Acetylcysteine
a.k.a. N-acetylcysteine, N-acetyl-L-cysteine
Trade Names:
Mucomyst, Acetadote, Fluimucil, Parvolex
Generic Name:
Acetylcysteine
Classification:
- Mucolytic
- Antidote
Uses:
- Mucolytic Agent used in the treatment of patients with thick, viscous secretions as seen in: Cystic Fibrosis, Tuberculosis, Acute Tracheobronchitis, and Chronic Bronchitis. Works by disrupting the disulfide bonds in mucus.
- Antidote for Acetaminophen Overdose.
Dosage & Administration:
For use as a Mucolytic Agent:
- Aerosol or Direct Instillation to the tracheobronchial tree
- Nebulization Dosage of 10% solution: 6 to 10 mL t.i.d. or q.i.d via face mask, mouthpiece, or tracheostomy
- Nebulization Dosage of 20% solution: 3 to 5 mL t.i.d. or q.i.d via face mask, mouthpiece, or tracheostomy
- Dosage for direct instillation to tracheobronchial tree: 1 to 2 mL of 10% or 20% solution
For use as an antidote for Acetaminophen Overdose:
- Orally: Loading dose of 140 mg/kg administered as soon as possible, maintenance dose of 70 mg/kg every 4 hours for 17 doses (if indicated)
- Intravenously: Loading dose of 150 mg/kg administered as soon as possible; first maintenance dose 50 mg/kg; second maintenance dose 100 mg/kg
Pharmokinetics:
Onset: In vitro within 1 minute
Peak Effect: In vitro within 5-10 minutes
Duration: 6-8 hours
Metabolism: deacetylated in the liver to cysteine; crosses the placenta following oral or IV administration
Elimination: principally (70%) nonrenal; 6.25 hours after oral administration; 5.6 hours after IV administration in adults; and 11 hours after IV administration in neonates
Contraindications/Precautions:
- Contraindicated in patients with acute asthma
- Pregnancy: Category B
- To prevent bronchospasm, administer short acting bronchodilator prior to nebulization of Acetylcysteine
Adverse Reactions/Side Effects:
- Sulfurous odor
- Bronchospasm
- Nausea
- Vomiting
- Rhinorrhea
- Bronchorrhea
- Stomatitis
Drug Interactions:
- Afrezza (insulin inhalation, rapid acting)
- Exubera (insulin inhalation, rapid acting)