Acetylcysteine

Indications
 Oral
Mucolytic
Adult: As lozenges/ effervescent granules or tablets: 200 mg tid.
Child: As lozenges/ effervescent granules or tablets: 2-7 yr: 200 mg bid; <2 yr: 200 mg daily.
Oral
Paracetamol poisoning
Adult: After gastric lavage or induction of emesis with ipecac syrup, admin loading dose of 140 mg/kg, followed by maintenance doses of 70 mg/kg every 4 hr for a total of 17 doses. 1st maintenance dose to be given 4 hr after the loading dose. Repeat dose if the patient vomits within 1 hr of admin. Continue therapy until paracetamol levels are not detectable and there is no evidence of hepatotoxicity.
Child: After gastric lavage or induction of emesis with ipecac syrup, admin loading dose of 140 mg/kg, followed by maintenance doses of 70 mg/kg every 4 hr for a total of 17 doses. 1st maintenance dose to be given 4 hr after the loading dose. Repeat dose if the patient vomits within 1 hr of admin. Continue therapy until paracetamol levels are not detectable and there is no evidence of hepatotoxicity.
Intravenous
Paracetamol poisoning
Adult: Initially, 150 mg/kg in 200 ml of infusion fluid given over 15 minutes, followed by 50 mg/kg in 500 ml of infusion given over the next 4 hr, then 100 mg/kg in 1 L of infusion fluid over the next 16 hr.
Child: Child ≥20 kg: Initially, 150 mg/kg in 100 ml of infusion fluid given over 15 min, followed by 50 mg/kg in 250 ml of infusion given over the next 4 hr, then 100 mg/kg in 500 mL of infusion fluid over the next 16 hr. Child <20 kg: Doses as per adult dose but adjust volume of based on child age and wt to avoid fluid overload.
Inhalation
Mucolytic
Adult: 3-5 ml of a 20% solution or 6-10 ml of a 10% solution 3-4 times daily by nebulising through a face mask, mouth piece or tracheostomy. May increase to 1-10 ml of a 20% solution or 2-20 ml of a 10% solution every 2-6 hr if needed.
Child: 3-5 ml of a 20% solution or 6-10 ml of a 10% solution 3-4 times daily by nebulising through a face mask, mouth piece or tracheostomy. May increase to 1-10 ml of a 20% solution or 2-20 ml of a 10% solution every 2-6 hr if needed.
Endotracheal
Mucolytic
Adult: Instill 1-2 ml of a 10-20% solution as often as every hrly.
Child: Instill 1-2 ml of a 10-20% solution as often as every hrly.
Ophthalmic
Dry eye associated with abnormal mucus production
Adult: Instill 1-2 drops of a 5% solution into the affected eye 3-4 times daily.

Reconstitution: To be diluted for IV infusion with 5% dextrose, 0.9% sodium chloride, 0.3% potassium chloride with 5% glucose, 0.3% potassium chloride with 0.9% sodium chloride.
Incompatibility: Incompatible with metals (e.g. iron, copper, nickel), rubber, oxygen, oxidising substances (e.g. hydrogen peroxide), and some antibiotics (e.g. tetracycline HCl, oxytetracycline HCl, erythromycin lactobionate, ampicillin sodium, amphotericin B). A change in colour of solution to light purple may be observed and does not indicate significant change in safety or efficacy.
Warnings / Precautions
 Asthmatic patients, history of bronchospasm, peptic ulceration. Pregnancy, lactation.
Adverse Reactions
 Flushing, fever, stomatitis, nausea, vomiting, rhinorrhoea, bronchospasm, anaphylactoid reactions, rashes. Rarely, blurred vision, bradycardia, syncope, thrombocytopenia, convulsions.
Potentially Fatal: Rarely, respiratory or cardiac arrest.
Mechanism of Actions
 Acetylcysteine may decrease the viscosity of secretions by splitting of disulphide bonds in mucoproteins. It also promotes the detoxification of an intermediate paracetamol metabolite which is used in the management of paracetamol overdosage.
Absorption: Rapidly absorbed from the GI tract (oral); peak plasma concentrations after 0.5-1 hr.
Distribution: Protein-binding: 50%.
Metabolism: Extensively hepatic.
Excretion: Urine; elimination half-life: 6.25 hr (oral); 5.58 (IV).
Storage Conditions
 Endotracheal: Store between 59-86°F (15-30°C). Undiluted solution may be kept refrigerated for 96 hr. Inhalation: Store between 59-86°F (15-30°C). Undiluted solution may be kept refrigerated for 96 hr. Diluted solution to be used within 1 hr. Intravenous: Store below 25°C. Ophthalmic: Store below 25°C. Oral: Store below 25°C.
ATC Classification
 R05CB01 - acetylcysteine ; Belongs to the class of mucolytics. Used in the treatment of wet cough.
S01XA08 - acetylcysteine ; Belongs to the class of other ophthalmologicals.
V03AB23 - acetylcysteine ; Belongs to the class of antidotes. Used to neutralize paracetamol overdose.
Storage
 Endotracheal: Store between 59-86°F (15-30°C). Undiluted solution may be kept refrigerated for 96 hr. Inhalation: Store between 59-86°F (15-30°C). Undiluted solution may be kept refrigerated for 96 hr. Diluted solution to be used within 1 hr. Intravenous: Store below 25°C. Ophthalmic: Store below 25°C. Oral: Store below 25°C.
Available As
  • Acetylcysteine 0.5 gm
  • Acetylcysteine 100 mg
  • Acetylcysteine 150 mg
  • Acetylcysteine 200 mg
  • Acetylcysteine 25 mg
  • Acetylcysteine 300 mg
  • Acetylcysteine 50 mg
  • Acetylcysteine 600 mg

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