What are the names of commonly used mucolytics?

Common Mucolytic Medications

The most commonly used mucolytics include N-acetylcysteine (NAC), ambroxol, carbocisteine, and erdosteine, which work through different mechanisms to reduce mucus viscosity and improve clearance from the respiratory tract. 1, 2, 3

Classification of Mucoactive Agents

Mucoactive drugs can be categorized into several groups based on their mechanism of action:

• Mucolytics: Decrease mucus viscosity

  • N-acetylcysteine (NAC) - breaks disulfide bonds in mucoproteins 2, 4
  • Erdosteine 1
  • Dornase alfa (rhDNase) - breaks down DNA in sputum (primarily used in cystic fibrosis) 1, 5

• Mucoregulators: Regulate mucus secretion

  • Carbocisteine 1
  • Anticholinergic agents 1

• Mucokinetics: Increase mucociliary clearance

  • Bronchodilators 1
  • Surfactants 1

• Expectorants:

  • Hypertonic saline 1

Key Mucolytic Medications

N-acetylcysteine (NAC)

• Available as oral tablets/sachets (200-600 mg) and solution for inhalation (10-20%) 2, 4
• Reduces viscosity of respiratory secretions by cleaving disulfide bonds in mucoproteins 2, 6
• High-dose therapy (600 mg twice daily) shows greater efficacy in reducing COPD exacerbations 1, 2
• Generally well-tolerated with rare gastrointestinal side effects 2

Ambroxol

• Available as syrup, tablets, and solution for nebulization 3
• Acts as a mucoregulator that reduces mucus viscosity by altering sialomucin synthesis 3
• May be beneficial in patients with moderate to severe COPD and recurrent exacerbations 3

Carbocisteine

• Regulates mucus secretion as a mucoregulator 1
• Used in management of chronic respiratory conditions with excessive mucus 1
• May reduce exacerbations in patients with COPD 1

Erdosteine

• Has mucolytic, anti-bacterial, anti-oxidant, and anti-inflammatory effects 1
• May improve spirometry and sputum clearance when combined with physiotherapy 5

Bromhexine

• Has been shown to ease expectoration difficulty and reduce sputum production when used at high doses with antibiotics 1, 5

Clinical Applications

• COPD: Mucolytics (particularly NAC, carbocisteine) may reduce exacerbation frequency and hospitalization rates in patients with moderate to severe airflow obstruction 1, 2
• Chronic Bronchitis: Mucolytics may provide modest improvement in symptom control and quality of life 1, 7
• Bronchiectasis: Evidence is limited, but high doses of bromhexine with antibiotics may help with sputum production and clearance 5
• Asthma: NAC can be used as a 10% solution with a bronchodilator to clear tracheobronchial secretions 8

Important Considerations

• The European Respiratory Society suggests oral mucolytic therapy for patients with moderate or severe COPD and exacerbations despite optimal inhaled therapy 1, 2
• Recombinant human DNase (rhDNase) should be avoided in non-cystic fibrosis bronchiectasis due to potential harmful effects 1, 5
• High-dose mucolytic therapy shows greater efficacy than lower doses in reducing exacerbations 1, 2
• Most clinical evidence supporting mucolytic use comes from studies with N-acetylcysteine rather than other agents 3

Caution

• Regular use of oral mucolytics is not routinely recommended for prevention of lower respiratory tract infections in patients with chronic bronchitis, COPD, or bronchiectasis 1
• Clinical trials in children using various mucolytic agents are lacking 5