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# Acetylcysteine ## Overview Acetylcysteine is a mucolytic agent used to thin mucus secretions and as an antidote for acetaminophen overdose. ## Primary Indications * **Mucolytic:** Adjunct therapy in patients with chronic bronchitis, emphysema, cystic fibrosis, or other conditions causing thick mucus secretions. * **Acetaminophen Overdose Antidote:** To prevent or lessen liver damage following acetaminophen overdose. ## Adult Dosing * **Mucolytic:** 200 mg (3 mL of 10% solution or 6 mL of 5% solution) administered via nebulization every 4-12 hours. Higher doses may be used in cystic fibrosis. * **Acetaminophen Overdose:** * **Loading Dose:** 150 mg/kg IV infused over 60 minutes. * **Second Dose:** 50 mg/kg IV infused over 4 hours. * **Third Dose:** 100 mg/kg IV infused over 16 hours. * *Alternatively, oral dosing protocols exist, typically 17 doses over 72 hours, starting with 140 mg/kg PO every 4 hours.* ## Pediatric Dosing * **Mucolytic:** Dosing is based on patient age and condition, often 10% or 20% solution administered via nebulizer. Consult institutional guidelines or product labeling for specific pediatric recommendations. * **Acetaminophen Overdose:** Dosing follows the same mg/kg regimen as adults for IV administration. For oral administration, the loading dose is 140 mg/kg PO, followed by 70 mg/kg PO every 4 hours for 17 doses. ## Dose Adjustments No specific dose adjustments are typically required for renal or hepatic impairment for mucolytic use. For acetaminophen overdose, IV dosing is weight-based and adjusted for patient weight. ## Contraindications * Hypersensitivity to acetylcysteine. * Active thisComponent ulcer disease (for oral administration). ## Adverse Effects * **Inhaled:** Bronchospasm, bronchoconstriction, rhinorrhea, nausea, vomiting, stomatitis. * **IV (Acetaminophen Overdose):** Anaphylactoid reactions (rash, urticaria, pruritus, angioedema, bronchospasm), flushing, hypotension, tachycardia. ## Key Drug Interactions * Activated charcoal may bind acetylcysteine, reducing its absorption when given orally for acetaminophen overdose. Administer at least 2 hours apart. * Nitroglycerin: Potentiation of hypotensive effects. ## Monitoring * **Mucolytic:** Assess respiratory status, sputum clearance, and signs of bronchospasm. * **Acetaminophen Overdose:** Monitor acetaminophen levels, liver function tests (ALT, AST, bilirubin), INR, and prothrombin time. Monitor for signs of anaphylactoid reactions during IV infusion. ## Clinical Pearls * The odor of acetylcysteine can be unpleasant; this is normal. * For IV administration in acetaminophen overdose, monitoring for anaphylactoid reactions is crucial, especially during the initial loading dose. Pretreatment with antihistamines may be considered. * If bronchospasm occurs with inhaled acetylcysteine, a bronchodilator should be administered. * For acetaminophen overdose, the duration of treatment may be extended if acetaminophen levels remain elevated or liver enzymes are rising. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and institutional protocols for the most current and complete guidelines before initiating or modifying therapy.