Acetyl%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520cysteine

# Acetylcysteine ## Overview Acetylcysteine (NAC) is an antioxidant and mucolytic agent. It is the precursor to glutathione, a potent endogenous antioxidant. ## Primary Indications * **Acetaminophen (APAP) Overdose:** Antidote. * **Mucolytic:** To thin and loosen mucus secretions in patients with chronic bronchopulmonary diseases (e.g., COPD, cystic fibrosis) and as an adjunct to tracheostomy care. ## Adult Dosing ### Acetaminophen Overdose: * **Oral Protocol:** 140 mg/kg loading dose, followed by 70 mg/kg every 4 hours for 17 doses. Maximum dose: 140 mg/kg per dose. * **Intravenous Protocol:** 150 mg/kg over 1 hour, followed by 50 mg/kg over the next 4 hours, followed by 100 mg/kg over the next 16 hours. * *Note:* IV protocols can vary; specific hospital protocols should be followed. ### Mucolytic: * **Inhaled:** 3-10 mL of a 10-20% solution every 2-6 hours. * **Oral:** 200 mg twice daily to 1000 mg daily in divided doses. ## Pediatric Dosing ### Acetaminophen Overdose: * **Oral Protocol:** 140 mg/kg loading dose, followed by 70 mg/kg every 4 hours for 17 doses. Maximum dose: 140 mg/kg per dose. * **Intravenous Protocol:** 150 mg/kg over 1 hour, followed by 50 mg/kg over the next 4 hours, followed by 100 mg/kg over the next 16 hours. * *Note:* IV protocols can vary; specific hospital protocols should be followed. Dosing based on weight is crucial. ### Mucolytic: * **Inhaled:** 1-2 mL of a 10-20% solution every 2-6 hours. ## Dose Adjustments * **Renal Impairment:** No specific dose adjustment is typically recommended, but caution is advised. * **Hepatic Impairment:** No specific dose adjustment is typically recommended, but caution is advised, particularly with oral administration for acetaminophen overdose. ## Contraindications * Hypersensitivity to acetylcysteine or any component of the formulation. ## Adverse Effects * **Common:** Nausea, vomiting, stomatitis, rhinorrhea, rash, urticaria, bronchospasm (especially with nebulized form). * **Serious:** Anaphylactoid reactions, respiratory distress. ## Key Drug Interactions * **Activated Charcoal:** May adsorb oral acetylcysteine, reducing its absorption. Administer NAC at least 1 hour after activated charcoal. * **Nitroglycerin:** May potentiate the hypotensive effects of nitroglycerin. ## Monitoring * **Acetaminophen Overdose:** Liver function tests (LFTs), prothrombin time (PT), international normalized ratio (INR), glucose, electrolytes, and creatinine at baseline and regularly throughout treatment. Clinical signs of acetaminophen toxicity (e.g., hepatic encephalopathy). * **Mucolytic:** Respiratory status, sputum production, and patient tolerance. ## Clinical Pearls * Oral acetylcysteine has a characteristic sulfur odor. * For IV use in acetaminophen overdose, ensure adequate hydration and monitor for fluid overload. * Bronchospasm with nebulized acetylcysteine can be managed with concurrent bronchodilator therapy. * The efficacy of IV acetylcysteine decreases significantly after 8-10 hours from APAP ingestion. *** *This information is intended for healthcare professionals and does not substitute for consulting the most current prescribing information or professional medical advice. Always verify current dosing and safety information with official drug references and institutional protocols.*