Pulmonary - acetylcysteine

acetylcysteine (Mucomyst ®, Acetadote ®)

Mucolytic agent.
Adult (usual):
Acetaminophen poisoning: 140 mg/kg orally, followed by 17 doses of 70 mg/kg every 4 hours. Repeat dose if emesis occurs within 1 hour of administration. Therapy should continue until all doses are administered even though the acetaminophen plasma level has dropped below the toxic range. Alternatively: Give Acetadote ®: Loading dose: 150 mg/kg IV over 60 minutes. Maintenance dose: 50 mg/kg infused over 4 hours followed by 100 mg /kg infused over 16 hours. Note: To avoid fluid overload in patients <40 kg and those requiring fluid restriction, decrease volume of D5W proportionally.

Adjuvant therapy in respiratory conditions: Note: Patients should receive bronchodilator 15 minutes prior to dose. Inhalation, nebulization: 10% and 20% solution. Dilute 20% solution with sodium chloride or sterile water for inhalation. 10% solution may be used undiluted: 3-5 ml of 20% solution or 6-10 ml of 10% solution until nebulized - given 3-4 times/day. Dosing range: 1-10 ml of 20% solution or 2-20 ml of 10% solution every 2-6 hours. Into tracheostomy: 1-2 ml of 10% to 20% solution every 1-4 hours.

Decrease risk of contrast-induced nephropathy: (4 doses total): 600 mg (3ml) po BID on the day before the contrast injection, then 600 mg (3ml) in a.m. on the day of the contrast injection (immediately before) and 600 mg (3ml) in the evening. In all cases the patient should be well hydrated. This is particularly important in patients with underlying renal dx or diabetes mellitus. Hydrate patient with saline concurrently.

Supplied: (Mucomyst ® soln): 10% [100 mg/ml] - 4 ml, 10 ml, 30 ml. 20% [200 mg/ml] - 4 ml, 10 ml, 30 ml. (Acetadote ® injection): 20% [200 mg/ml] (30 ml)
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David F. McAuley, Pharm.D., R.Ph.  GlobalRPh Inc.
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