety Profile

• Generally well-tolerated with minimal adverse effects 1
• Most common side effects include nausea, vomiting, and diarrhea 2
• No significant difference in adverse events compared to placebo in clinical trials 1

Important Considerations

• NAC should be considered for patients with moderate to severe COPD who continue to have exacerbations despite optimal inhaled therapy 1
• The beneficial effects are most pronounced with high-dose therapy (600 mg twice daily) 1
• NAC has multiple mechanisms of action beyond mucolysis, including antioxidant and anti-inflammatory effects 5, 6, 7
• Store diluted solutions appropriately and use within recommended timeframes to maintain efficacy 3