What is the recommended dosage for Mucomix (acetylcysteine) nebulisation?

Mucomix (Acetylcysteine) Nebulisation Dosage

For nebulisation via face mask, mouthpiece, or tracheostomy, administer 3-5 mL of 20% acetylcysteine solution or 6-10 mL of 10% solution, 3-4 times daily, which is the FDA-approved standard dosing for most patients. 1

Standard Dosing Regimens

Face Mask, Mouthpiece, or Tracheostomy Administration

• Dose range: 1-10 mL of 20% solution OR 2-20 mL of 10% solution every 2-6 hours 1
• Recommended dose for most patients: 3-5 mL of 20% solution OR 6-10 mL of 10% solution, administered 3-4 times daily 1
• The 20% solution may be diluted with Sodium Chloride Injection, Sodium Chloride Inhalation Solution, Sterile Water for Injection, or Sterile Water for Inhalation 1
• The 10% solution may be used undiluted 1

Direct Instillation (Alternative Route)

• For direct instillation: 1-2 mL of 10-20% solution as often as every hour 1
• For routine tracheostomy care: 1-2 mL of 10-20% solution every 1-4 hours by instillation 1

Tent or Croupette Administration (Special Circumstances)

• Requires individualized volumes based on equipment and patient needs 1
• May require up to 300 mL during a single treatment period to maintain heavy mist 1
• Can be administered intermittently or continuously, including overnight 1

Administration Guidelines

Nebulizer Equipment

• Use compressed tank gas (air) or air compressor to provide pressure for nebulization 1
• Oxygen may be used but exercise caution in patients with severe respiratory disease and CO2 retention 1
• Nebulizers should produce particles less than 10 microns in diameter for optimal respiratory tract retention 1

Material Compatibility

• Acceptable materials: glass, plastic, aluminum, anodized aluminum, chromed metal, tantalum, sterling silver, or stainless steel 1
• Avoid: iron, copper, and rubber, which react with acetylcysteine 1

Storage and Contamination Prevention

Critical Storage Requirements

• Acetylcysteine contains no antimicrobial agent - strict aseptic technique is mandatory 1
• If only partial vial used: refrigerate remainder and use within 96 hours 1
• Minimize contamination of the sterile solution during handling 1

Clinical Context and Evidence Quality

Limited Evidence for Bronchiolitis

• One pediatric study (2014) showed N-acetylcysteine improved clinical severity scores in acute bronchiolitis, with mean hospitalization of 4.36 days versus 4.98 days with salbutamol 2
• However, this represents lower-quality evidence compared to FDA labeling, which should guide primary dosing decisions 2

Alternative Delivery Methods

• Before initiating home nebulizer therapy, consider metered dose inhalers with spacers or dry powder inhalers as more convenient and cost-effective alternatives 3
• Nebulizers are reserved for patients who cannot use alternative delivery systems 3

Common Pitfalls to Avoid

• Do not use opened vials beyond 96 hours - this is a frequent source of contamination 1
• Do not use equipment containing iron, copper, or rubber - these materials react with acetylcysteine and compromise drug integrity 1
• Do not assume all nebulizers deliver equivalent doses - output and particle size vary significantly by device type 4
• Do not prepare multi-patient doses from single bottles - this practice increases nosocomial infection risk 5