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Acetylcysteine

Oral
Intravenous
Inhalation
Class
Mucolytics
Subclass
Thiol derivatives
Generic name
Acetylcysteine, N-acetylcysteine
Brand names
Acetadote®
Common formulations
Oral solution
Dosage and administration
Adults patients
Treatment
Acetaminophen overdose
•
Loading: 140 mg/kg PO once
•
Maintenance: 70 mg/kg PO q4h for 17 doses starting 4 hours after the loading dose
Facilitation
Facilitation of diagnostic bronchial studies
•
1-2 mL PO twice (20% solution)
Alternative
•
2-4 mL PO twice (10% solution)
Other off-label uses
•
Treatment of OCD
Indications for use
Labeled indications
Adults
•
Treatment of acetaminophen overdose
•
Adjunctive treatment for respiratory conditions (abnormal, viscid, or inspissated bronchial secretions)
•
Facilitation of diagnostic bronchial studies
Off-label indications
Adults
•
Treatment of OCD
Safety risks
Contraindications
Hypersensitivity to acetylcysteine or any of its components
Warnings and precautions
Bronchospasm
•
Use caution in patients with asthma or a history of bronchospasm.
Gastrointestinal hemorrhage
•
Use caution in patients with esophageal varices or peptic ulcer disease.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B2
•
Use only if clearly needed. Evidence of fetal harm in animals. Adequate and well-controlled studies have not been performed in women receiving acetylcysteine during pregnancy; however, acetylcysteine does cross the placenta and has been detected in the cord blood of infants whose mothers received the drug at delivery.
Breastfeeding
Unlikely to have adverse effects in breastfed infants.
•
Acceptable for use during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Anaphylaxis
Common 1-10%
•
Edema, itching, skin flushing, urticaria
Uncommon < 1%
•
Hypotension
Unknown frequency
•
Bronchospasm, dysgeusia, erythema, pharyngitis, dyspnea, fever, hemoptysis, nausea, rhinorrhea, skin rash, somnolence, vomiting, stomatitis, wheezing
Interactions
Drug(s)
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