Treatment of acetaminophen overdosage. Optimal if given within 8 hours of acetaminophen ingestion; may be effective when given ≥24 hours after ingestion.
Prevention of Nephropathy Associated with Radiographic Contrast Media
Has been used to prevent radiographic contrast media-induced nephropathy†. Efficacy for this indication not established; additional study needed.
Mucolytic Uses
Adjunctive treatment for patients with abnormal, viscid, or inspissated mucous secretions associated with conditions such as acute and chronic bronchopulmonary disorders (e.g., pneumonia, bronchitis, emphysema, tracheobronchitis, chronic asthmatic bronchitis, tuberculosis, bronchiectasis, primary amyloidosis of the lung); atelectasis caused by mucus obstruction; pulmonary complications of cystic fibrosis; pulmonary complications of thoracic and cardiovascular surgery; and post-traumatic chest conditions.
Used during anesthesia and in the preparation of patients for bronchograms, bronchospirometry, bronchial wedge catheterization, and other diagnostic bronchial studies.
Determine plasma or serum acetaminophen concentrations as soon as possible (but no sooner than 4 hours) after ingestion. May be appropriate to obtain an additional sample at 4–6 hours after initial sample if extended-release acetaminophen preparation was ingested.
Use plasma or serum acetaminophen concentrations in conjunction with a nomogram to estimate potential for hepatotoxicity and necessity of acetylcysteine therapy.
Full course of acetylcysteine therapy indicated if initial plasma or serum acetaminophen concentrations fall on or above the dashed line on the nomogram. (See nomogram.)
Assistance available from a regional poison center at 800-222-1222 or an assistance line for acetaminophen overdosage at 800-525-6115.
Multiple Supratherapeutic Acetaminophen Doses
Guidelines for the treatment of ingestions involving multiple, higher-than-recommended acetaminophen doses over an extended period of time currently are not available. Plasma AST/ALT concentrations and plasma or serum acetaminophen concentrations have been used to estimate potential for hepatotoxicity and necessity of acetylcysteine therapy.
Assistance available from a regional poison center at 800-222-1222 or an assistance line for acetaminophen overdosage at 800-525-6115.
Administration
Administer orally or by IV infusion as an antidote for acetaminophen overdosage; administer by oral inhalation or intracheal instillation for mucolytic uses.
Has been administered orally or IV for prevention of radiographic contrast media-induced nephropathy†.
Oral Administration
Usually administered as a 5% solution. Dilute 20% solution 1:3 with diet soft drink.
Initiate antiemetic therapy or administer via duodenal tube if persistently unable to retain orally administered drug.
NG Tube
Administer as 5% solution; may use water as the diluent.
IV Administration
For solution and drug compatibility information, see Compatibility under Stability.
Administer as a loading dose, followed by a first maintenance dose, then a second maintenance dose.
Injection concentrate must be diluted prior to IV administration.
Dilution
Dilute dose with an appropriate volume of 5% dextrose injection (see table).
Adjust total volume for patients who weigh <40 kg (see table) and for those requiring fluid restriction.
Table 1. Recommended Volumes of 5% Dextrose Injection for Dilution of IV Acetylcysteine Doses
Volume of Diluent for Indicated Dose
Patient’s Weight (kg)
Loading Dose
First Maintenance Dose
Second Maintenance Dose
≥40
200 mL
500 mL
1 L
30
100 mL
250 mL
500 mL
25
100 mL
250 mL
500 mL
20
60 mL
140 mL
280 mL
15
45 mL
105 ml
210 mL
10
30 mL
70 ml
140 mL
Rate of Administration
Loading dose: Infuse over 60 minutes.
First maintenance dose: Infuse over 4 hours.
Second maintenance dose: Infuse over 16 hours.
Oral Inhalation and Intratracheal Instillation
For drug compatibility information, see Compatibility under Stability.
Use 20% acetylcysteine solution undiluted or dilute with 0.9% sodium chloride injection or inhalation solution or sterile water for injection or inhalation.
May use 10% acetylcysteine solution undiluted.
Dosage
Available as acetylcysteine and acetylcysteine sodium; dosage expressed in terms of acetylcysteine.
Pediatric Patients
Antidote for Acetaminophen Overdosage
Oral
Loading dose: 140 mg/kg, administered as soon as possible. Maintenance dosage, if indicated: 70 mg/kg every 4 hours for 17 doses.
If patient vomits a loading or maintenance dose within 1 hour of administration, repeat the dose.
IV
Loading dose: 150 mg/kg, administered as soon as possible.
First maintenance dose: 50 mg/kg.
Second maintenance dose: 100 mg/kg.
Mucolytic Uses
Nebulization
Face mask, mouthpiece, or tracheostomy: 3–5 mL of the 20% solution or 6–10 mL of the 10% solution 3 or 4 times daily; alternatively, 1–10 mL of the 20% solution or 2–20 mL of the 10% solution every 2–6 hours.
Tent or croupette: Volume of acetylcysteine solution should be sufficient to maintain a very heavy mist in the tent or croupette for the desired period; maintenance of heavy mist may require up to 300 mL of the 10 or 20% solution for a single, continuous treatment. Administer intermittently or for continuous prolonged periods.
Direct Instillation
1–2 mL of a 10–20% solution as often as every hour.
Intratracheal Instillation
Instillation through a percutaneous intratracheal catheter: 1–2 mL of the 20% solution or 2–4 mL of the 10% solution every 1–4 hours via a syringe attached to the catheter.
Instillation through a catheter into the trachea: 2–5 mL of the 20% solution via a syringe attached to the catheter.
Diagnostic Bronchial Studies
Nebulization
2 or 3 doses of 1–2 mL of the 20% solution or 2–4 mL of the 10% solution prior to the procedure.
Intratracheal Instillation
2 or 3 doses of 1–2 mL of the 20% solution or 2–4 mL of the 10% solution prior to the procedure.
Tracheostomy Care
Intratracheal Instillation
1–2 mL of a 10–20% solution into the tracheostomy every 1–4 hours.
Adults
Antidote for Acetaminophen Overdosage
Oral
Loading dose: 140 mg/kg, administered as soon as possible. Maintenance dosage, if indicated: 70 mg/kg every 4 hours for 17 doses.
If patient vomits a loading or maintenance dose within 1 hour of administration, repeat the dose.
IV
Loading dose: 150 mg/kg, administered as soon as possible.
First maintenance dose: 50 mg/kg.
Second maintenance dose: 100 mg/kg.
Prevention of Nephropathy Associated with Radiographic Contrast Media
Oral
600 mg twice daily, given the day before and the day of contrast media administration (total of 4 doses), has been used. Other dosage regimens have been investigated. †
Mucolytic Uses
Nebulization
Face mask, mouthpiece, tracheostomy: 3–5 mL of the 20% solution or 6–10 mL of the 10% solution 3 or 4 times daily; alternatively, 1–10 mL of the 20% solution or 2–20 mL of the 10% solution every 2–6 hours.
Tent or croupette: Volume of acetylcysteine solution should be sufficient to maintain a very heavy mist in the tent or croupette for the desired period; maintenance of heavy mist may require up to 300 mL of the 10 or 20% solution for a single, continuous treatment. Administer intermittently or for continuous prolonged periods.
Direct Instillation
1–2 mL of a 10–20% solution as often as every hour.
Intratracheal Instillation
Instillation through a percutaneous intratracheal catheter: 1–2 mL of the 20% solution or 2–4 mL of the 10% solution every 1–4 hours via a syringe attached to the catheter.
Instillation through a catheter into the trachea: 2–5 mL of the 20% solution via a syringe attached to the catheter.
Diagnostic Bronchial Studies
Nebulization
For diagnostic bronchial studies: 2 or 3 doses of 1–2 mL of the 20% solution or 2–4 mL of the 10% solution prior to the procedure.
Intratracheal Instillation
For diagnostic bronchial studies: 2 or 3 doses of 1–2 mL of the 20% solution or 2–4 mL of the 10% solution prior to the procedure.
Tracheostomy Care
Intratracheal Instillation
1–2 mL of a 10–20% solution into the tracheostomy every 1–4 hours.
Special Populations
Hepatic Impairment
Antidote for Acetaminophen Overdosage
IV
Published reports do not indicate that the dose should be reduced in patients with hepatic impairment. Data are not available to determine whether dosage adjustment is needed in patients with hepatic cirrhosis.
Renal Impairment
Antidote for Acetaminophen Overdosage
IV
Data are not available to determine whether dosage adjustment is needed in patients with moderate or severe renal impairment.
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