Amoxicillin + carbocisteine

Oral
Respiratory tract infections associated with excessive and/or viscous mucus
Adult: Each capsule contains amoxicillin 250/500 mg and carbocisteine 150 mg: 1 or 2 cap tid.

Allergy to penicillins, pregnancy.

History of peptic ulcer, severe renal impairment. Infectious mononucleosis and lactation.

Headache, nausea, dizziness, vomiting, diarrhoea, GI discomfort/ bleeding, black hairy tongue, maculopapular rash, urticaria, eosinophilia, hemolytic anemia, thrombocytopenia.
Potentially Fatal: Anaphylaxis, pseudomembranous colitis, acute cytoloytic hepatitis and Stevens-Johnson syndrome.

Live oral typhoid vaccine should not be given 3 days before or 3 days after amoxicillin admin as immune response may be attenuated. Amoxicillin increases the anticoagulant response of coumarins. Amoxicillin may reduce OC pill absorption leading to breakthrough bleeding or pregnancy. Amoxicillin reduces the renal clearance of methotrexate and pemetrexate. Amoxicillin level significantly reduced when given with or 2 hr after acacia admin.

Tannins in catha reduced amoxicillin absorption if amoxicillin is admin <2 hr after chewing catha.

Possible interference with urinary glucose tests using cupric sulfate. May increase degradation of aminoglycosides in vitro. Increase in ALT and AST.

Amoxicillin inhibits the final transpeptidation of peptidoglycan synthesis in bacterial cell walls. Hence, cell wall synthesis is inhibited and results in bacterial lysis. Carbocisteine is a mucolytic. It penetrates into lung tissue and respiratory mucus. Reduces viscosity of bronchial secretions and allows greater penetration of antibacterial drug. Expectoration of the mucus is facilitated.
Absorption: Amoxicillin: Rapidly and almost completely absorbed from the GI tract; peak plasma concentration (oral): 1-2 hr. Carbocisteine: Rapidly and well absorbed from GI tract; peak plasma concentration (oral): 2 hr.
Distribution: Amoxicillin: Protein binding: 17-20 %; Widely distributed to body fluid and bone, CSF (small concentrations except when meninges are inflamed). Carbocisteine: Lungs.
Metabolism: Amoxicillin: Partially metabolised to penicilloic acid. Carbocisteine: Metabolised via acetylation, decarboxylation and sulfoxidation.
Excretion: Amoxicillin: Via urine: 60% as unchanged drug. Elimination half-life: Adults: 0.7-1.4hr, CrCl<10 ml/min: 7-21 hr; infants & children: 1-2 hr. Carbocisteine: Via urine: Unchanged and as metabolites.

Penicillins

R05CB03 - carbocisteine ; Belongs to the class of mucolytics. Used in the treatment of wet cough.
J01CA04 - amoxicillin ; Belongs to the class of penicillins with extended spectrum. Used in the systemic treatment of infections.