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.
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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)

References:

www.drugs.com

www.reference.medscape.com

Integrated Cardiopulmonary Pharmacology, Colbert, Bruce.