CF patient- inhalation of Mesna no longer possible

Question

Dear,
Mistabron® is no longer available in the pharmacy. I’m worried that my daughter gets worse with hypertonic saline. What is the best to use for CF? My daughter is 6 years old.
Thank you.

Answer

Dear parent,
We do understand your concern. When a medicine that you have been using for a long time is suddenly no longer available that can cause stress and worries. The medicine you name contains the substance Mesna; it has been taken out of the market because there is very little evidence that this medicine does improve the course of the disease cystic fibrosis.
Luckily there are several options to replace Mesna treatment. We suggest that you discuss with your doctor which option is the best for your child.
Mesna is a derivative of acetylcysteine, and this is still available. However, this medicine has also been poorly studied in CF; but some patients do report that they get better with it.
Very well studied is rhDNase and this can be used certainly from the age of 6 years on.
Moderately well studied is hypertonic saline. With this medicine the aim is to better hydrate the airway so that the tenacious secretions become more easy to expectorate. Some patients do have a narrowing of the airway after using this product and that is why it is advised to use a bronchodilator prior to the treatment.
In the future, mannitol, a sugar used as a dry powder inhaler, will become available. Also this medicine attracts water so that the secretions are less tenacious and easier to expectorate.
Prof. K. De Boeck

03.05.2012