This information is intended for use by health professionals

1. Name of the medicinal product

Mucodyne 250 mg/5 ml Syrup

Mucodyne 250 mg/5 ml Paediatric Syrup

2. Qualitative and quantitative composition

Each 5 ml of oral solution contains 250 mg of Carbocisteine. Also contains 2 g of sucrose, 70 mg of ethanol (1.6% v/v), 7.5 mg of methyl parahydroxybenzoate (E218) and 33 mg of sodium (1.4 mmol).

For a full list of excipients, see section 6.1.

3. Pharmaceutical form

Syrup

A clear amber coloured syrupy liquid

4. Clinical particulars
4.1 Therapeutic indications

Carbocisteine is a mucolytic agent for the adjunctive therapy of respiratory tract disorders characterised by excessive, viscous mucus, including chronic obstructive airways disease.

4.2 Posology and method of administration

Adults including the elderly (300 ml presentation only):

Dosage is based upon an initial daily dosage of 2250 mg Carbocisteine in divided doses, reducing to 1500 mg daily in divided doses when a satisfactory response is obtained e.g. for normal syrup 15 ml tds reducing to 10 ml tds.

Children (125 ml presentation only):

Children 2 – 5 years: The usual dose is 1.25 – 2.5 ml four times daily.

Children 5 – 12 years: The usual dose is 5 ml three times daily.

Mucodyne Syrup and Mucodyne Paediatric Syrup are for oral use.

Use of syringe for dosing (125 ml presentation only)

An oral dosing syringe is provided for use for dosing children.

How to use the oral dosing syringe for children

The syringe end should be placed into the neck of the bottle below the liquid fill line. To fill the syringe whilst holding the syringe in place, gently pull the plunger down drawing the medicine to the correct mark on the syringe. The dose for children is given above based on age. Remove the syringe from the bottle neck carefully. Place the end of the syringe into the child's mouth against the cheek and gently press the plunger down slowly to gently release the medicine. After use replace the bottle cap. Wash the syringe in warm water and allow to dry. Store out of the reach of children.

4.3 Contraindications

• Mucodyne Paediatric Syrup is contraindicated for use in children less than 2 years of age.

• Hypersensitivity to the active substance(s) or to any of the excipients.

• Use in patients with active peptic ulceration.

4.4 Special warnings and precautions for use

Caution is recommended in the elderly, in those with a history of gastroduodenal ulcers, or those taking concomitant medications known to cause gastrointestinal bleeding. If gastrointestinal bleeding occurs, patients should discontinue medication.

Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine.

4.5 Interaction with other medicinal products and other forms of interaction

None stated.

4.6 Pregnancy and lactation

Although tests in mammalian species have revealed no teratogenic effects, Mucodyne is not recommended during the first trimester of pregnancy.

Use in lactation: Effects not known.

4.7 Effects on ability to drive and use machines

None.

4.8 Undesirable effects

Immune system disorders

There have been reports of anaphylactic reactions and fixed drug eruption.

Gastrointestinal disorders

There have been reports of gastrointestinal bleeding occurring during treatment with Mucodyne.

Frequency not known: vomiting, gastrointestinal bleeding

Skin and subcutaneous tissue disorders

There have been reports of skin rashes and allergic skin eruptions. Isolated cases of bullous dermatitis such as Stevens-Johnson syndrome and erythema multiforme have also been reported.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via Yellow Card Scheme at: www.mhra.gov.uk/yellowcard

4.9 Overdose

Gastric lavage may be beneficial, followed by observation. Gastrointestinal disturbance is the most likely symptom of Mucodyne overdosage.

5. Pharmacological properties
5.1 Pharmacodynamic properties

ATC code: R05CB03

Carbocisteine (S-carboxymethyl L-cysteine) has been shown in normal and bronchitic animal models to affect the nature and amount of mucus glycoprotein which is secreted by the respiratory tract. An increase in the acid:neutral glycoprotein ratio of the mucus and a transformation of serous cells to mucus cells is known to be the initial response to irritation and will normally be followed by hypersecretion. The administration of Carbocisteine to animals exposed to irritants indicates that the glycoprotein that is secreted remains normal; administration after exposure indicates that return to the normal state is accelerated. Studies in humans have demonstrated that Carbocisteine reduces goblet cell hyperplasia. Carbocisteine can therefore be demonstrated to have a role in the management of disorders characterised by abnormal mucus.

5.2 Pharmacokinetic properties

Carbocisteine is rapidly absorbed from the GI tract. In an 'in-house' study, at steady state (7 days) Mucodyne capsules 375 mg given as 2 capsules t.d.s. to healthy volunteers gave the following pharmacokinetic parameters:

Plasma Determinations

Mean

Range

T Max (Hr)

2.0

1.0 - 3.0

T½ (Hr)

1.87

1.4 - 2.5

KEL (Hr-1)

0.387

0.28 - 0.50

AUC0-7.5 (mcg.Hr.ml-1)

39.26

26.0 - 62.4

Derived Pharmacokinetic Parameters

*CLS (L.Hr-1)

20.2

-

CLS (ml.min-1)

331

-

VD (L)

105.2

-

VD (L.Kg-1)

1/75

-

*Calculated from dose for day 7 of study

5.3 Preclinical safety data

There are no preclinical data of relevance to the prescriber, which are additional to those already included in other section of the SmPC.

6. Pharmaceutical particulars
6.1 List of excipients

Methyl parahydroxybenzoate (E218),

Sucrose,

Caramel powder (E150),

Aromatic Elixir (containing ethanol and aromatic flavourings),

Cinnamon oil,

Sodium hydroxide,

Purified water.

6.2 Incompatibilities

Mixture with linctus of pholcodine causes precipitation of carbocisteine from solution.

6.3 Shelf life

36 months.

6.4 Special precautions for storage

Store below 25°C.

6.5 Nature and contents of container

*125 ml, 200 ml, 250 ml or 300 ml clear glass bottle (Type III glass) and a polypropylene childproof, tamper-evident screw cap with polyethylene liner together with a graduated polypropylene beaker for oral dose delivery to adults.

125 ml clear glass bottle (Type III glass) and a polypropylene childproof, tamper-evident cap with a polyethylene liner together with a 5 ml CE marked graduated syringe for oral dose delivery in children.

*The 125 ml pack size only will be provided with a syringe composed of a polyethylene barrel and a polystyrene piston with graduation markings each of 0.25 ml on the outside of the barrel.

Not all pack sizes may be marketed

6.6 Special precautions for disposal and other handling

No special requirements.

7. Marketing authorisation holder

Aventis Pharma Limited

410 Thames Valley Park Drive

Reading

Berkshire

RG6 1PT

UK

Trading as:

Sanofi

410 Thames Valley Park Drive

Reading

Berkshire

RG6 1PT

UK

8. Marketing authorisation number(s)

PL 04425/0204

9. Date of first authorisation/renewal of the authorisation

30 April 2003

10. Date of revision of the text

13/11/2019