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# Acetylcysteine ## Overview Acetylcysteine is a mucolytic agent that works by breaking disulfide bonds in mucus, decreasing its viscosity. It is also an antidote for acetaminophen overdose. ## Primary Indications * **Acetaminophen Overdose:** Treatment of acetaminophen overdose to prevent liver damage. * **Mucolytic:** To thin respiratory secretions in patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis, or bronchitis. ## Adult Dosing * **Acetaminophen Overdose:** * **Oral:** Loading dose of 140 mg/kg, followed by 70 mg/kg every 4 hours for 17 doses. Maximum dose 1000 mg per dose. * **Intravenous (IV):** Typically a 3-bag infusion. * Bag 1: 150 mg/kg in 200 mL NS over 60 minutes. * Bag 2: 50 mg/kg in 400 mL NS over 16 hours. * Bag 3: 100 mg/kg in 400 mL NS over 16 hours. * *Local protocols may vary. Confirm specific IV regimens.* * **Mucolytic:** * **Inhaled:** 3 to 5 mL of a 20% solution or 5 to 10 mL of a 10% solution nebulized every 3 to 4 hours. ## Pediatric Dosing * **Acetaminophen Overdose:** Dosing is the same as adults, weight-based. * **Mucolytic:** * **Inhaled:** 1 mL of a 20% solution or 2 to 4 mL of a 10% solution nebulized every 3 to 4 hours. ## Dose Adjustments * No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised in severe cases, especially for IV administration in overdose due to potential volume overload and metabolic derangements. ## Contraindications * Hypersensitivity to acetylcysteine or any component of the formulation. ## Adverse Effects * **Inhaled:** Bronchospasm, nausea, vomiting, stomatitis. * **Intravenous (IV) (especially with rapid infusion):** Anaphylactoid reactions (rash, urticaria, angioedema, bronchospasm, dyspnea), hypotension, tachycardia. * **Oral:** Nausea, vomiting, diarrhea. ## Key Drug Interactions * **Activated Charcoal:** May adsorb oral acetylcysteine, reducing its absorption. Separate administration by at least 1 hour. * **Nitroglycerin:** May potentiate hypotensive effects. ## Monitoring * **Acetaminophen Overdose:** Liver function tests (LFTs), acetaminophen levels, prothrombin time (PT), international normalized ratio (INR), glucose levels, and electrolytes. Monitor for signs of anaphylaxis with IV administration. * **Mucolytic:** Respiratory status, sputum viscosity, and presence of bronchospasm. ## Clinical Pearls * For IV acetaminophen overdose, prompt initiation of therapy is crucial for efficacy. * Dilute IV acetylcysteine to reduce the risk of anaphylactoid reactions. * Pretreatment with a bronchodilator may be necessary for patients prone to bronchospasm when using inhaled acetylcysteine. * The characteristic sulfurous odor of acetylcysteine can be unpleasant and may cause nausea or vomiting, especially with oral administration. *** *This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and local protocols for definitive guidance.*