Acetaminophen or Paracetamol or N-(4-Hydroxyphenyl)acetamide, first marketed in the United States in 1950 and in U.K. in 1956, is an active ingredient,analgesic and antipyretic, used for the treatment of influenza and colds, present in the hundreds of drugs that can be sold without a prescription.

Take only under medical supervision

Paracetamol has antipyretic properties similar to aspirin, but unlike aspirin, it has no anti-inflammatory activity. The antipyretic properties of both paracetamol and aspirin are based on the inhibition of prostglandins and other substances by arachidonic acid (1).

The maximum daily dose for adults is 4 grams per day (12). It is usually considered safe even if, in overdose, it is associated with liver injury. Avoid using alcohol, smoking, or other drugs while taking this medicine.

It's also a drug for patients who suffer from pain associated with osteoarthritis.

This study found that paracetamol is effective in reducing fever and symptoms and reflects current recommendations that only treat symptoms and not routine prophylaxis (3).

In particular, in elderly people it is important to strictly follow the advice on maximum doses that should not be exceeded (4).

In infants undergoing major surgery, morphine is used as standard postoperative analgesic therapy. To reduce the amount of morphine, paracetamol has been successfully used (5). 

In children the use of aspirin has almost disappeared and paracetamol has become the primary treatment for analgesia and antipyresis (6).

Contraindications

After ingestion, 90% of paracetamol is metabolized in the liver in combination with glucuronic acid, sulfuric acid and cystine (7).

Paracetamol overdose is the main causative factor of acute liver failure (8) (9) but some natural products have demonstrated hepatoprotective effects against paracetamol-induced hepatotoxicity (10).

Taking paracetamol on an occasional basis does not pose any problems, but taking it regularly and continuously for a few days can increase the risk of cardiovascular disease (11).

Like all drugs it can cause side effects. Always ask the physician.

More about paracetamol

Typical optimal characteristics of the commercial product Paracetamol

Appearance	Powder fine white
Boiling Point	387.8±25.0 °C at 760 mmHg
Melting Point	168.0°C to 172.0°C
Density	1.2930g/mL
Flash Point	188.4±23.2 °C
PSA	49.33000
LogP	0.34
Index of Refraction	1.619
Vapour Pressure	0.0±0.9 mmHg at 25°C
Safety

• Molecular Formula: C₈H₉NO₂
• Linear Formula:  CH₃CONHC₆H₄OH 
• Molecular  Weight: 151.16 g/mol
• CAS: 103-90-2
• EC Number: 203-157-5
• UNII 362O9ITL9D
• InChI=1S/C8H9NO2/c1-6(10)9-7-2-4-8(11)5-3-7/h2-5,11H,1H3,(H,9,10) 
• InChl Key      RZVAJINKPMORJF-UHFFFAOYSA-N
• SMILES    CC(=O)NC1=CC=C(C=C1)O
• IUPAC   N-(4-hydroxyphenyl)acetamide
• ChEBI   46195
• DSSTox Substance ID: DTXSID2020006
• MDL number MFCD00002328
• PubChem Substance  ID 329820028
• NACRES NA.24
• Beilstein/REAXYS Number 2208089

Synonyms: 

• N-(4-hydroxyphenyl)acetamide
• Panadol
• N-Acetyl-p-aminophenol
• Algotropyl
• p-Acetamidophenol
• Hydroxyacetanilide
• p-Hydroxyacetanilide

References__________________________________________________________________

(1) Meredith TJ, Goulding R. Paracetamol. Postgrad Med J. 1980;56(657):459–473. doi:10.1136/pgmj.56.657.459

(2) Food and Drug Administration, HHS.  Organ-specific warnings; internal analgesic, antipyretic, and antirheumatic drug products for over-the-counter human use; final monograph. Final rule.  Fed Regist. 2009 Apr 29;74(81):19385-409.

(3) Rose MA, Juergens C, Schmoele-Thoma B, Gruber WC, Baker S, Zielen S. An open-label randomized clinical trial of prophylactic paracetamol coadministered with 7-valent pneumococcal conjugate vaccine and hexavalent diphtheria toxoid, tetanus toxoid, 3-component acellular pertussis, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b vaccine. BMC Pediatr. 2013;13:98. Published 2013 Jun 21. doi:10.1186/1471-2431-13-98

(4) What dose of paracetamol for older people?. Drug Ther Bull. 2018;56(6):69–72. doi:10.1136/dtb.2018.6.0636

(5) Krekels EH, van Ham S, Allegaert K, et al. Developmental changes rather than repeated administration drive paracetamol glucuronidation in neonates and infants. Eur J Clin Pharmacol. 2015;71(9):1075–1082. doi:10.1007/s00228-015-1887-y

(6) Cranswick N, Coghlan D. Paracetamol efficacy and safety in children: the first 40 years. Am J Ther. 2000;7(2):135–141. doi:10.1097/00045391-200007020-00010

(7) Jóźwiak-Bebenista M, Nowak JZ. Paracetamol: mechanism of action, applications and safety concern. Acta Pol Pharm. 2014;71(1):11–23.

(8) Bretherick AD, Craig DG, Masterton G, et al. Acute liver failure in Scotland between 1992 and 2009; incidence, aetiology and outcome. QJM. 2011;104(11):945–956. doi:10.1093/qjmed/hcr098

(9) Minsart C, Liefferinckx C, Lemmers A, et al. New insights in acetaminophen toxicity: HMGB1 contributes by itself to amplify hepatocyte necrosis in vitro through the TLR4-TRIF-RIPK3 axis. Sci Rep. 2020;10(1):5557. Published 2020 Mar 27. (z) doi:10.1038/s41598-020-61270-1

(10) Chang L, Xu D, Zhu J, Ge G, Kong X, Zhou Y. Herbal Therapy for the Treatment of Acetaminophen-Associated Liver Injury: Recent Advances and Future Perspectives. Front Pharmacol. 2020;11:313. Published 2020 Mar 11. doi:10.3389/fphar.2020.00313

(11) Perrin G, Arnoux A, Berdot S, Katsahian S, Danchin N, Sabatier B. Association Between Exposure to Effervescent Paracetamol and Hospitalization for Acute Heart Failure: A Case-Crossover Study. J Clin Pharmacol. 2022 Jan 16. doi: 10.1002/jcph.2027.

D-Mannose is a monosaccharide, a simple sugar, the natural C-2 epimer of glucose. It is present in many fruits and plants. It is extracted from larch cane and occurs as a white or almost white crystalline powder, sweet and bitter taste easily soluble in water and pyridine, slightly soluble in methanol and ethanol and 1g of mannose is soluble in 0.4ml of water.

What it is used for and where

Take only under medical supervision

Medical

D-Mannose is an effective non-antibiotic protection for the prevention and treatment of urinary tract infections, e.g. cystitis, and in particular against the uropathogenic Escherichia coli and other members of the Enterobacteriaceae family that promote infection through adhesion to urothelial cells and an early inflammatory response. The efficacy of D-Mannose is comparable to that of antibiotics, it is well tolerated and can give minimal side effects, including diarrhoea (1).

D-Mannose has been reported in relatively recent research to be an immune modulator (2).

Another interesting discovery attributed D-Mannose's chondroprotective effect on osteoarthritis by attenuating the sensitivity of chondrocytes to ferroptosis and alleviating the progression of osteoarthritis itself by suppressing cartilage degeneration (3).

Like all drugs it can cause side effects. Always ask the physician.

D-Mannose studies

Typical commercial product characteristics D-Mannose

• Molecular Formula  C₆H₁₂O₆
• Molecular Weight    180.16
• Exact Mass    180.063385
• CAS  3458-28-4    530-26-7
• UNII    PHA4727WTP
• EC Number   208-474-2
• DSSTox Substance ID  DTXSID5040463
• IUPAC  (3S,4S,5S,6R)-6-(hydroxymethyl)oxane-2,3,4,5-tetrol
• InChI=1S/C6H12O6/c7-1-2-3(8)4(9)5(10)6(11)12-2/h2-11H,1H2/t2-,3-,4+,5+,6?/m1/s1 
• InChl Key      WQZGKKKJIJFFOK-QTVWNMPRSA-N
• SMILES   C(C1C(C(C(C(O1)O)O)O)O)O
• MDL number  MFCD00064122
• PubChem Substance ID    
• ChEBI  4208
• ICSC    
• NSC   
• RTECS   
• UN   
• NCI  

Synonyms:

• D-Mannopyranose
• D-Mannopyranoside

References_______________________________________________________________________

(1) Lenger SM, Bradley MS, Thomas DA, Bertolet MH, Lowder JL, Sutcliffe S. D-mannose vs other agents for recurrent urinary tract infection prevention in adult women: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020 Aug;223(2):265.e1-265.e13. doi: 10.1016/j.ajog.2020.05.048.

(2) Zhang D, Chia C, Jiao X, Jin W, Kasagi S, Wu R, Konkel JE, Nakatsukasa H, Zanvit P, Goldberg N, Chen Q, Sun L, Chen ZJ, Chen W. D-mannose induces regulatory T cells and suppresses immunopathology. Nat Med. 2017 Sep;23(9):1036-1045. doi: 10.1038/nm.4375.

(3) Zhou X, Zheng Y, Sun W, Zhang Z, Liu J, Yang W, Yuan W, Yi Y, Wang J, Liu J. D-mannose alleviates osteoarthritis progression by inhibiting chondrocyte ferroptosis in a HIF-2α-dependent manner. Cell Prolif. 2021 Nov;54(11):e13134. doi: 10.1111/cpr.13134.

Compendium of the most significant studies with reference to properties, intake, effects.

Torretta S, Scagliola A, Ricci L, Mainini F, Di Marco S, Cuccovillo I, Kajaste-Rudnitski A, Sumpton D, Ryan KM, Cardaci S. D-mannose suppresses macrophage IL-1β production. Nat Commun. 2020 Dec 11;11(1):6343. doi: 10.1038/s41467-020-20164-6. 

Abstract. Here, we show that D-mannose suppresses LPS-induced macrophage activation by impairing IL-1β production. In vivo, mannose administration improves survival in a mouse model of LPS-induced endotoxemia as well as decreases progression in a mouse model of DSS-induced colitis. 

Domenici L, Monti M, Bracchi C, Giorgini M, Colagiovanni V, Muzii L, Benedetti Panici P. D-mannose: a promising support for acute urinary tract infections in women. A pilot study. Eur Rev Med Pharmacol Sci. 2016 Jul;20(13):2920-5. 

Abstract. The results of this study suggest that D-mannose can be an effective aid in acute cystitis management and also a successful prophylactic agent in a selected population; however, more studies will certainly be needed to confirm the results of our pilot study. 

Pugliese D, Acampora A, Porreca A, Schips L, Cindolo L. Effectiveness of a novel oral combination of D-Mannose, pomegranate extract, prebiotics and probiotics in the treatment of acute cystitis in women. Arch Ital Urol Androl. 2020 Apr 6;92(1):34-38. doi: 10.4081/aiua.2020.1.34.

Abstract. Our study suggests that the action of the compounds, administered in this new combination, could help in an effective management of symptoms of acute cystitis in women, without antibiotics, in a wide majority of the cases. Lack of microbiological assessment is a clear limitation of the study. Moreover, lack of a control group is another important limitation. Finally, hyperhydration could have been a confounding factor in interpretation of results.

Wang J, Jalali Motlagh N, Wang C, Wojtkiewicz GR, Schmidt S, Chau C, Narsimhan R, Kullenberg EG, Zhu C, Linnoila J, Yao Z, Chen JW. d-mannose suppresses oxidative response and blocks phagocytosis in experimental neuroinflammation. Proc Natl Acad Sci U S A. 2021 Nov 2;118(44):e2107663118. doi: 10.1073/pnas.2107663118.

Abstract. Inflammation drives the pathology of many neurological diseases. d-mannose has been found to exert an antiinflammatory effect in peripheral diseases, but its effects on neuroinflammation and inflammatory cells in the central nervous system have not been studied. We aimed to determine the effects of d-mannose on key macrophage/microglial functions-oxidative stress and phagocytosis.

Deng YL, Liu R, Cai ZD, Han ZD, Feng YF, Cai SH, Chen QB, Zhu JG, Zhong WD. Mannose inhibits the growth of prostate cancer through a mitochondrial mechanism. Asian J Androl. 2022 Feb 4. doi: 10.4103/aja2021104.

Abstract. In this study, we demonstrated that mannose inhibits the proliferation and promotes the apoptosis of PCa cells in vitro, and mannose was observed to have an anticancer effect in mice without harming their health.

Nakagawa Y, Ito Y. Mannose-binding analysis and biological application of pradimicins. Proc Jpn Acad Ser B Phys Biol Sci. 2022;98(1):15-29. doi: 10.2183/pjab.98.002.

Abstract. This article first outlines the challenges in studying Man-binding mechanisms and structural modifications of Pradimicins (PRMs) , and then describes our approach to address them. We also present our recent attempts toward the development of PRM-based research tools.

Compendium of the most significant studies with reference to properties, intake, effects.

Huttner A, Bielicki J, Clements MN, Frimodt-Møller N, Muller AE, Paccaud JP, Mouton JW. Oral amoxicillin and amoxicillin-clavulanic acid: properties, indications and usage. Clin Microbiol Infect. 2020 Jul;26(7):871-879. doi: 10.1016/j.cmi.2019.11.028. 

Abstract.  In this narrative review, we re-examine the properties of oral amoxicillin and clavulanic acid and provide guidance on their use, with emphasis on the preferred use of amoxicillin alone.

Todd PA, Benfield P. Amoxicillin/clavulanic acid. An update of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs. 1990 Feb;39(2):264-307. doi: 10.2165/00003495-199039020-00008.

Abstract. Clavulanic acid enhances the antibacterial spectrum of amoxicillin by rendering most beta-lactamase-producing isolates susceptible to the drug. In clinical trials amoxicillin/clavulanic acid is clinically and bacteriologically superior to amoxicillin alone and at least as effective as numerous other comparative agents, such as orally administered cephalosporins, cotrimoxazole, doxycycline and bacampicillin, in the treatment of adults and children with the most common forms of infection encountered in general practice, i.e. urinary tract infections, upper and lower respiratory tract infections, otorhinolaryngological infections, and skin and soft tissue infections.

Binson G, Grignon C, Le Moal G, Lazaro P, Lelong J, Roblot F, Venisse N, Dupuis A. Overcoming stability challenges during continuous intravenous administration of high-dose amoxicillin using portable elastomeric pumps. PLoS One. 2019 Aug 16;14(8):e0221391. doi: 10.1371/journal.pone.0221391.

Abstract. While treatment of serious infectious diseases may require high-dose amoxicillin, continuous infusion may be limited by lack of knowledge regarding the chemical stability of the drug. Therefore, we have performed a comprehensive study so as to determine the chemical stability of high-dose amoxicillin solutions conducive to safe and effective continuous intravenous administration using portable elastomeric pumps. 

Gras-Le Guen C, Boscher C, Godon N, Caillon J, Denis C, Nguyen JM, Kergueris MF, Roze JC. Therapeutic amoxicillin levels achieved with oral administration in term neonates. Eur J Clin Pharmacol. 2007 Jul;63(7):657-62. doi: 10.1007/s00228-007-0307-3.

Abstract.  We investigated whether effective serum amoxicillin concentrations could be reached by switching to oral amoxicillin after 48 h of intravenous administration in full-term neonates with group B Streptococcus infection.

Thombre NA, Gide PS. Floating-bioadhesive gastroretentive Caesalpinia pulcherrima-based beads of amoxicillin trihydrate for Helicobacter pylori eradication. Drug Deliv. 2016;23(2):405-19. doi: 10.3109/10717544.2014.916766.

Abstract.  An oral dosage form containing floating bioadhesive gastroretentive microspheres forms a stomach-specific drug delivery system for the treatment of Helicobacter pylori.

Wildermuth BE, Griffin CE, Rosenkrantz WS. Response of feline eosinophilic plaques and lip ulcers to amoxicillin trihydrate-clavulanate potassium therapy: a randomized, double-blind placebo-controlled prospective study. Vet Dermatol. 2012 Apr;23(2):110-8, e24-5. doi: 10.1111/j.1365-3164.2011.01020.x.

Abstract. In this study, we evaluated the treatment of feline eosinophilic plaques and lip ulcers with amoxicillin trihydrate-potassium clavulanate (Clavamox(®); Pfizer Animal Health). Nineteen cats with clinical and cytological findings consistent with eosinophilic plaques and/or lip ulcers were enrolled. 

Compendium of the most significant studies with reference to properties, intake, effects.

Kloskowski T, Szeliski K, Fekner Z, Rasmus M, Dąbrowski P, Wolska A, Siedlecka N, Adamowicz J, Drewa T, Pokrywczyńska M. Ciprofloxacin and Levofloxacin as Potential Drugs in Genitourinary Cancer Treatment-The Effect of Dose-Response on 2D and 3D Cell Cultures. Int J Mol Sci. 2021 Nov 4;22(21):11970. doi: 10.3390/ijms222111970.

Abstract. Introducing new drugs for clinical application is a very difficult, long, drawn-out, and costly process, which is why drug repositioning is increasingly gaining in importance. The aim of this study was to analyze the cytotoxic properties of ciprofloxacin and levofloxacin on bladder and prostate cell lines in vitro.

Podder V, Sadiq NM. Levofloxacin. 2021 Sep 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.

Abstract. Levofloxacin is FDA-approved for the treatment of nosocomial pneumonia, community-acquired pneumonia, acute bacterial rhinosinusitis, acute bacterial exacerbation of chronic bronchitis, acute bacterial prostatitis, acute pyelonephritis, urinary tract infection, skin or skin structure infections, prophylaxis, and treatment of plaque due to Yersinia pestis, and to reduce the incidence of disease progression of inhalational anthrax. 

Deshpande D, Pasipanodya JG, Mpagama SG, Bendet P, Srivastava S, Koeuth T, Lee PS, Bhavnani SM, Ambrose PG, Thwaites G, Heysell SK, Gumbo T. Levofloxacin Pharmacokinetics/Pharmacodynamics, Dosing, Susceptibility Breakpoints, and Artificial Intelligence in the Treatment of Multidrug-resistant Tuberculosis. Clin Infect Dis. 2018 Nov 28;67(suppl_3):S293-S302. doi:

Abstract. The levofloxacin dose of 25 mg/kg or 1500 mg/day was adequate for replacement of high-dose moxifloxacin in treatment of multidrug-resistant tuberculosis.

Rafat C, Debrix I, Hertig A. Levofloxacin for the treatment of pyelonephritis. Expert Opin Pharmacother. 2013 Jun;14(9):1241-53. doi: 10.1517/14656566.2013.792805.

Abstract. Levofloxacin has achieved satisfactory bacterial eradication rates and clinical success across all available trials, similar to the antibiotic comparator. 

Wrońska N, Majoral JP, Appelhans D, Bryszewska M, Lisowska K. Synergistic Effects of Anionic/Cationic Dendrimers and Levofloxacin on Antibacterial Activities. Molecules. 2019 Aug 9;24(16):2894. doi: 10.3390/molecules24162894.

Abstract. Despite the numerous studies on dendrimers for biomedical applications, the antibacterial activity of anionic phosphorus dendrimers has not been explored. In our research, we evaluated the antibacterial activity of modified polycationic and polyanionic dendrimers in combination with levofloxacin 

Grillon A, Schramm F, Kleinberg M, Jehl F. Comparative Activity of Ciprofloxacin, Levofloxacin and Moxifloxacin against Klebsiella pneumoniae, Pseudomonas aeruginosa and Stenotrophomonas maltophilia Assessed by Minimum Inhibitory Concentrations and Time-Kill Studies. PLoS One. 2016 Jun 3;11(6):e0156690. doi: 10.1371/journal.pone.0156690.

Abstract. The aim of this study was to compare the in vitro susceptibility of Klebsiella pneumoniae, Pseudomonas aeruginosa and Stenotrophomonas maltophilia to three fluoroquinolones. 

Sitovs A, Sartini I, Giorgi M. Levofloxacin in veterinary medicine: a literature review. Res Vet Sci. 2021 Jul;137:111-126. doi: 10.1016/j.rvsc.2021.04.031.

Abstract. Levofloxacin is also used in veterinary medicine, however its use is limited: it is completely banned for veterinary use in the EU, and used extralabel in only companion animals in the USA. 

 Bientinesi R, Murri R, Sacco E. Efficacy and safety of levofloxacin as a treatment for complicated urinary tract infections and pyelonephritis. Expert Opin Pharmacother. 2020 Apr;21(6):637-644. doi: 10.1080/14656566.2020.1720647. 

Abstract. La levofloxacina è un antibatterico fluorochinolonico che è diventato uno dei capisaldi della terapia antibiotica delle infezioni del tratto urinario complicate e della pielonefrite sin dalla sua introduzione nel 1990 a causa del suo eccezionale profilo farmacocinetico (PK) e farmacodinamico (PD). Tuttavia, l'emergere di una diffusa resistenza ai fluorochinoloni negli ultimi dieci anni ha spinto gli investigatori a riesaminare il suo posto nel trattamento delle infezioni del tratto urinario.

Brunetti L, Lee SM, Nahass RG, Suh D, Miao B, Bucek J, Kim D, Kim OK, Suh DC. The risk of cardiac events in patients who received concomitant levofloxacin and amiodarone. Int J Infect Dis. 2019 Jan;78:50-56. doi: 10.1016/j.ijid.2018.10.017. 

Abstract. Levofloxacin and amiodarone are both known to prolong the QT interval. This study was conducted to estimate the risk of cardiac events in patients receiving concomitant levofloxacin and amiodarone.

Compendium of the most significant studies with reference to properties, intake, effects.

Neuhaus W, Mandikova J, Pawlowitsch R, Linz B, Bennani-Baiti B, Lauer R, Lachmann B, Noe CR. Blood-brain barrier in vitro models as tools in drug discovery: assessment of the transport ranking of antihistaminic drugs. Pharmazie. 2012 May;67(5):432-9.

Sperl G, Gattner J, Deschner J, Wolf M, Proff P, Schröder A, Kirschneck C. Effects of Histamine Receptor Antagonist Cetirizine on Orthodontic Tooth Movement. Biomedicines. 2020 Dec 8;8(12):583. doi: 10.3390/biomedicines8120583.

Bielory L. Allergic inflammation of the anterior surface of the eye. Allergy Asthma Proc. 2020 Nov 1;41(6):449-453. doi: 10.2500/aap.2020.41.200068.

Iriarte Sotés P, Armisén M, Usero-Bárcena T, Rodriguez Fernández A, Otero Rivas M, Gonzalez MT, Meijide Calderón A, Veleiro B; Urtigal, the Galician Group of Interest in Urticaria. Up-Dosing Antihistamines in Chronic Spontaneous Urticaria: Efficacy and Safety. A Systematic Review of the Literature. J Investig Allergol Clin Immunol. 2020 Oct 8:0. doi: 10.18176/jiaci.0649.

Sugiura K, Hirai S, Suzuki T, Usuda T, Kondo T, Azumi T, Masaki S, Yokoi T, Nitta Y, Kamiya S, Ando K, Mori T, Tomita Y. Evaluation of cetirizine hydrochloride-based therapeutic strategy for chronic urticaria. Nagoya J Med Sci. 2008 Aug;70(3-4):97-106.

Abstract.  We investigated the suitability of cetirizine HCl (cetirizine) for the initial treatment of chronic urticaria. A secondary aim was to identify the optimal alternative treatments when switching from this drug to other drugs in patients who are dissatisfied with cetirizine.

Wilkerson H, Datta P, Rewers-Felkins K, Baker T, Hale TW. Maternal Transfer of Cetirizine Into Human Milk. J Hum Lact. 2021 Feb;37(1):135-138. doi: 10.1177/0890334420949847.

Abstract. We suggest that transfer of cetirizine into human milk is minimal and unlikely to pose a significant risk to the breastfeeding infant. This is the first report presenting the transfer of cetirizine in human milk.

Paczkowska M, Mizera M, Lewandowska K, Kozak M, Miklaszewski A, Cielecka-Piontek J. Effects of inclusion of cetirizine hydrochloride in β-cyclodextrin. J Incl Phenom Macrocycl Chem. 2018;91(3):149-159. doi: 10.1007/s10847-018-0808-y.

Abstract.  Following the preparation of inclusion complex of cetirizine (CTZ) and β-cyclodextrin (β-CD), the compound was investigated to assess the possibility of modifying the physicochemical properties (solubility, release, stability, permeability) of CTZ after complexation that are vital for subsequent formulation studies involving the said complex.

Fluimucil is suggested for the treatment of respiratory diseases characterized by increased production of thick and sticky mucus. as:

• inflammation of the bronchi
• pathology of the pulmonary alveoli
• cystic fibrosis
• bronchial dilations

in 30 bags that contain:

• N-acetylcysteine
• aspartame
• orange aroma
• sorbitol

Let's examine the ingredients in descending order of quantity on the label and they will be taken with these sachets.

N-acetylcysteine (it is present with 300mg in 1 sachet) is a compound of acetylated cysteine used for a long time as an adjuvant in bronchitis in the role of fluidifying agent and expectorant of excessive mucus as well as to combat the toxicity of some components such as doxorubicin, paracetamol, acute respiratory distress syndrome. It is included in many formulas of food supplements for its established role as an antioxidant and anti-inflammatory.

Aspartame is one of the most widespread arificial sweeteners and on which research has focused to establish the risks associated with the consumption of this product. In the European Union it is labelled as E 951 and is considered safe for human health by the Efsa (European Food Safety Authority). A contraindication may be a laxative effect if ingested in quantity.   It has a sweetening power about 180/200 times higher than sugar.

Aroma is a flavouring chemical component.

Sorbitol is an artificial sweetener with a sweetening power of about 60% of sugar and a caloric power of about 40% less than sugar. It is obtained industrially by a chemical process from glucose. It also has other interesting qualities such as anti-mould, anti-yeast and preservative.

Comment

The ingredients are carefully chosen and targeted to the most common winter sicknesses such as colds, coughs. In particular  N-acetylcysteine plays the primary role as a fluidifying agent.I am surprised to see in third place, in order of quantity, Aroma, pure chemistry that I hope can be replaced with a natural flavouring. 

After 2 days of intake (1 sachet before sleep at night) I have already noticed a clear improvement and complete healing occurred after 4/5 days. 

Conclusion

Great product, but I'd prefer without Aroma.