carbocisteine / Generic mfg. - LARVOL DELTA

What is the clinical effectiveness and cost-effectiveness of nebulised 7% saline in patients with chronic obstructive pulmonary disease (COPD)- (MucAct COPD Trial) (BTS WM 2025) - "There was a prolonged time to first exacerbation requiring antibiotic therapy and/or systemic steroids (p=0.044) in the intervention arm. Conclusion Although hypertonic saline compared with carbocisteine treatment led to no significant difference in the CAT questionnaire, there was a prolonged time to first exacerbation and reduced exacerbations."

Clinical • Cost effectiveness • HEOR • Bronchiectasis • Chronic Obstructive Pulmonary Disease • Immunology • Infectious Disease • Novel Coronavirus Disease • Pulmonary Disease • Respiratory Diseases

Famotidine-Induced Rash and Eosinophilia: A Case Report. (PubMed, Cureus) - "He initially received intravenous gentamicin followed by oral amoxicillin-clavulanic acid for the urinary tract infection. Oseltamivir and carbocisteine were prescribed for the flu...Considering the timing of the rash and the patient's lack of prior adverse reactions to penicillin, famotidine was identified as the most probable causative agent for the rash. The rash improved following discontinuation of famotidine, supporting the diagnosis of famotidine-induced hypersensitivity reaction."

Journal • Allergy • Cardiovascular • Eosinophilia • Heart Failure • Immunology • Infectious Disease • Influenza • Nephrology • Respiratory Diseases

Unmasking disease in ulcerative colitis-associated bronchiectasis after treatment with vedolizumab (WBC 2025) - "Her bowel disease was in remission after treatment with infliximab and tofacitinib...Sputum cultures grew Serratia marcescens but despite numerous antibiotic courses, inhaled corticosteroids and bronchodilators, low dose azithromycin and carbocisteine, he continued to wheeze and produce mucopurulent sputum...He was maintained on low dose prednisone while he was transitioned to Ustekinumab for his UC... These cases highlight the potential for vedolizumab to unmask bronchiectasis symptoms in people with UC, possibly due to its gut-selective immune mechanism. Pulmonologists and gastroenterologists should be aware of this issue and should have a high index of suspicion for bronchiectasis in people with worsening airway symptoms on vedolizumab, particularly when repeat antibiotic courses are ineffective. Adjustments to UC therapy, aimed at broader systemic immunomodulation, may be necessary to address both intestinal and pulmonary disease effectively."

Bronchiectasis • Cough • Dermatology • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammatory Bowel Disease • Mucositis • Pulmonary Disease • Respiratory Diseases • Ulcerative Colitis

PHARMACOLOGIC VS NONPHARMACOLOGIC INTERVENTION IN THE MANAGEMENT OF EXCESSIVE DAYTIME SLEEPINESS IN OBSTRUCTIVE SLEEP APNEA (CHEST 2025) - "Other pharmacologic treatments, including armodafinil, pitolisant, and solriamfetol, have demonstrated efficacy in improving wakefulness, particularly in patients with residual sleepiness. Excessive daytime sleepiness (EDS) is a major concern in obstructive sleep apnea (OSA), especially for those with persistent symptoms despite CPAP therapy. While CPAP remains the gold standard, other interventions offer potential benefits. Treatment options like carbocysteine and herbal remedies have shown promise in reducing EDS, though more research is needed."

Excessive Daytime Sleepiness • Obstructive Sleep Apnea • Respiratory Diseases • Sleep Disorder

Association between early administration of mucoactive agents and in-hospital mortality in patients with pneumonia requiring mechanical ventilation: a nationwide cohort study. (PubMed, J Intensive Care) - "In patients with ventilated pneumonia, early administration of mucoactive agents was associated with lower in-hospital mortality."

Journal • Infectious Disease • Pneumonia • Respiratory Diseases

Hypertonic Saline or Carbocisteine in Bronchiectasis. (PubMed, N Engl J Med) - "In participants with bronchiectasis, neither hypertonic saline nor carbocisteine significantly reduced the mean incidence of pulmonary exacerbations over a period of 52 weeks. (Funded by the National Institute for Health and Care Research Health Technology Assessment Programme and others; ISRCTN Registry number, ISRCTN89040295.)."

Journal • Bronchiectasis • Genetic Disorders • Immunology • Non‐Cystic Fibrosis Bronchiectasis • Pulmonary Disease • Respiratory Diseases

RCT Abstract - Effectiveness of hypertonic saline (HTS 6%) and carbocisteine in reducing bronchiectasis exacerbations (Results of the CLEAR randomised trial) (ERS 2025) - No abstract available

Clinical • Bronchiectasis • Pulmonary Disease • Respiratory Diseases

Late Breaking Abstract - Rheological, inflammatory and bacterial analysis of sputum samples from patients with bronchiectasis in the CLEAR trial (ERS 2025) - "In the CLEAR trial, the effectiveness of hypertonic saline (HTS) and/or carbocisteine (CS) were compared to usual care in patients with bronchiectasis...These findings indicate that, in patients with bronchiectasis, higher sputum yield stress (the shear-stress at which sputum transitions to fluid-like behaviour) is associated with increased pulmonary inflammation, oxidative stress and a less diverse bacterial microbiome, with greater species dominance. Subsequent analysis of sputum samples collected at 2 and 8 weeks will address whether treatment with mucoactives alters sputum properties."

Clinical • Late-breaking abstract • Bronchiectasis • Inflammation • Pneumonia • Pulmonary Disease • Respiratory Diseases • CXCL8

Drug response assessment trials for inhaled hypertonic saline in patients with bronchiectasis: Analysis of data from the CLEAR trial (ERS 2025) - "As part of a randomized, open-label trial of HTS and/or carbocisteine vs usual care in bronchiectasis (CLEAR, ISRCTN89040295), we investigated the usefulness of DRAs... Remote staff training for DRAs is feasible. Only 3/145 patients failed the DRA and were not recruited to the trial. The DRA was insufficient in predicting failure to remain on HTS, challenging the value of routine DRAs in bronchiectasis."

Clinical • Bronchiectasis • Pulmonary Disease • Respiratory Diseases

Effectiveness of mucoactives compared to standard care in adult bronchiectasis: A systematic review (ERS 2025) - "Lung function and exacerbation data were extracted from 23 eligible trials and observational studies comparing mucoactives (including carbocisteine, HTS, ambroxol, rhDNase, and mannitol) with standard care and meta-analysed. While mucoactive treatment shows promising effects on lung function, impact on exacerbations remains inconclusive, requiring further research. The CLEAR trial (ISRCTN89040295), comparing HTS and/or carbocisteine with usual care in bronchiectasis, aims to provide insight and guide treatment."

Clinical • Review • Bronchiectasis • Infectious Disease • Inflammation • Pulmonary Disease • Respiratory Diseases

In vitro and in vivo effects of Carbocysteine on TSLP and oxidative stress (ERS 2025) - "Carbocysteine was able to counteract the effects of CSE in oxidative stress and in TSLP gene expression in 16HBE and to reduce TSLP in exacerbated COPD. In conclusion, increased oxidative stress induced by smoke exposure in airway epithelium leads to increased TSLP production and carbocysteine in vitro and in vivo mitigates the induced TSLP production."

Oxidative stress • Preclinical • Chronic Obstructive Pulmonary Disease • Immunology • Pulmonary Disease • Respiratory Diseases • NOTCH1 • TSLP

Attenuation of NF-κB/NLRP3 inflammasome axis and oxidative stress, and upregulation of Nrf2/HO-1 signaling mediate the protective effect of S-carboxymethylcysteine against cyclophosphamide-induced cardiotoxicity. (PubMed, Tissue Cell) - "Given its established clinical safety, SCMC may represent a translatable adjunctive therapy to protect against CP-induced cardiotoxicity. However, further studies and clinical trials are warranted to confirm these findings."

Journal • Cardiovascular • Inflammation • Oncology • Solid Tumor • IL1B • NLRP3

Development and validation of a sensitive assay for analysis of D/L-serine in cells using ultra-high performance liquid chromatography-fluorescence detector. (PubMed, Talanta) - "Carbocisteine was selected as the internal standard...In short, we have established a simple, stable, reliable and robust method for the determination of D/L-serine in cells. In addition, the D/L-serine levels in different cells were quantified in this study, which can provide a reference for the study of D/L-serine metabolism in cells."

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Screening for Potential Compounds Using Drug-Repurposing of N-Methyl-D-Aspartate (NMDA) Receptor for Autism Spectrum Disorder (ASD). (PubMed, Trop Life Sci Res) - "The drugs were alitretinoin, salicylic acid and indinavir, respectively. Finally, ADMET (Absorption, Distribution, Metabolism, Excretion and Toxicity) predictions identify 4-androstenedione, tryptophan, carbocisteine and vitamin A as having minimal toxic effects. This study showed that alitretinoin, which was known to treat skin lesions from Kaposi's sarcoma, might have the ability to reverse the effect in ASD, particularly in NMDA receptors, potentially making a significant impact on the field of neurology and psychiatry."

Journal • Autism Spectrum Disorder • Genetic Disorders • Kaposi Sarcoma • Oncology • Psychiatry • Sarcoma • Solid Tumor • NRXN1

Effectiveness of mucoactives (carbocisteine and hypertonic saline) in addition to usual airway clearance management with usual airway clearance management alone in acute respiratory failure (MARCH): study protocol for a multi-centre 2x2 factorial, randomised, controlled, open-label, Phase 3, pragmatic, clinical and cost-effectiveness trial with internal pilot. (PubMed, NIHR Open Res) - "All participants will provide written, informed consent via either Personal or Professional Legal Representatives, and subsequently directly once capacity is regained. Main trial: ISRCTN17683568, https://www.isrctn.com/ISRCTN17683568, 25 th November 2021Study Within A Trial: ISRCTN16675252, https://www.isrctn.com/ISRCTN16675252, 3 rd November 2021EudraCT Number, 2021-003763-94."

HEOR • Journal • P3 data • Respiratory Diseases

Reducing unnecessary carbon in haemodialysis by reducing pharmaceutical waste in a dialysis unit (UKKW 2025) - "In April 2024, the nursing staff reviewed all medications that were discarded due to being over their expiry date. This included ten glucose 50% solution for infusion 50ml vials, 20 boxes containing ten vials each of Tinzaparin 7500 IU/0.3mls ampoules, four hydrocortisone 100mg powder for solution for injection vials, a box of carbocisteine 375mg capsules (120 capsules), ten ferric carboxymaltose 100mg/2ml solution for injection vials, a bottle of Gaviscon liquid and a box containing 10 ampoules of ondansetron 4mg/2ml solution for injection (Figure 1). The total financial impact of these discarded medications alone was measured at approximately £1,260 and 732 kgCO2e (Table 1)."

Treatment of Long Coronavirus Disease in Japan: A Nationwide Study of Symptom-Associated Drug Prescriptions. (PubMed, Biol Pharm Bull) - "Other frequently prescribed drugs included dextromethorphan, l-carbocisteine, and polaprezinc. Long COVID in Japan is characterized by a wide range of symptoms, leading to symptom-based drug prescriptions, particularly fatigue, respiratory issues, and taste disturbances. These findings offer insights into the pharmacological management of Long COVID in Japan, highlighting the need for further research on optimal treatments in the future."

Journal • Asthma • CNS Disorders • Fatigue • Immunology • Infectious Disease • Insomnia • Novel Coronavirus Disease • Pulmonary Disease • Respiratory Diseases • Sleep Disorder

Randomised Open Label Trial of Hypertonic Saline and Carbocisteine in Bronchiectasis (CLEAR) (clinicaltrials.gov) - P3 | N=288 | Completed | Sponsor: Belfast Health and Social Care Trust | Recruiting ➔ Completed

HEOR • Trial completion • Bronchiectasis • Pulmonary Disease • Respiratory Diseases

Increased TSLP and oxidative stress reflect airway epithelium injury upon cigarette smoke exposure. Is there a role for carbocysteine? (PubMed, Toxicology) - "In conclusion, increased oxidative stress induced by smoke exposure in airway epithelium leads to increased TSLP production and carbocysteine in vitro and in vivo mitigates the induced TSLP production. Oxidative stress detection by electrochemical sensors can open new avenues for evaluating epithelial damage and for identifying patients eligible to alarmin targeted biologics."

Journal • Chronic Obstructive Pulmonary Disease • Immunology • Inflammation • Pulmonary Disease • Respiratory Diseases • NOTCH1 • TSLP

Hyperforin-induced gut microbiota metabolite carbocysteine protects against depressive-like behaviors in mice by modulating the colonic mucus barrier. (PubMed, J Affect Disord) - "Our research highlights Hyperforin's role in modulating gut microbiota metabolism and identifies Carbocysteine as a potential antidepressant. These findings advance our understanding of the gut-brain axis (GBA) in depression and pave the way for developing new therapeutics."

Journal • Preclinical • CNS Disorders • Depression • Psychiatry

Evaluating the Safety and Efficacy of Carbocisteine in the Treatment of Nonalcoholic Fatty Liver Disease Patients (clinicaltrials.gov) - P2 | N=46 | Recruiting | Sponsor: Tanta University | Not yet recruiting ➔ Recruiting

Enrollment open • Hepatology • Metabolic Dysfunction-Associated Steatotic Liver Disease

Evaluating the Safety and Efficacy of Carbocisteine in the Treatment of Nonalcoholic Fatty Liver Disease Patients (clinicaltrials.gov) - P2 | N=46 | Not yet recruiting | Sponsor: Tanta University

New P2 trial • Hepatology • Metabolic Dysfunction-Associated Steatotic Liver Disease

Effect of Carbocysteine on Exacerbations and Lung Function in Patients With Mild-to-Moderate Chronic Obstructive Pulmonary Disease: A Multicentre, Double-Blind, Randomized, Placebo-Controlled Trial. (PubMed, Arch Bronconeumol) - P4 | "Our findings suggested that carbocysteine might not significantly reduce the annual rate of total exacerbations in patients with mild-to-moderate COPD. The findings may have been compromised by an overestimation of the efficacy of carbocysteine on reducing exacerbations in mild-to-moderate COPD and potential confounding by baseline imbalances. The efficacy on lung function could not be adequately evaluated. Clinical trial registered with Chictr.org.cn (ChiCTR1800016712)."

Journal • Chronic Obstructive Pulmonary Disease • Immunology • Infectious Disease • Novel Coronavirus Disease • Pulmonary Disease • Respiratory Diseases

Physiology and pathophysiology of mucus and mucolytic use in critically ill patients. (PubMed, Crit Care) - "Mucolytics, including hypertonic saline, dornase alfa/rhDNase, nebulised heparin, carbocisteine/N-Acetyl cysteine, are commonly used in critically ill patients. This review summarises the physiology and pathophysiology of mucus and the existing evidence for the use of mucolytics in critically ill patients and speculates on journey to individualised mucolytic therapy."

Journal • Review • Critical care • Infectious Disease • Pneumonia • Respiratory Diseases

A New Fluorescence Probe for the Quantification of Acetylcysteine and Carbocisteine in Bulk and Spiked Urine: Greenness Appraisal by Exploiting Different GAC-Metric Strategies. (PubMed, Luminescence) - "The proposed spectrofluorometric platform was successfully applied to the analysis of ACT and CST in pharmaceutical dosage forms and spiked urine, within concentration ranges 0.25-2.25 and 0.25-2.50 μg/mL and LODs = 80.21 and 71.48 ng/mL, respectively. Finally, the greenness of the proposed protocol was evaluated employing GAPI, hexagon, and AGREE approaches."

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