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# Acetylcysteine
## Overview
Acetylcysteine is a mucolytic agent that reduces the viscosity of respiratory tract secretions. It also acts as an antidote for acetaminophen overdose.
## Primary Indications
* **Acetaminophen Overdose:** Treatment to prevent or lessen liver toxicity.
* **Mucolytic:** To aid in the clearance of mucus in patients with conditions such as chronic bronchitis, emphysema, cystic fibrosis, and bronchiectasis.
## Adult Dosing
* **Acetaminophen Overdose:**
* **Oral Loading Dose:** 140 mg/kg.
* **Subsequent Doses (Oral):** 70 mg/kg every 4 hours for a total of 17 doses.
* **Intravenous (IV):** Protocols vary. Common regimens include an initial loading dose of 150 mg/kg over 1 hour, followed by 12.5 mg/kg/hour for 4 hours, then 6.25 mg/kg/hour for up to 72 hours. *Always confirm with local protocol for IV dosing.*
* **Mucolytic (Inhaled):** 1 to 2 mL of a 10% or 20% solution every 2 to 6 hours as needed. Can also be nebulized as 3 to 5 mL of a 10% solution every 3 to 4 hours.
## Pediatric Dosing
* **Acetaminophen Overdose (Oral):**
* **Loading Dose:** 140 mg/kg.
* **Subsequent Doses:** 70 mg/kg every 4 hours for a total of 17 doses.
* **Acetaminophen Overdose (Intravenous):** Similar to adults, but doses are adjusted based on weight and protocol. *Confirm with local protocol.*
* **Mucolytic (Inhaled):**
* **Less than 6 years:** 1 mL of 10% or 20% solution every 2 to 6 hours.
* **Greater than 6 years:** 1 to 2 mL of 10% or 20% solution every 2 to 6 hours.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment for the mucolytic indication. For acetaminophen overdose, the dose is weight-based.
## Contraindications
Hypersensitivity to acetylcysteine or any component of the formulation.
## Adverse Effects
* **Inhaled:** Bronchospasm, rhinorrhea, nausea, vomiting, stomatitis.
* **IV (Acetaminophen Overdose):** Anaphylactoid reactions (rash, pruritus, angioedema, bronchospasm, hypotension), nausea, vomiting.
## Key Drug Interactions
No significant drug interactions are clinically established for inhaled acetylcysteine. For IV acetylcysteine in acetaminophen overdose, interactions are not a primary concern due to the emergent nature of treatment.
## Monitoring
* **Acetaminophen Overdose:** Monitor acetaminophen levels, liver function tests (ALT, AST, bilirubin, INR), and clinical status.
* **Mucolytic:** Monitor respiratory status, sputum volume, and viscosity. Assess for bronchospasm.
## Clinical Pearls
* For inhaled use, acetylcysteine may have an unpleasant odor.
* Oral administration for acetaminophen overdose may cause nausea and vomiting; antiemetics may be necessary.
* IV acetylcysteine can cause anaphylactoid reactions; a test dose may be administered, and patients should be monitored closely.
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*Please verify current prescribing information for the most up-to-date and complete details.*
