CARBOCISTEINE (Mucodyne)

Carbocisteine affects the nature and amount of mucus glycoprotein that is secreted by the respiratory tract. It is a well-tolerated treatment with a favourable safety profile that provides symptomatic relief to some patients with sputum production in COPD. It can be used in the ICU to treat mucous plugging as an alternative to saline or acetylcysteine nebulisation. In addition to its mucoregulatory activity, carbocisteine exhibits free-radical scavenging and anti-inflammatory properties. There is a theoretical risk of gastric erosion because carbocisteine may disrupt the gastric mucosal barrier. Peak serum concentrations are achieved at 1–1.7 hours and the plasma half-life is 1.3 hours. It achieves good penetration into lung tissue and bronchial secretions. It is excreted in the urine as unchanged drug and metabolites.

Uses

Reduction of sputum viscosity

Contraindications

Active peptic ulceration

Administration

Orally: 750 mg 8–12 hourly

Adverse effects

Anaphylactic reactions

Skin rashes/allergy

Gastrointestinal bleeding

Renal replacement therapy

No dose adjustment is required

CASPOFUNGIN (Cancidas)

Caspofungin covers a wider range of Candida species causing invasive candidiasis than fluconazole and is active against Aspergillus species. It has a better side-effect profile than amphotericin. In mild liver failure, AUC is increased by 20% and moderate liver failure by 75%, hence the dose reduction in moderate liver failure. Side-effects are typically mild and rarely lead to discontinuation.