Flumil: Formula, Presentation, Indications, Action Mechanism, Dosage and Side Effects

It is used orally for the symptomatic treatment of some pulmonary pathologies that occur with excess mucus.

Flail is a mucolytic drug that reduces nasal mucus.

It is known as symptomatic because it does not cure the disease; it only helps relieve symptoms.

The mucus is typical of many diseases, from a cold to bronchitis or pulmonary fibrosis; acetylcysteine helps relieve symptoms.

Chemical formula

  • The active substance in full is acetylcysteine.
  • C5H9NO3S.
  • (R) -2-Acetamido-3-sulfanylpropanoic acid.

Presentation

  • Granules for adults in 200 mg oral solution.
  • Child granulate for oral solution 100 mg.
  • Effervescent tablets (Flumil Forte) 600 mg.
  • Oral solution 20 mg / ml.
  • Oral solution 40 mg / ml.
  • Syrup.
  • Blisters

Indications

Flail is indicated in cases of bronchial hyperviscosity as a coadjuvant treatment in respiratory processes that present excessive mucous secretions.

To treat ions such as acute and chronic bronchitis, chronic obstructive pulmonary diseases, pulmonary emphysema, common cold, influenza, atelectasis caused by mucous obstructions, pulmonary complications due to cystic fibrosis, and other related pathologies.

It is also used as an antidote in the case of an overdose of paracetamol.

 

Flail is indicated when treating a genetic disorder in which the physiological secretions appear much thicker than usual, thus obstructing the respiratory tract, the pancreatic or sperm ducts.

Mechanism of action

This compound is an N-acetylated derivative of the natural amino acid cysteine.

This reduces the viscosity of bronchial secretions, favoring their elimination, probably due to a free thiol group.

This group of thiols can fragment the disulfide bonds responsible for maintaining the structure of mucoproteins, which produces a fluidification of secretions.

On the other hand, acetylcysteine ​​also acts on the respiratory mucosa, allowing expectoration or expulsion of mucus.

It protects the mucous cells from the irritations that excessive mucus can produce due to its cytoprotective effect.

Dose

The recommended administration is oral, in doses distributed during the day or in a single dose.

Granulated Flumil

  • In adults and children over seven years: The usual recommended dose is 600 mg per day orally; it can be administered in a single daily dose of 600 mg or three doses per day of 200 mg every 8 hours.
  • In children between 2 and 7 years: The usual recommended dose is 300 mg per day orally, in 3 100 mg each and every 8 hours.

In cases of pulmonary complications of cystic fibrosis, the usual dose recommended for these cases is as follows:

  • In adults and children over 7 years: 200 to 400 mg every 8 hours.
  • In children from 2 to 7 years old: 200 mg every 8 hours.

Blisters

The ampoules can be administered parenterally, intravenously, intramuscularly, inhalation, and intratracheal instillation.

Syrup

  • In adults: The recommended dose is 10 ml (200 mg) every 8 hours or 30 ml (600 mg) every 24 hours in a single dose, preferably in the morning.
  • In adolescents from 12 years of age: 10 ml (200 mg) every 8 hours.
  • In children from 6 to 11 years old: The dose is 5 ml (100 mg) every 8 hours.
  • In children younger than six years: Their safety and effectiveness have not yet been evaluated.

Side effects

Adverse effects of fluid administration are uncommon. However, when they are presented, they are very mild and transient. Among these are:

Digestive: On some occasions, nausea, vomiting, diarrhea, and gastric hyperacidity may appear. This type of effect appears especially when high doses are used.

Hepatic: Some cases of transaminase increases have been reported after administration of high doses of acetylcysteine, which were reversed within a few days after stopping treatment.

Neurological and psychological: In some cases, there have been headaches and drowsiness.

Respiratory: These effects are usually exclusive of administration by inhalation. Bronchitis, hemoptysis, rhinorrhea, tracheitis, and bronchial spasms may occur.

Eyepieces: Effects such as blurred vision occur.

Ear disorders: In the particular case of the labyrinth, such as tinnitus.

Dermatological allergies: After administering flumil, side effects can occur after 30 to 60 minutes as hypersensitivity reactions to the component, which present generalized urticarias, moderate fevers, rash, pruritusangioedema , dyspnea, and hypotension.

These reactions occur more frequently and with a greater degree of severity in cases of parenteral administration, which can be fatal in some cases. In contrast, these effects are infrequent when administered orally or inhalational.

In case of allergic reactions, the temporary suspension of the treatment and the administration of antihistamines H1 is recommended, and if necessary, the adrenaline application. If this allergic reaction happens again, it should be stopped immediately and not be administered similarly to the patient.

General: Flumil can cause excessive sweating.

Warnings and contraindications

Sufficient fluid: It is advisable to drink plenty of fluids during treatment with flumil.

Alcohol and drugs: It should not be administered in conjunction with alcohol or drugs.

Children: Flumil is recommended for children from 2 years of age.

Pregnancy: The use of fluid during pregnancy is contraindicated, although no research has shown that this drug causes fetal damage.

Lactation: Its administration should be avoided during lactation.

Allergies: Acetylcysteine, the active ingredient in full, is a derivative of an amino acid called cysteine. For this reason, its use is contraindicated in case of allergies or hypersensitivity to compounds linked to cysteine. The first manifestation of an allergic reaction to this drug must be removed.

Drowsiness: Flumil causes drowsiness, so you should avoid driving vehicles and operating machinery or equipment during your administration.

Severe hepatic insufficiency and liver cirrhosis: The metabolism of this medicine is hepatic, and its elimination is renal.

Therefore, special care must be taken, and the patient must be closely monitored in a case presenting pathologies in some of these organs due to the risk of adverse reactions. In that case, it is necessary to adjust the dose or search for an alternative treatment.

Peptic ulcer: Flumil is contraindicated, especially in cases of gastrointestinal ulcers. Acetylcysteine ​​can sometimes cause nausea and vomiting, especially at high doses, so there is an increased risk of gastric bleeding.

In addition, it has also been reported that acetylcysteine ​​produces an increase in the fluidity of gastric mucus, causing a decrease in the protective action of the mucous membranes. It is recommended to weigh the precautions in those patients who suffer from peptic ulcers.

Asthma: In patients with asthma problems who suffer from severe respiratory insufficiency or in those cases of diseases that present bronchial spasms, an increase in fluidity in the secretions can cause a blockage of the respiratory tract if adequate expectoration does not occur.

Therefore, in these cases, extreme caution is recommended. Bronchospasm may occur in patients who receive acetylcysteine ​​by oral inhalation or intratracheal instillation.

In case this happens, it is recommended to include a bronchodilator in the liquid that will be used to make the nebulizations. If the bronchospasm persists, the treatment should be stopped immediately.

An increase in expectorations may occur when treatment is started, caused by increased fluidity in the secretions. This effect is reduced after a few days of treatment. If these symptoms continue or become worse after five days of treatment, it is advisable to reevaluate this clinical situation.

Interactions

It should not be co-administered with antitussive drugs, such as codeine and other cough medicines.

Neither with drugs inhibiting bronchial secretions such as anticholinergic or antihistamine H1, tricyclic antidepressants, antiparkinsonian, inhibitors of monoamine oxidase, or neuroleptics.

They can antagonize the effects of acetylcysteine ​​and could cause the accumulation of fluid mucus.

In addition, its hepatic metabolism can interact when high doses are administered with other drugs; in these cases, it should consult the doctor about possible drug interactions.

In the case of antibiotics, acetylcysteine ​​may be incompatible with amphotericin B, ampicillin sodium, cephalosporins, erythromycin lactobionate, or some tetracyclines.

It is recommended to take separate shots for at least two hours.

When taken together with nitroglycerin, acetylcysteine ​​may potentiate the vasodilatory effects of nitroglycerin and cause adverse reactions at very high doses (100 mg/kg).

With the salts of metals, acetylcysteine ​​could have specific chelating effects on some metals, such as gold, calcium, or iron, to decrease its absorption.

It is advisable to separate the intake of mineral supplements and acetylcysteine ​​with at least two hours of difference between one and another.