Acetylcysteine

Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active ingredient acetylcysteine ​​is an expectorant and expectorant that is derived from the natural amino acid (protein building block) cysteine. It can also be used as an antidote for poisoning with the pain reliever paracetamol. Here you can read everything you need to know about the effects and use of acetylcysteine, as well as possible interactions and side effects.

This is how acetylcysteine ​​works

The expectorant effect of acetylcysteine ​​is best studied and confirmed in cystic fibrosis. However, the active ingredient is also recommended for other diseases that are associated with an increased formation of thick mucus in the bronchi.

The long polysaccharide chains of the mucus are cross-linked via so-called disulfide bridges. Acetylcysteine ​​and the amino acid cysteine ​​released from it can dissolve these cross-links and thereby liquefy the mucus, making it easier to cough up and remove.

The active ingredient acetylcysteine ​​is also used in high doses in the therapy of paracetamol overdoses. Paracetamol, a commonly used pain reliever, is broken down in the liver in two stages, whereby the short-lived transitional form (abbreviated NAPQI) is very reactive and has to be detoxified immediately by the small protein glutathione. If glutathione is used up before the reactive transitional form has been completely detoxified, it accumulates and reacts with the genetic material and proteins of the liver cells, which leads to cell death. In order to avoid liver failure, acetylcysteine ​​must therefore be administered as quickly as possible, from which the body can form glutathione again.

Acetylcysteine ​​uptake, breakdown and excretion

After ingestion, the active ingredient is quickly absorbed into the blood through the intestines and converted to cysteine ​​in the liver. After about an hour, half of the active ingredient has already been excreted via the kidneys; with impaired kidney function, this time can increase to up to eight hours.

When is acetylcysteine ​​used?

The expectorant acetylcysteine ​​is approved for the treatment of diseases in which increased mucus forms in the bronchi or is difficult to remove. These include, for example, severe lung infections, pneumonia and cystic fibrosis.

Acetylcysteine ​​is also approved as an antidote for the treatment of acetaminophen or acrylonitrile poisoning.

Acetylcysteine ​​is often used as a cysteine ​​substitute for parenteral nutrition (for example, for nutrition via infusion) and for dietary nutrition. Cysteine ​​is a building block of protein.

Off-label, i.e. outside the approval area, the active ingredient is used preventively for the treatment of kidney dysfunction and also for psychiatric illnesses such as schizophrenia, obsessive-compulsive disorder and depression.

Depending on the clinical picture, the intake can range from a few days to permanent.

This is how acetylcysteine ​​is used

In self-medication, acetylcysteine ​​is usually drunk as a juice or effervescent tablet to dissolve mucus. Adults and children aged 14 and over take either 600 milligrams of acetylcysteine ​​once a day in the morning or 200 milligrams of acetylcysteine ​​up to three times a day. Smaller children (from two years of age) receive less, depending on their body weight. It is important that enough water or tea is drunk with it, otherwise the expectorant cannot work. The active ingredient can be combined with other drugs that promote expectoration.

Use as an antidote is reserved for the doctor

What are the side effects of acetylcysteine?

Acetylcysteine ​​can hardly be overdosed and is almost free of side effects in therapeutic doses. One in one in one hundred to one thousand people treated may experience allergic reactions to the active ingredient (itching, rash, palpitations, drop in blood pressure - and the intake must be stopped immediately!). Ringing in the ears, headache, fever, abdominal pain, heartburn, nausea, vomiting and diarrhea are also possible.

What should be considered when taking acetylcysteine?

Acetylcysteine ​​should not be taken together with cough suppressants (pentoxyverine, dextromethorphan, codeine). Otherwise, the suppressed cough reflex will lead to a build-up of secretion. This can be particularly dangerous at night.

Studies show that acetylcysteine ​​can react with some antibiotics (tetracycline, gentamycin, penicillin, and others) and limit their effectiveness. However, since this only happens when the substances come into direct contact, it is recommended to take the active ingredients at least two hours apart.

The use of acetylcysteine ​​during pregnancy and breastfeeding does not show any direct harmful effects, but should nevertheless be discussed with a doctor first.

The active ingredient can be taken by children from two years of age and older patients, provided they do not have severe liver or kidney problems.

How to get medicines with acetylcysteine

Preparations with the active ingredient acetylcysteine ​​are available in pharmacies as an expectorant without a prescription.

In some cases, acetylcysteine ​​effervescent tablets are also offered in drugstores, but here they may only be sold as a dietetic product and not for the treatment of diseases.

Since when has acetylcysteine ​​been known?

Although the structure of the amino acids has been known for much longer, acetylcysteine ​​was not approved as an expectorant in Germany until 1960. It has been approved as an antidote for acetaminophen poisoning since the mid-1970s. Since it is not subject to ongoing patent protection, there are numerous generics with the active ingredient acetylcysteine ​​on the German pharmaceutical market.

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