Acetylcysteine

Class
Antidote
Mucolytic

Trade Names
Acetadote
- Injection, solution 20% (200 mg/mL)
Acetylcysteine
- Solution, inhalation or oral 10%
- Solution, concentrate, inhalation or oral 20%

Indications

chronic bronchopulmonary disease (chronic emphysema, emphysema

with bronchitis, chronic asthmatic bronchitis, tuberculosis, bronchiectasis
acute bronchopulmonary disease (pneumonia, bronchitis,
tracheobronchitis),
pulmonary complications of cystic fibrosis,
tracheostomy care,
pulmonary complications associated with surgery, during anesthesia,
posttraumatic chest conditions,
atelectasis caused by mucous obstruction,
diagnostic bronchial studies (eg, bronchograms, bronchospirometry,
bronchial wedge catheterization) (inhalation);
prevention or lessening of liver damage after potentially toxic quantity of
acetaminophen (oral or IV).

Unlabeled Uses
Ophthalmic preparation for dry eyes
enema for bowel obstruction
prevention of radiocontrast-induced nephrotoxicity
H pylori infection

 N-acetyl-p-benzoquinone imine
acetylcysteine acts to maintain or replenish depleted
glutathione reserves in the liver and enhance non-toxic
metabolism of acetaminophen

Contraindications
Sensitivity to acetylcysteine
Use with caution in patients with asthma or a history of
bronchospasm

Administration
Inhalation
Direct instillation into a particular segment of the
bronchopulmonary tree
Direct instillation into percutaneous intratracheal
catheter
Direct instillation for routine care of tracheostomy
Nebulization with face mask, mouth piece,
tracheostomy
IV
Oral

Acetaminophen Overdose
Loading dose 150 mg/kg in 200 mL of diluent infused
over 60 min.
Maintenance dose
50 mg/kg in 500 mL of diluent infused over 4 h followed
by 100 mg/kg in 1,000 mL of diluent infused over 16 h.

PO
140 mg/kg loading dose administered immediately if 24
h or less have elapsed from the reported time of
ingestion of an acetaminophen overdose,
then 70 mg/kg 4 h after loading dose and repeated at 4h intervals for total of 17 doses, unless acetaminophen
assay indicates otherwise.

 On admission, draw a serum blood sample at least 4 h

after ingestion to determine the acetaminophen level,
which will serve as a basis for determining the need for
treatment.
Administer acetylcysteine within 8 h from
acetaminophen ingestion for max protection against
hepatic injury.
Acetylcysteine is compatible with dextrose 5%,
sodium chloride 0.45% injection, and water for
injection

 Administer diluted solution within 1 h of preparation.

If the patient vomits within 1 h of administration, repeat
that dose.

Storage
Inhalation or oral solution
Use freshly prepared solutions within 1 h.
Discard any unused solution after 96 h
Injection
Diluted solution is stable for up to 24 h

Adverse Reactions
Tachycardia, hypotension
Rash, flushing, pruritus, urticaria
Pharyngitis, rhinorrhea, throat tightness
Vomiting, nausea, stomatitis
Rhonchi, bronchoconstriction; bronchospasm; irritation
to the tracheal and bronchial tracts; hemoptysis;
edema,
Miscellaneous
Anaphylaxis, chest tightness; clamminess; drowsiness;
fever;