**Instructions for Use**
**Description**
ACC® Long – only 1 tablet per day to combat cough! The direct-action formula helps clear the bronchi of mucus and fight coughs! The active molecule of ACC® provides a mucolytic effect by directly affecting the structure of mucus. ACC® works by breaking the intermolecular bonds in the mucus structure, reducing its viscosity. This makes it easier to cough up the mucus and helps alleviate the cough.
1. Cough as a symptom of respiratory diseases accompanied by the formation of thick, hard-to-remove mucus.
2. In short-term colds, the treatment duration is 5-7 days, according to the medical instructions for ACC® Active.
**Active ingredients**
Acetylcysteine
**Dosage form**
Effervescent tablets
**Composition**
1 effervescent tablet contains:
- Active ingredient: acetylcysteine - 600.00 mg
- Excipients: citric acid - 625.00 mg, sodium bicarbonate - 327.00 mg, sodium carbonate - 104.00 mg, mannitol - 72.80 mg, lactose - 70.00 mg, ascorbic acid - 75.00 mg, sodium cyclamate - 30.75 mg, sodium saccharinate dihydrate - 5.00 mg, sodium citrate dihydrate - 0.45 mg, blackberry flavor “B” - 40.00 mg.
**Pharmacological effect**
**Pharmacodynamics**
Acetylcysteine is a derivative of the amino acid cysteine. It has a mucolytic effect, facilitating the removal of mucus by directly affecting its rheological properties. The action is due to its ability to break the disulfide bonds in the mucopolysaccharide chains and cause the depolymerization of mucus proteins, reducing its viscosity. The drug remains effective even in the presence of purulent mucus. It also has antioxidant effects, based on its reactive sulfhydryl groups (SH groups), which bind to oxidative radicals, neutralizing them. Additionally, acetylcysteine promotes the synthesis of glutathione, an important component of the body's antioxidant system and chemical detoxification. The antioxidant effect of acetylcysteine enhances the protection of cells from the damaging effects of free radical oxidation, which is characteristic of intense inflammatory reactions. When used prophylactically, acetylcysteine reduces the frequency and severity of bacterial exacerbations in patients with chronic bronchitis and cystic fibrosis.
**Pharmacokinetics**
Absorption is high. It is rapidly metabolized in the liver to form the pharmacologically active metabolite – cysteine, as well as diacetylcysteine, cystine, and mixed disulfides. The bioavailability after oral administration is 10% (due to the pronounced "first-pass effect" through the liver). The time to reach maximum plasma concentration is 1-3 hours. Plasma protein binding is 50%. It is excreted by the kidneys as inactive metabolites (inorganic sulfates, diacetylcysteine). The half-life (T1/2) is approximately 1 hour, but liver dysfunction extends the T1/2 to 8 hours. It crosses the placental barrier. There is no data on whether acetylcysteine crosses the blood-brain barrier or is excreted in breast milk.
**Indications**
Respiratory diseases accompanied by the formation of thick, hard-to-remove mucus:
- Acute and chronic bronchitis, obstructive bronchitis,
- Tracheitis, laryngotracheitis,
- Pneumonia,
- Lung abscess,
- Bronchiectasis, bronchial asthma, chronic obstructive pulmonary disease (COPD), bronchiolitis,
- Cystic fibrosis.
Acute and chronic sinusitis, otitis media (middle ear inflammation).
**Contraindications**
- Hypersensitivity to acetylcysteine or other components of the drug,
- Peptic ulcer of the stomach and duodenum in the acute stage,
- Hemoptysis, pulmonary hemorrhage,
- Pregnancy,
- Breastfeeding,
- Children under 14 years old (for this dosage form),
- Lactase deficiency, lactose intolerance, glucose-galactose malabsorption.
**Precautions**
Peptic ulcer of the stomach and duodenum in the medical history, bronchial asthma, obstructive bronchitis, liver and/or kidney failure, histamine intolerance (long-term use of the drug should be avoided, as acetylcysteine affects histamine metabolism and may lead to intolerance symptoms such as headache, vasomotor rhinitis, itching), esophageal varices, adrenal gland diseases, arterial hypertension.
**Use during pregnancy and breastfeeding**
Data on the use of acetylcysteine during pregnancy and breastfeeding are limited, so the use of the drug during pregnancy is contraindicated. If necessary, during breastfeeding, a decision should be made to discontinue breastfeeding.
**Method of administration and dosage**
Take orally after meals. Effervescent tablets should be dissolved in a glass of water. Tablets should be taken immediately after dissolving; in exceptional cases, the prepared solution can be left for 2 hours. Additional fluid intake enhances the mucolytic effect of the drug. For short-term colds, the duration of treatment is 5-7 days. For chronic bronchitis and cystic fibrosis, the drug should be taken for a longer period to achieve a prophylactic effect.
If there are no other prescriptions, the following dosages are recommended:
**Mucolytic therapy**:  
Adults and children over 14 years: 1 effervescent tablet once a day (600 mg).