Generic Name

Acetylcysteine

Precaution

Asthmatic patients, history of bronchospasm, peptic ulceration. Pregnancy, lactation. Lactation: Unknown whether agent is excreted in milk; use with caution.

Indication

Tuberculosis, Chronic emphysema, Paracetamol poisoning, Bronchiectasis, Pneumonia, Atelectasis, Cystic fibrosis, Tracheostomy care, during anaesthesia

Contra Indication

Acetylcysteine is contraindicated in those patients who are sensitive to it.

Dose

N/A

Side Effect

Flushing, fever, stomatitis, nausea, vomiting, rhinorrhoea, bronchospasm, anaphylactoid reactions, rashes. Rarely, blurred vision, bradycardia, syncope, thrombocytopenia, convulsions. Potentially Fatal: Rarely, respiratory or cardiac arrest.

Pregnancy Category

Mode of Action

Acetylcysteine may decrease the viscosity of secretions by splitting of disulphide bonds in mucoproteins. It also promotes the detoxification of an intermediate paracetamol metabolite which is used in the management of paracetamol overdosage.

Interaction

Drug stability and safety of acetylcysteine when mixed with other drugs in a nebulizer have not been established.

Pregnancy Category Note

Pregnancy category: B Lactation: Unknown whether agent is excreted in milk; use with caution

Adult Dose

Oral As a mucolytic Adult: As effervescent granules or tablets: 200 mg tid. Paracetamol poisoning Adult: After gastric lavage or induction of emesis with ipecac syrup, admin loading dose of 140 mg/kg, followed by maintenance doses of 70 mg/kg every 4 hr for a total of 17 doses. 1st maintenance dose to be given 4 hr after the loading dose. Repeat dose if the patient vomits within 1 hr of admin. Continue therapy until paracetamol levels are not detectable and there is no evidence of hepatotoxicity. Inhalation As a mucolytic Adult: 3-5 ml of a 20% solution or 6-10 ml of a 10% solution 3-4 times daily by nebulising through a face mask, mouth piece or tracheostomy. May increase to 1-10 ml of a 20% solution or 2-20 ml of a 10% solution every 2-6 hr if needed. Endotracheal As a mucolytic Adult: Instill 1-2 ml of a 10-20% solution as often as every hrly.

Child Dose

Oral As a mucolytic Child: As effervescent granules or tablets: 2-7 yr: 200 mg bid; <2 yr: 200 mg daily. Paracetamol poisoning Child: After gastric lavage or induction of emesis with ipecac syrup, admin loading dose of 140 mg/kg, followed by maintenance doses of 70 mg/kg every 4 hr for a total of 17 doses. 1st maintenance dose to be given 4 hr after the loading dose. Repeat dose if the patient vomits within 1 hr of admin. Continue therapy until paracetamol levels are not detectable and there is no evidence of hepatotoxicity. Inhalation As a mucolytic Child: 3-5 ml of a 20% solution or 6-10 ml of a 10% solution 3-4 times daily by nebulising through a face mask, mouth piece or tracheostomy. May increase to 1-10 ml of a 20% solution or 2-20 ml of a 10% solution every 2-6 hr if needed. Endotracheal As a mucolytic Child: Instill 1-2 ml of a 10-20% solution as often as every hrly.

Renal Dose

N/A

Administration

N/A