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# Acetylcysteine
## Overview
Acetylcysteine is a mucolytic agent that reduces the viscosity of respiratory secretions. It also serves as an antidote for acetaminophen overdose.
## Primary Indications
* Acetaminophen overdose
* Management of airway mucus secretions in patients with excessive or tenacious mucus
## Adult Dosing
**Acetaminophen Overdose:**
* **Loading Dose:** 150 mg/kg IV infused over 60 minutes.
* **Second Dose:** 50 mg/kg IV infused over 60 minutes, 4 hours after the loading dose.
* **Subsequent Doses:** 100 mg/kg IV infused over 15-60 minutes every 4 hours for a total of 17 doses (approximately 72 hours).
* *Note:* Dosing may vary based on acetaminophen levels and time since ingestion. Local protocols should be followed.
**Mucolytic:**
* **Oral:** 200 mg to 400 mg twice to four times daily.
* **Nebulization:** 10% solution (3-5 mL) every 3-4 hours or 20% solution (2-3 mL) every 3-4 hours.
* **Intravenous (for pulmonary conditions other than acetaminophen overdose):** Not FDA-approved. Typically reserved for cystic fibrosis, used cautiously at doses of 600 mg once daily or divided twice daily.
## Pediatric Dosing
**Acetaminophen Overdose:**
* Same as adult dosing (150 mg/kg loading dose, followed by 50 mg/kg, then 100 mg/kg every 4 hours for 17 doses).
* *Note:* Dosing may vary based on acetaminophen levels and time since ingestion. Local protocols should be followed.
**Mucolytic:**
* **Oral:** 50 mg/kg to 100 mg/kg twice to four times daily (maximum 800 mg/day).
* **Nebulization:** 10% solution (1-3 mL) or 20% solution (1-2 mL) every 3-4 hours.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment for the antidote indication. For mucolytic use, dose may be adjusted based on patient tolerance and response.
## Contraindications
* Hypersensitivity to acetylcysteine or any component of the formulation.
## Adverse Effects
* **Anaphylactoid Reactions:** Rash, pruritus, urticaria, bronchospasm, dyspnea, angioedema, hypotension (most common with IV administration).
* **Gastrointestinal:** Nausea, vomiting, diarrhea.
* **Other:** Fever, headache, dizziness.
## Key Drug Interactions
* **Activated Charcoal:** May adsorb acetylcysteine if given concurrently in acetaminophen overdose. Separate administration by at least 1 hour.
## Monitoring
* **Acetaminophen Overdose:** Plasma acetaminophen concentrations, liver function tests, prothrombin time, clinical signs of liver toxicity.
* **Mucolytic Use:** Respiratory status, sputum characteristics, patient tolerance.
* **IV Administration (for anaphylactoid reactions):** Vital signs, respiratory status.
## Clinical Pearls
* IV acetylcysteine for acetaminophen overdose is most effective when started within 8-10 hours of ingestion.
* Anaphylactoid reactions are common with IV acetylcysteine and can occur even with therapeutic doses. Have emergency equipment readily available.
* Oral acetylcysteine may have an unpleasant odor; mixing with flavored beverages can improve palatability.
* Nebulized acetylcysteine can sometimes induce bronchospasm; concurrent administration of a bronchodilator may be necessary.
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*This information is intended for healthcare professionals. Please consult the current prescribing information and institutional protocols for definitive guidance.*
