Acetylcysteine (N-Acetylcysteine)(a se teel sis’ tay een)
Acetadote
PREGNANCY CATEGORY B
Drug Classes
Antidote
Mucolytic
Therapeutic Actions
Mucolytic activity: Splits links in the mucoproteins contained in respiratory mucus secretions, decreasing the viscosity of the mucus. Antidote to acetaminophen hepatotoxicity: Protects liver cells by maintaining cell function and detoxifying acetaminophen metabolites.
Indications
Mucolytic adjuvant therapy for abnormal, viscid, or inspissated mucus secretions in acute and chronic bronchopulmonary disease (emphysema with bronchitis, asthmatic bronchitis, tuberculosis, pneumonia, primary bronchiectasis, lung amyloidosis), in pulmonary complications of cystic fibrosis, and in tracheostomy care; pulmonary complications associated with surgery, anesthesia, post-traumatic chest conditions; diagnostic bronchial studies (oral solution only)
To prevent or lessen hepatic injury that may occur after ingestion of a potentially hepatotoxic dose of acetaminophen; treatment must start as soon as possible; most often administered if levels are still high 8 hr after the overdose, but can be given within 24 hr after ingestion; IV use approved for this indication
Unlabeled uses: As ophthalmic solution to treat keratoconjunctivitis sicca (dry eye); as an enema to treat bowel obstruction due to meconium ileus or its equivalent; prevention of radiocontrast-induced nephrotoxicity; chronic blepharitis
Contraindications and Cautions
Mucolytic use
Contraindicated with hypersensitivity to acetylcysteine; use caution and discontinue immediately if bronchospasm occurs.
Antidotal use
No contraindications; use caution with esophageal varices, peptic ulcer.
Available Forms
Solution—10%, 20%; injection—200 mg/mL
Dosages
Adult and pediatric patients
Mucolytic use
Nebulization with face mask, mouthpiece, tracheostomy: 3–5 mL of the 20% solution or 6–10 mL of the 10% solution tid or qid.
Nebulization with tent, croupette: Very large volumes are required, occasionally up to 300 mL, during a treatment period. The dose is the volume or solution that will maintain a very heavy mist in the tent or croupette for the desired period. Administration for intermittent or continuous prolonged periods, including overnight, may be desirable.
Instillation
Direct or by tracheostomy: 1–2 mL of a 10%–20% solution every 1–4 hr; may be introduced into a particular segment of the bronchopulmonary tree by way of a plastic catheter (inserted under local anesthesia and with direct visualization). Instill 2–5 mL of the 20% solution by a syringe connected to the catheter.
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