Please check your internet connection and try again.
# Acetylcysteine
## Overview
Acetylcysteine is a mucolytic agent and an antidote for acetaminophen overdose. It is available in oral and intravenous formulations.
## Primary Indications
* **Acetaminophen Overdose:** Treatment to prevent or reduce liver damage.
* **Mucolytic:** To thin and loosen mucus in conditions such as chronic bronchitis, cystic fibrosis, and pneumonia.
## Adult Dosing
### Acetaminophen Overdose (Oral)
* **Loading Dose:** 140 mg/kg orally.
* **Maintenance Dose:** 70 mg/kg orally every 4 hours for 17 doses.
* **Maximum Dose:** Generally, no specific maximum dose is listed for the loading dose, but total daily doses can be substantial.
### Acetaminophen Overdose (Intravenous - IV)
* **Loading Dose:** 150 mg/kg IV infused over 1 hour.
* **Second Infusion:** 50 mg/kg IV infused over the next 4 hours.
* **Third Infusion:** 100 mg/kg IV infused over the subsequent 16 hours.
* **Maximum Dose:** Individual infusion rates should be adhered to, with the total dose dependent on patient weight and duration of therapy.
### Mucolytic (Oral/Nebulized)
* **Oral:** Typically 200 mg to 600 mg twice or three times daily.
* **Nebulized:** 1 mL to 10 mL of a 10% or 20% solution (100 mg/mL to 200 mg/mL), often administered every 2 to 6 hours. Specific concentrations and volumes can vary based on protocol.
## Pediatric Dosing
### Acetaminophen Overdose (Oral)
* **Loading Dose:** 140 mg/kg orally.
* **Maintenance Dose:** 70 mg/kg orally every 4 hours for 17 doses.
### Acetaminophen Overdose (Intravenous - IV)
* **Loading Dose:** 150 mg/kg IV infused over 1 hour.
* **Second Infusion:** 50 mg/kg IV infused over the next 4 hours.
* **Third Infusion:** 100 mg/kg IV infused over the subsequent 16 hours.
### Mucolytic (Nebulized)
* **Nebulized:** Typically 1 mL to 10 mL of a 10% or 20% solution, often administered every 2 to 6 hours. Dosing may be weight-based in some protocols, particularly for younger children.
## Dose Adjustments
No dose adjustments are typically required for renal or hepatic impairment in the setting of acetaminophen overdose, as the goal is to overwhelm these pathways. For mucolytic use, adjustments are generally based on clinical response and tolerance.
## Contraindications
* Hypersensitivity to acetylcysteine or any component of the formulation.
## Adverse Effects
* **Common (Oral):** Nausea, vomiting, stomatitis.
* **Common (IV):** Anaphylactoid reactions (rash, pruritus, bronchospasm, angioedema), flushing, tachycardia, hypotension.
* **Common (Nebulized):** Bronchospasm, nausea, vomiting, stomatitis.
## Key Drug Interactions
* **Activated Charcoal:** Can adsorb oral acetylcysteine, potentially reducing its efficacy in acetaminophen overdose. Administer activated charcoal at least 1 hour after oral acetylcysteine.
## Monitoring
* **Acetaminophen Overdose:** Serum acetaminophen levels, liver function tests (AST, ALT, bilirubin, INR), glucose, and renal function. Clinical signs of liver toxicity.
* **Mucolytic Use:** Respiratory status, sputum production, and occurrence of bronchospasm.
## Clinical Pearls
* The efficacy of acetylcysteine in acetaminophen overdose is time-dependent; initiation as soon as possible is crucial.
* Intravenous acetylcysteine can cause anaphylactoid reactions. Premedication with an antihistamine may be considered, and patients should be closely monitored for signs of hypersensitivity.
* Oral acetylcysteine has an unpleasant sulfurous odor and taste; dilution and flavorings may improve palatability.
* Bronchospasm can occur with nebulized acetylcysteine; a bronchodilator should be readily available.
* For intravenous administration, specific diluents and infusion rates are critical and vary by product and local protocol.
***
*This information is intended for clinical use and does not replace the need to consult the official prescribing information or local protocols.*
