AHFS Class:

91:04.04 Acetaminophen antidote

Generic Name

• Acetylcysteine

Acetylcysteine is available as a 20% (200 mg/mL) concentrate for injection in 30-mL single-dose preservative-free vials containing 6 g of the drug.²⁸⁶¹ Each mL of the concentrate contains acetylcysteine 200 mg in water for injection with sodium hydroxide to adjust the pH.²⁸⁶¹ This concentrate must be diluted prior to administration.²⁸⁶¹

pH

6 to 7.5.²⁸⁶¹

Osmolarity

Acetylcysteine concentrate for injection has an osmolarity of 2600 mOsm/L.²⁸⁶¹ The manufacturer provides the osmolarity of acetylcysteine solutions for the following dilutions:²⁸⁶¹

The osmolarity of acetylcysteine solutions was calculated for the following dilutions:³⁸⁸⁶

Trade Name(s)

Acetadote

Acetylcysteine is administered by intravenous infusion after dilution in dextrose 5%, sodium chloride 0.45%, or sterile water for injection.²⁸⁶¹ The total recommended dose of the drug is generally administered as 3 sequential intravenous infusions (loading dose, second dose, third dose) over 21 hours.²⁸⁶¹ The total volume of the infusions should be adjusted for patients weighing 40 kg or less and those requiring fluid restriction.²⁸⁶¹

For patients weighing 41 kg or more, the manufacturer recommends the loading dose be added to 200 mL for infusion over 60 minutes.²⁸⁶¹ The second dose should be mixed in 500 mL and delivered over 4 hours.²⁸⁶¹ The third dose should be mixed in 1 L and delivered over 16 hours.²⁸⁶¹

For patients weighing 21 to 40 kg, the manufacturer recommends the loading dose be added to 100 mL for infusion over 60 minutes.²⁸⁶¹ The second dose should be mixed in 250 mL and delivered over 4 hours.²⁸⁶¹ The third dose should be mixed in 500 mL and delivered over 16 hours.²⁸⁶¹

For patients weighing 5 to 20 kg, the manufacturer recommends the loading dose be diluted in 3 mL/kg of body weight for infusion over 60 minutes.²⁸⁶¹ The second dose should be mixed in 7 mL/kg of body weight and delivered over 4 hours.²⁸⁶¹ The third dose should be mixed in 14 mL/kg of body weight and delivered over 16 hours.²⁸⁶¹

Intact vials of acetylcysteine should be stored at controlled room temperature.²⁸⁶¹ The vials are for single use; any unused portion remaining in vials should be discarded.²⁸⁶¹ The manufacturer states that the color of acetylcysteine injection may vary from colorless to slight pink or purple after stopper penetration, but this color change does not indicate an adverse effect on drug quality.²⁸⁶¹

The manufacturer states diluted solutions may be stored for 24 hours at room temperature.²⁸⁶¹

Solution Compatibility

Y-Site Injection Compatibility (1:1 Mixture)

For a list of references cited in the text of this monograph, search the monograph titled References.

ASHP^® Injectable Drug Information^TM. Selected Revisions December 5, 2024. © Copyright, 2024. American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.