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# Acetylcysteine
## Overview
Acetylcysteine (NAC) is a mucolytic agent that breaks disulfide bonds in mucoproteins, reducing mucus viscosity. It is also an antidote for acetaminophen overdose.
## Primary Indications
* **Acetaminophen Overdose:** Treatment of acetaminophen toxicity.
* **Mucolytic Agent:** To thin mucus secretions in patients with chronic bronchitis, emphysema, and other conditions causing excessive mucus.
## Adult Dosing
* **Acetaminophen Overdose:**
* **Loading Dose:** 150 mg/kg IV infused over 1 hour.
* **Second Dose:** 50 mg/kg IV infused over 16 hours.
* **Third Dose:** 50 mg/kg IV infused over 16 hours.
* *Note: Specific IV protocols may vary; consult local guidelines. Oral dosing is also an option, with a similar total dose but different infusion schedule. Maximum dose is typically 150 mg/kg for the loading dose.*
* **Mucolytic Agent:**
* **Nebulization:** 3-10 mL of a 20% solution or 6-12 mL of a 10% solution every 2-6 hours as needed.
* **Oral:** 200 mg twice daily to 1000 mg daily in divided doses.
## Pediatric Dosing
* **Acetaminophen Overdose:**
* **Loading Dose:** 150 mg/kg IV infused over 1 hour.
* **Subsequent Doses:** 50 mg/kg IV infused over 16 hours, repeated for a total of 17 doses over 21 hours.
* *Note: Specific IV protocols may vary; consult local guidelines. Oral dosing is also an option for children.*
* **Mucolytic Agent:**
* **Nebulization:** 1-10 mL of a 20% solution or 1-5 mL of a 10% solution every 2-6 hours as needed. Dosing is often weight-based or based on age; consult specific pediatric guidelines.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised.
## Contraindications
Hypersensitivity to acetylcysteine or any component of the formulation.
## Adverse Effects
* **Common:** Nausea, vomiting, rash, pruritus, stomatitis.
* **Less Common/Serious:** Bronchospasm,
