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# Acetylcysteine ## Overview Acetylcysteine is a mucolytic agent that breaks down disulfide bonds in mucus, reducing its viscosity. It is also an antidote for acetaminophen overdose by replenishing glutathione stores. ## Primary Indications * **Acetaminophen Overdose:** Treatment of overdose. * **Mucolytic:** To thin respiratory secretions in conditions such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), and bronchitis. ## Adult Dosing **Acetaminophen Overdose (Oral/IV):** * **Initial Loading Dose:** 150 mg/kg IV (over 1 hour) or 140 mg/kg PO. * **Subsequent Doses:** 50 mg/kg IV (over 16 hours) or 70 mg/kg PO every 4 hours for 17 doses. * **Maximum Oral Dose:** 70 mg/kg per dose. * **Maximum IV Dose:** 150 mg/kg per dose. **Mucolytic (Nebulized):** * **Dose:** 3 mL to 5 mL of 20% solution (600-1000 mg) or 6 mL to 10 mL of 10% solution (600-1000 mg) via nebulizer every 2 to 6 hours. * **Dosing frequency and concentration may vary based on local protocol and patient tolerance.** ## Pediatric Dosing **Acetaminophen Overdose (Oral/IV):** * **Initial Loading Dose:** 150 mg/kg IV (over 1 hour) or 140 mg/kg PO. * **Subsequent Doses:** 50 mg/kg IV (over 16 hours) or 70 mg/kg PO every 4 hours for 17 doses. * **Maximum Oral Dose:** 70 mg/kg per dose. * **Maximum IV Dose:** 150 mg/kg per dose. **Mucolytic (Nebulized):** * **Dose:** 1 mL to 3 mL of 20% solution (200-600 mg) or 2 mL to 6 mL of 10% solution (200-600 mg) via nebulizer every 2 to 6 hours. * **Dosing frequency and concentration may vary based on local protocol and patient tolerance.** ## Dose Adjustments No dose adjustment is typically required for renal or hepatic impairment, though caution is advised. ## Contraindications * Known hypersensitivity to acetylcysteine. ## Adverse Effects * **Common (Nebulized):** Bronchospasm, nausea, vomiting, stomatitis. * **Common (IV):** Anaphylactoid reactions (rash, pruritus, angioedema, bronchospasm, dyspnea), nausea, vomiting. ## Key Drug Interactions * **Activated Charcoal:** May bind to oral acetylcysteine, reducing its absorption. Administer acetylcysteine at least 1 hour after activated charcoal if used for acetaminophen overdose. * **Nitroglycerin:** Concurrent use may potentiate hypotensive effects. ## Monitoring * **Acetaminophen Overdose:** Serum acetaminophen levels, liver function tests (LFTs), prothrombin time (PT), international normalized ratio (INR), and clinical signs of hepatotoxicity. * **Mucolytic:** Respiratory status, effectiveness in clearing secretions. ## Clinical Pearls * For nebulized acetylcysteine, co-administration with a bronchodilator may be necessary to prevent bronchospasm. * The smell of acetylcysteine can be unpleasant; this is normal. * IV acetylcysteine can cause anaphylactoid reactions; monitor closely and have emergency equipment readily available. *** **Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and guidelines before administering any medication.