Trade Names:Acetadote- Injection 20% (200 mg/mL)
Trade Names:Mucomyst- Solution 10% (as sodium)- Solution 20% (as sodium)Acetylcysteine Solution (Canada)
Decreases thickness of mucous secretions in lung.
C max is 0.35 to 4 mg/L; T max is 1 to 2 h.
Vd is 0.47 L/kg, and 83% protein bound.Oral
About 50% protein bound. Vd is 0.33 to 0.47 L/kg.
Undergoes rapid deacetylation to yield cysteine or oxidation to yield diacetylcysteine.
The t ½ is 5.6 h. The mean Cl is 0.11 L/h/kg, renally about 30% of total Cl.Oral
The t ½ is 6.25 h. About 70% is excreted by nonrenal mechanisms.
For severe liver impairment, primary and/or secondary biliary cirrhosis, t ½ increased 80%, Cl decreased 30%.Children
The t ½ is increased to 11 h.
Reduction of viscosity of bronchopulmonary mucous secretions in patients with chronic or acute lung diseases, pulmonary complications associated with cystic fibrosis, surgery, anesthesia, or atelectasis caused by mucous obstruction; diagnostic bronchial studies; tracheostomy care, posttraumatic chest conditions (oral solution); prevention or lessening of liver damage after potentially toxic quantity of acetaminophen (oral or IV).
Ophthalmic preparation for dry eyes; enema for bowel obstruction.
Nebulization (face mask, mouthpiece, tracheostomy) 1 to 10 mL (usually 3 to 5 mL) of 20% solution or 2 to 20 mL (usually 6 to 10 mL) of 10% solution every 2 to 6 h (usually twice daily or 4 times daily); (nebulization tent) large volumes (up to 300 mL) during treatment period.Instillation
1 to 2 mL of 10% to 20% solution as often as every 1 h.Diagnostic Bronchograms
2 to 3 administrations of 1 to 2 mL of 20% solution or 2 to 4 mL of 10% solution by nebulization or tracheal instillation before procedure.Acetaminophen Overdose
After appropriate overdose procedures (eg, lavage, induction of emesis), PO 140 mg/kg as oral loading dose (diluted with diet soft drink). Then 70 mg/kg orally 4 h after loading dose and repeated at 4-h intervals for total of 17 doses, unless acetaminophen assay indicates otherwise. IV On admission, draw a serum blood sample at least 4 h after ingestion to determine the acetaminophen level, which will serve as a basis for determining the need for acetylcysteine treatment. If patient presents 4 h post-ingestion, determine acetylcysteine serum sample immediately. Administer acetylcysteine within 8 h from acetaminophen ingestion for max protection against hepatic injury. If time of ingestion is unknown, or acetaminophen level is not available, administer acetylcysteine immediately if 24 h or less has elapsed from the time of the reported overdose ingestion of acetaminophen, regardless of quantity reported to have been ingested. Critical ingestion-treatment interval for max protection against severe hepatic injury is 0 to 8 h. Efficacy diminishes progressively after 8 h and treatment initiated 15 h postingestion of acetaminophen yields limited efficacy. However, it does not appear to worsen the condition and should not be withheld.Loading dose
150 mg/kg in 200 mL of 5% dextrose; infuse over 15 min.Maintenance dose
50 mg/kg in 500 mL of 5% dextrose; infuse over 4 h followed by 100 mg/kg in 1,000 mL of 5% dextrose infused over 16 h.
Oral solution for acetaminophen overdose
Store unopened vials at controlled room temperature (59° to 86°F). Once opened, store any unused solution in refrigerator (36° to 46°F). Discard any unused solution after 96 h.Injection for acetaminophen overdose
Store unopened vials at controlled room temperature (68° to 77°F). Diluted solution is stable for up to 24 h at controlled room temperature.
None well documented.
Do not mix with tetracycline, chlortetracycline, oxytetracycline, erythromycin lactobionate, amphotericin B, ampicillin sodium, iodized oil, chymotrypsin, trypsin, or hydrogen peroxide.
None well documented.
Tachycardia, hypotension, hypertension, chest tightness (oral); tachycardia, chest tightness (greater than 1%; IV).
Rash, pruritus, angioedema (oral); pruritus, rash, flushing (greater than 1%; IV).
Rhinorrhea (oral); ear pain, pharyngitis, throat tightness (greater than 1%; IV).
Nausea, vomiting, stomatitis (oral); nausea, vomiting (greater than 1%; IV).
Anaphylactoid reactions (greater than 1%; IV).
Bronchospasm, bronchial irritation (oral); rhinorrhea, rhonchi (greater than 1%; IV).
Fever, clamminess (oral).
Ensure that blood for baseline acetaminophen plasma level, liver enzymes, bilirubin, prothrombin time, electrolytes, blood sugar, BUN, and creatinine has been drawn before initiating therapy and then daily for duration of therapy.Mucolytic
Category B .
Serious anaphylactoid reactions, including death, have been reported with IV administration.
If allergic reaction, encephalopathy, or severe, persistent vomiting occurs, discontinuation of drug may be necessary.
Use with caution. If bronchospasm progresses, medication must be discontinued immediately.
Increased secretion volume may occur. When cough is inadequate, open airway may need to be maintained by mechanical suction.
Acute flushing and erythema may occur with IV use.
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