Carbocysteine is prescribed for conditions characterized by the accumulation of excessive mucus. Although often described as a mucolytic, its function is probably that of mucoregulation, which results in physical changes in accumulated secretions that are favorable in terms of clearance. The chemistry, pharmacology, pharmacokinetics, clinical applications, and toxicology of carbocysteine are reviewed.
DavisSSDeverellLC. Rheological factors in mucociliary clearance. The assessment of mucotropic agents using an in vitro model. Mod Probl Paediatr1977; 19: 207–17.
3.
MartinRLittMMarriottC. The effect of mucolytic agents on the rheologic and transport properties of canine tracheal mucus. Am Rev Respir Dis1980; 121: 495–500.
4.
BrownDTWetmoreRFMarshRR. The action of mucolytic agents on respiratory mucins and the implications for secretory otitis media. Proc Pa Acad Ophthalmol Otolaryngol1982; 35: 169–77.
5.
MuittariALinnoilaM. Effect of mucolytics on chronic obstructive pulmonary disease. Curr Ther Res Clin Exp1977; 22: 246–52.
6.
EdwardsGFSteelAEScottJKJordanJW. S-carboxymethyl-cysteine in the humidification of sputum and treatment of chronic airway disease. Chest1976; 70: 505–13.
7.
PhamQTPuchelleE. Treatment with mucolytics and antibiotics in exacerbations of chronic bronchitis. Poumon Coeur1970; 26: 103–7.
8.
PuchelleEAugFPoluJM. Effect of the mucoregulator S-carboxymethyl-cysteine in patients with chronic bronchitis. Eur J Clin Pharmacol1978; 14: 177–84.
9.
CoxAJabbal-GillIMarriottCDavisSS. Effect of S-carboxymethyl-cysteine on the biophysical and biochemical properties of mucus in chronic bronchitics. Adv Exp Med Biol1982; 144: 423–9.
10.
MolinaCAiacheJMPradelleJ. Clinical value of fluidifiers of bronchial secretion. Poumon Coeur1970; 26: 91–101.
11.
AylwardM. An assessment of S-carboxymethyl-cysteine in the treatment of chronic bronchitis. Curr Med Res Opin1974; 2: 387–94.
12.
CasaliLRampullaCRossiA. Double-blind clinical trial of domiodol versus S-carboxymethyl-cysteine in chronic obstructive lung disease. Int J Clin Pharmacol Ther Toxicol1982; 20: 554–7.
13.
BragaPCBossiRAllegraL. Evaluation of the elastic and viscous components of bronchial mucus before and after S-carboxymethyl-cysteine-lys treatment. Int J Clin Pharm Res1984; 4: 121–7.
14.
FerrarisSZanniniG. A further investigation into the possibility of using carbocisteine in cystic fibrosis. Minerva Pediatr1983; 35: 1145–50.
15.
NigamBK. S-carboxymethyl-cysteine in bronchographic technique. Indian J Chest Dis Allied Sci1981; 23: 81–4.
16.
LamblinAHumbertPDegandPRousselP. Heterogenicity of the sugar side chains of bronchial mucins isolated from two subjects with chronic bronchitis. Clin Chim Acta1977; 79: 425–36.
17.
HavezRDegandPRousselPRandouxP. Biochemical mechanism of action of cysteine derivatives on bronchial mucus. Poumon Coeur1970; 26: 81–90.
18.
DegandP. Etude biochimique du mode d'action de la S-carboxymethyl-cysteine. Bull Physiopathol Respir1973; 9: 462–3.
19.
QueveauvillerAGarcetSHuyenVN. Pharmacokinetics and mode of action of a new mucoregulator, S-carboxymethyl-cysteine. Therapiewoche1976; 26: 8244–6.
20.
QueveauvillerAHuyenVNGarcetS. Experimental methods for the study of modifiers of bronchial secretions. Lung1970; 26: 71–80.
21.
MuhJPLatreilleJPGuerrinF. Study of the natural inhibitors of bradykinin-induced bronchospasm in the guinea pig. In: Bronchial secretion. Proceedings of the College of Internal Pathology and Thoracics meeting, Sept. 27–29, 1968, Lille, France. Paris: Medic Diffuseur, 1969: 193.
22.
KarjaJNuitinenJKarjalainerP. Mucociliary function in children with secretory otitis media. Acta Otolaryngol1983; 95: 544–6.
23.
WarnerA. Clinical aspects of mucociliary transport. Am Rev Respir Dis1977; 116: 73–124.
24.
KohlerDSieboldADaikelerG. The influence of carbocisteine on the mucociliary clearance. Atemweg-Lungenkrankh1982; 8: 201–4.
25.
ThomsonMLPaviaDJonesCJMcQuistonTAC. No demonstrable effect of S-carboxymethyl-cysteine on clearance of secretions from the human lung. Thorax1975; 30: 669–73.
26.
GoodmanRMYerginBMSachnonM. Effects of S-carboxymethyl-cysteine on tracheal mucus velocity. Chest1978; 44: 615–8.
27.
IravaniJMelvilleGNHorstmannG. N-acetylcysteine and mucociliary activity in mammalian airways. Arzneimittelforschung1978; 28: 250–4.
28.
AicheJMBorelJPKantelipJP. Comparative bioavailability of S-carboxymethyl-cysteine from two dosage forms: Hard gelatin capsule and syrup. Biopharm Drug Dispos1982; 9: 275–81.
29.
ServinAGarcetSHuyenNCohenY. Comparative pharmacokinetics of l-cysteine and one of its S-substituted derivatives, S-carboxymethyl-cysteine. J Pharmacol (Paris)1976; 7: 275–86.
30.
BragaPCBorsaMDe AngelisLBossiR. Pharmacokinetic behavior of S-carboxymethyl-cysteine-lys in patients with chronic bronchitis. Clin Ther1982; 4: 480–8.
31.
WaringRH. Variation in human metabolism of S-carboxymethyl-cysteine. J Drug Metab Pharmacokinet1980; 5: 49–52.
32.
WaringRHMitchellSC. The metabolism and elimination of S-carboxymethyl-cysteine in man. Drug Metab Dispos1982; 10: 61–2.
33.
ParadiseJL. Otitis media in infants and children. Pediatrics1980; 65: 917–43.
34.
BlackN. Glue ear: The new dyslexia?Br Med J1985; 290: 1963–5.
35.
BrownMJRichardsSHAmbegaokarS. Grommets and glue ear: A five year follow up of a controlled trial. J R Soc Med1978; 71: 353–6.
36.
Secretory otitis media and grommets (editorial). Br Med J1981; 282: 501–2.
37.
Van BuchemFLDunkJHMVan T'HofMA. Therapy of acute otitis media: Myringotomy, antibiotics or neither? A double blind study in children. Lancet1981; 2: 883–7.
38.
BrownDTPotsicWPMarshRRLittM. Drugs affecting clearance of middle ear secretions: A perspective for the management of otitis media with effusion. Ann Otol Rhinol Laryngol1985; 84: 3–15.
SchullerA. The value of Rhinathiol in certain forms of otitis with intact tympanic membrane. Cah ORL1977; 12: 141–3.
41.
McGuinnessRJ. Carboxymethylcysteine in the glue ear syndrome. Br J Clin Pract1977; 31: 105–6.
42.
RamsdenRTMoffatDAGibsonSPRJayMM. S-carboxymethyl-cysteine in the treatment of glue ear. J Laryngol Otol1977; 91: 847–51.
43.
KhanJAMarcusPCummingsSW. S-carboxymethyl-cysteine in otitis media with effusion. J Laryngol Otol1981; 95: 995–1001.
44.
HughesKB. Management of middle ear effusions in children. J Laryngol Otol1984; 98: 677–84.
45.
MiskovitisGSzulePMescarosK. Double blind study of carbocisteine against placebo in chronic bronchitis. Mucoregulation in respiratory tract disorders 1982. Proc R Soc Med1982; 5: 1–3.
46.
AylwardMDaviesDEDewlandPMMaddockJ. Clinical evaluation of carbocisteine in the treatment of patients with chronic bronchitis. A double blind trial with placebo control. Clin Trials J1985; 22: 36–44.
47.
GrillageMBarnard-JonesK. Long term oral carbocisteine therapy in patients with chronic bronchitis. A double blind trial with placebo control. Br J Clin Pract1985; 39: 395–8.
48.
AylwardM. A between-patient double blind comparison of carbocisteine and bromhexine in chronic obstructive bronchitis. Curr Med Res Opin1973; 1: 219–27.
49.
PuchelleEGirardFZahmJM. Rheology of bronchial secretions and mucociliary transport. Bull Physiopathol Respir1976; 12: 771–9.
50.
SadeJEliezerWSilbergergANevoAC. The role of mucus in transport by cilia. Am Rev Respir Dis1970; 102: 48–52.
51.
GelmanRAMeyerFA. Mucociliary transference rate and mucus viscoelasticity: Dependence on dynamic storage and loss modulus. Am Rev Respir Dis1979; 120: 553–7.
