Adult Dosing

Acetaminophen overdosage

• Loading dose: 140 mg/kg PO
• Maintenance dose: 70 mg/kg 4 hrs after the loading dose, repeat q4 hrs x 17 doses

Note:

• Before administering acetylcysteine stomach should be emptied promptly by lavage or by inducing emesis
• To be administer within 24 hrs of ingestion
• Repeat dose if vomited within 1 hr of the oral administration

Pediatric Dosing

Acetaminophen overdosage

• Loading dose: 140 mg/kg PO
• Maintenance dose: 70 mg/kg PO 4 hrs after the loading dose, repeat q4 hrs x 17 doses

Note:

• Before administering acetylcysteine stomach should be emptied promptly by lavage or by inducing emesis
• To be administer within 24 hrs of ingestion
• Repeat dose if vomited within 1 hr of the oral administration

• To prevent or lessen hepatic injury following potentially hepatotoxic overdosage of acetaminophen

• Hypersensitivity to any of the ingredients of the product

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• To avoid further administration of nitrogenous substances, discontinue the acetylcysteine treatment, if encephalopathy due to hepatic failure becomes evident
• Acetylcysteine treatment can aggravate the vomiting, occurred due to acute acetaminophen overdosage. Evaluate the patient at risk of gastric hemorrhage, concerning the risk of upper gastrointestinal hemorrhage versus the risk of developing hepatic toxicity and then give the acetylcysteine treatment accordingly
• Dilution of acetylcysteine minimizes risk of aggravating vomiting
• Occasionally urticaria and other allergic reactions have been observed with oral acetylcysteine therapy, discontinue the treatment unless it is deemed essential or the allergic symptoms are controlled

Caution: Use cautiously in

• Risk of gastric hemorrhage

Pregnancy Category:B

Breastfeeding: Safety unknown; manufacturer advises caution.

• GI: Nausea, vomiting, GI bleeding
• DERM: Pruritus, rash, urticaria
• CV: Decreased cardiac function, EKG changes
• IMMU: Anaphylactoid reaction
• NEURO: Status epilepticus
• RESP: Bronchospasm, Respiratory distress
• MISC: Fever

• Antidote; protect against acetaminophen overdose-induced hepatotoxicity, by producing the glutathione precursor cysteine and thus maintaining or restoring hepatic concentrations of glutathione, which inactivates intermediate metabolite of acetaminophen that is thought to be hepatotoxic
• Partially metabolized by liver
• Renally excreted 22%
• Half-life: 5.6 hrs (adult); 11 hrs (newborns)

US Trade Name(s)

• Only generic available

US Availability

acetylcysteine (generic)

• ORAL SOLN: 10% (100 mg/mL)
• ORAL SOLN: 20% (200 mg/mL)

Canadian Trade Name(s)

• Mucomyst
• Parvolex

Canadian Availability

acetylcysteine (generic)

• ORAL SOLN: 20% (200 mg/mL)

Mucomyst

• ORAL SOLN: 20% (200 mg/mL)

Parvolex

• ORAL SOLN: 20% (200 mg/mL)

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• Mucomyst

Australian Availability

Mucomyst

• ORAL SOLN: 20% (200 mg/mL)

Pulmonary

Mucolytics

Emergency/Critical Care

Antidotes