Fluimucil and ACC injection ampoules — what they are and how they relate to a NAC IV drip

Fluimucil and ACC are brand names of acetylcysteine (NAC) sold in Romania: according to the Summary of Product Characteristics (SmPC — labelled *RCP* on the Romanian documents), the 300 mg/3 ml ampoules are a mucolytic for respiratory conditions with thick, viscous secretions, given by medical staff, and in hospital intravenous acetylcysteine is also used as an antidote in paracetamol poisoning. The NAC IV drip at Synerva uses the same substance, but for a different purpose — supporting glutathione reserves — and it does not replace the treatment of bronchitis.

Which forms of Fluimucil and ACC exist

The active substance is the same in all of them: acetylcysteine. What differs is the form, the strength and who it is meant for. The Nomenclature of the National Agency for Medicines and Medical Devices (ANM — the official register of medicines authorised in Romania) lists, among others:

Anyone searching for "Fluimucil ampoules" (*Fluimucil fiole* in Romanian) usually lands on the 300 mg/3 ml form. It is worth knowing from the start that the same ampoule has several routes of administration — injection, aerosol, instillation — and that none of them is meant for use at home.

What the SmPC says about the 300 mg/3 ml ampoules

The SmPC for Fluimucil 300 mg/3 ml, published by ANM, describes the indication as follows: respiratory conditions characterised by thick, viscous hypersecretion — acute bronchitis, chronic bronchitis and its exacerbations, pulmonary emphysema, cystic fibrosis, bronchiectasis.

On administration, in brief:

• intravenously — as a slow infusion, diluted in saline or 5% glucose; in hospitalised patients, slow intravenous injection is also possible;
• in adults, one ampoule 1–2 times a day, i.e. 300–600 mg of acetylcysteine;
• by nebuliser — one ampoule 1–2 times a day, for 5–10 days;
• endotracheobronchial instillation — via a catheter or bronchoscope, in hospital.

Two warnings in the SmPC are worth reading for anyone considering the intravenous route:

• "Intravenous administration of acetylcysteine requires medical supervision." Side effects are more likely if the infusion runs too fast or if the dose is excessive.
• Bronchial asthma — patients with a history of atopy and asthma may be at increased risk of an anaphylactoid reaction and must be monitored; if bronchospasm occurs, administration is stopped immediately.

A practical detail: once the ampoule is opened there is a sulphurous smell, and the solution may turn pink. The SmPC states that this is not a sign of deterioration.

Some older leaflets, still published on pharmacy websites, also describe intramuscular administration. The version in the ANM database that we read describes the intravenous route, aerosols and instillation. What counts is the leaflet in the box you are holding.

Interactions mentioned in the SmPC

Acetylcysteine is not an inert substance, even though its oral forms are also sold without a prescription. The SmPC for the 300 mg/3 ml ampoules notes that giving it together with nitroglycerin can cause a significant drop in blood pressure and headache, so the patient must be monitored. Cough suppressants are not combined with acetylcysteine, because suppressing the cough reflex can lead to a build-up of the secretions the mucolytic thins. Acetylcysteine formulations are not dissolved in the same container as other medicines. And for lab tests: acetylcysteine can interfere with one method of measuring salicylates and with the urine ketone test — it is worth telling the laboratory if you take it. In pregnancy, clinical data are limited, and the decision is made by weighing risks and benefits.

ACC Injekt: the intravenous route, reserved for intensive care

For ACC Injekt 300 mg/3 ml, the SmPC is even more explicit: intravenous treatment is reserved for patients in intensive care units, and only when oral administration is not possible. The wording says a lot. For the respiratory indication, the intravenous route is not a "stronger" option you choose to get rid of a cough faster. It is the solution for the patient who cannot swallow a tablet.

Acetylcysteine as an antidote: the same molecule, a different scale

In hospital, acetylcysteine has a second use, and the most important one: the antidote in paracetamol poisoning. The form used in Romania is a concentrated solution for infusion, Hidonac 5 g/25 ml.

The Hidonac SmPC describes a loading dose of 150 mg/kg infused over 60 minutes, followed by 50 mg/kg every 4 hours for 72 hours. For a 70 kg adult, the loading dose means 10,500 mg in one hour — more than 17 times the dose in a 600 mg drip, before the maintenance doses.

The mechanism explains why this matters: the toxic metabolite of paracetamol uses up the liver's glutathione, and acetylcysteine supplies the cysteine from which cells rebuild it. This is also the setting from which most of the data on reactions to intravenous NAC come. A StatPearls review notes rate-dependent anaphylactoid reactions in up to 18% of patients, most of them mild or moderate. That figure comes from antidote doses. It does not transfer directly to a 600 mg drip given slowly, but the mechanism is the same — which is why the infusion rate matters.

For a cough, the oral form is the right one

To put it plainly: if you have bronchitis with thick secretions, oral Fluimucil or ACC is the right product, not an IV drip. The SmPC for Fluimucil 600 mg recommends one tablet a day, a maximum of 600 mg, for 5–10 days in acute conditions, and if symptoms do not improve within 5 days, the patient should see a doctor.

You often read that oral acetylcysteine is "poorly absorbed". This is true in the pharmacokinetic sense: the SmPC notes a very low oral bioavailability, due to metabolism in the gut wall and the liver, and a classic study in healthy volunteers measured similar values. For the mucolytic effect, this does not make the oral form ineffective — it is the authorised and recommended form for the respiratory indication.

A cough with fever, difficulty breathing, or one that lasts more than a week is not solved by any form of acetylcysteine chosen on your own. See a doctor.

What the NAC IV drip at Synerva is

Our IV drip uses the same substance, N-acetylcysteine, but for something else: supplying cysteine, the rate-limiting amino acid in glutathione synthesis. The relationship between the two molecules is explained in detail in NAC and glutathione.

What can honestly be said:

• given intravenously, acetylcysteine reaches the circulation completely and predictably — a measurable pharmacokinetic difference;
• its role as a glutathione precursor is established biochemistry;
• that a drip produces a noticeable clinical benefit in a healthy person has not been demonstrated by a solid body of evidence.

That is why we present it as a supportive protocol, not as a treatment, and we do not promise results.

Safety, at our doses

We give NAC diluted, slowly, by medical staff, after an assessment. At the assessment we ask specifically about:

• bronchial asthma and allergies — the risk of an anaphylactoid reaction is higher in atopic patients;
• active or past peptic ulcer — the SmPC advises caution;
• pregnancy and breastfeeding;
• previous reactions to acetylcysteine, including the oral form;
• current medication, especially nitroglycerin and other medicines that lower blood pressure.

For parenteral administration, the SmPC lists hypersensitivity reactions ranging from hives and itching to bronchospasm, angioedema and, rarely, anaphylactic shock, plus tachycardia and a drop in blood pressure. They are the reason the drip runs slowly, with someone next to you for its whole duration.

How we work

• NAC IV drip 600 mg — 300 RON, about 45 minutes;
• NAC Forte IV drip 1200 mg — 420 RON, 45–60 minutes;
• NAC combined with glutathione, in the Liver support (glutathione + NAC) protocol — 450 RON.

Prices include the medical assessment. The drips are given at the clinic or at home, in Bucharest and Ilfov.

What we do not do: we do not sell ampoules, we do not recommend self-administering injectables, and we do not treat respiratory infections with an IV drip. If you come to us with bronchitis, the first step is a consultation, not a protocol.

Sources

Fluimucil 300 mg/3 ml — Summary of Product Characteristics, ANM (in Romanian): indications, routes of administration, warnings on the intravenous route and asthma, oral bioavailability.

ACC Injekt 300 mg/3 ml — Summary of Product Characteristics, ANM (in Romanian): intravenous route reserved for intensive care.

Fluimucil 600 mg effervescent tablets — Summary of Product Characteristics, ANM (in Romanian): oral dose and duration of treatment.

Hidonac 5 g/25 ml — Summary of Product Characteristics, ANM (in Romanian): antidote regimen in paracetamol poisoning.

Borgström L. et al. — Pharmacokinetics of N-acetylcysteine in man, European Journal of Clinical Pharmacology, 1986.

N-Acetylcysteine — StatPearls, NCBI Bookshelf: authorised uses and anaphylactoid reactions with intravenous administration.

Nomenclature of medicinal products for human use, ANM (in Romanian): the authorised forms of Fluimucil and ACC, consulted on 13 September 2026.

Informational article. It does not replace a medical consultation and is not a treatment recommendation for respiratory conditions.