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▶ Manufacturer advises reduce dose to 150 mg once daily with concurrent use of moderate inhibitors of CYP3A4. l CONTRA-INDICATIONS Organ transplantation (no information available) l INTERACTIONS → Appendix 1: ivacaftor l SIDE-EFFECTS ▶ Common or very common Breast abnormalities . diarrhoea . dizziness . ear discomfort. headache . ototoxicity .rash . tympanic membrane hyperaemia ▶ Uncommon Gynaecomastia ▶ Frequency not known Hepatic function abnormal SIDE-EFFECTS, FURTHER INFORMATION Manufacturer advises interrupt treatment if transaminase levels more than 5 times the upper limit of normal or transaminase levels more than 3 times the upper limit of normal and blood bilirubin more than twice the upper limit of normal—consult product literature. l PREGNANCY Manufacturer advises use only if potential benefit outweighs risk—limited information available. l BREAST FEEDING Manufacturer advises avoid—present in milk in animal studies. l HEPATIC IMPAIRMENT Manufacturer advises caution in modera

  3 Conditions affecting sputum viscosity MUCOLYTICS Acetylcysteine 03-Apr-2018 l INDICATIONS AND DOSE NACSYS ® EFFERVESCENT TABLETS Reduction of sputum viscosity ▶ BY MOUTH ▶ Adult: 600 mg once daily l CAUTIONS History of peptic ulceration l SIDE-EFFECTS ▶ Uncommon Diarrhoea . fever. gastrointestinal discomfort. headache . hypotension . nausea . stomatitis .tinnitus . vomiting ▶ Rare or very rare Haemorrhage ▶ Frequency not known Face oedema l MEDICINAL FORMS There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: effervescent tablet, granules Effervescent tablet CAUTIONARY AND ADVISORY LABELS 13 ELECTROLYTES: May contain Sodium ▶ NACSYS (Atlantic Pharma Ltd) Acetylcysteine 600 mg NACSYS 600mg effervescent tablets sugarfree | 30 tablet P £5.50 DT = £89.50 Carbocisteine l INDICATIONS AND DOSE Reduction of sputum viscosity ▶ BY MOUTH ▶ Adult: Initially 2.25 g daily in divided doses, then reduced t