• PO, IV: Antidote for the management of potentially hepatotoxic overdose of acetaminophen.
• Inhaln: Mucolytic in the management of conditions associated with thick viscid mucous secretions.

Unlabeled Uses:

• PO: Prevention of radiocontrast-induced renal impairment.

Contraindicated in:

• Hypersensitivity.

Use Cautiously in:

• Severe respiratory insufficiency, asthma, or history of bronchospasm
• History of GI bleeding (oral only)
• OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk
• Lactation: Safety not established in breastfeeding.

CV: hypotension, tachycardia.

Derm: rash, clamminess, pruritus, urticaria.

EENT: rhinorrhea.

F and E: fluid overload.

GI: nausea, vomiting, stomatitis.

Neuro: drowsiness.

Resp: bronchospasm, ↑ secretions, bronchial/tracheal irritation, chest tightness.
Misc: chills, fever, (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA) (PRIMARILY WITH IV)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• Activated charcoal may adsorb orally administered acetylcysteine and ↓ its effectiveness as an antidote.

(Generic available)

• Solution for inhalation: 10% (100 mg/mL); 20% (200 mg/mL);
• Solution for injection: 200 mg/mL;

Acetaminophen Overdose

• PO (Adults and Children): 140 mg/kg initially, followed by 70 mg/kg every 4 hr for 17 additional doses.
• IV (Adults and Children): Loading dose: 150 mg/kg (maximum: 15 g) over 60 min initially, followed by First maintenance dose: 50 mg/kg (maximum: 5 g) over 4 hr. Second maintenance dose: 100 mg/kg (maximum: 10 g) over 16 hr.

Mucolytic

• Inhaln (Adults and Children 1–12 yr): Nebulization via face mask: 3–5 mL of 20% solution or 6–10 mL of the 10% solution 3–4 times daily; Nebulization via tent or croupette: volume of 10–20% solution required to maintain heavy mist; Direct instillation: 1–2 mL of 10–20% solution every 1–4 hr; Intratracheal instillation via tracheostomy: 1–2 mL of 10–20% solution every 1–4 hr (up to 2–5 mL of 20% solution via tracheal catheter into particular segments of the bronchopulmonary tree).
• Inhaln (Infants): Nebulization: 1–2 mL of 20% solution or 2–4 mL of 10% solution 3–4 times daily.

Prevention of Radiocontrast-Induced Renal Impairment

• PO (Adults): 600 mg twice daily for 2 days, beginning the day before the procedure.

Acetadote, Mucomyst

• PO, IV: Decreases the buildup of a hepatotoxic metabolite in acetaminophen overdosage.
• Inhaln: Degrades mucus, allowing easier mobilization and expectoration.

• PO: Prevention or lessening of liver damage following acetaminophen overdose.
• Inhaln: Lowers the viscosity of mucus.

Therapeutic Classification: antidotes (for acetaminophen toxicity), mucolytic

Absorption: Absorbed from the GI tract following oral administration. Action is local following inhalation; remainder may be absorbed from pulmonary epithelium. IV administration results in complete bioavailability.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Partially metabolized by the liver, 22% excreted renally.

Half-life: Adults: 5.6 hr (↑ in hepatic impairment) Newborns: 11 hr.

• Advise patient to notify health care professional if symptoms of hypersensitivity reaction or fluid overload occur.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding for 30 hr after administration.
• Acetaminophen Overdose: Explain purpose of medication to patient.
• Inhaln: Instruct patient to clear airway by coughing deeply before taking aerosol treatment.
  • Inform patient that unpleasant odor of this drug becomes less noticeable as treatment progresses and medicine dissipates.

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