Drug Index

Acetyl Cysteine

Synonym :

N-Acetyl Cysteine

Mechanism :

Acetylcysteine is the N-acetyl derivative of the naturally-occurring amino acid, cysteine. The compound is a white crystalline powder with the molecular formula C5H9NO3S5 a molecular weight of 163.2, and chemical name of N-acetyl-L-cysteine.
Acetylcysteine has mucolytic function which is related to the sulfhydryl group in the molecule. This group "opens" disulfide linkages in mucus thus lowering the viscosity.

Indication :

  • Acetaminophen toxicity
  • Post liver transplant
  • Acute liver failure
  • Adjunctive therapy in patients with abnormal or viscid mucous secretions in bronchopulmonary diseases, pulmonary complications of surgery, and cystic fibrosis.
  • Meconium ileus

Contraindications :

In patients with a prior history of hypersensitivity to any of the ingredients. Also, in asthmatics and patients with history of bronchospasm.

Dosing :

Only the 72-hour oral and 21-hour IV regimens are FDA approved.
Paracetamol overdose: (ideally within 8-10 hours following ingestion)
IV: Loading dose of 150 mg/kg IV in D5W infused over 1 hour, followed by 50 mg/kg in D5W infused over 4 hours and then 100 mg/kg IV in D5W infused over 16 hours.
Oral: 75 mg/kg orally every 4 hours for next 2-3 days.
Acute liver failure:
100 mg/kg/d IV infusion upto 72 hours.
Administer aerosolized bronchodilator 10-15 minutes prior to acetylcysteine nebulization.
1-11 months: 1-2 mL of 20% or 2-4 mL of 10% solution by nebulizer every 6-8 hours as when required.
12 months-11 years: 3-5 mL of 20% or 6-10 mL of 10% solution by nebulizer every 6-8 hours.
>11 years: 6-10 ml of 10% solution or 3-5 ml of 20% solution by nebulizer every 6-8 hours.

Adverse Effect :

Anaphylaxis and hypersensitivity reactions causing flushing, urticaria, angioedema, nausea, vomiting, tachycardia, hypotension, bronchospasm, chest tightness, disagreeable odour, drowsiness, fever, hemoptysis, increased volume of bronchial secretions.

Interaction :

There are no significant drug interactions with acetylcysteine however caution must be taken while administering it with:

Auranofin, activated charcoal and Gold sodium thiomalate: May decrease the efficacy of acetylcysteine.

Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Dose as in normal renal function
10-20Dose as in normal renal function
<10Dose as in normal renal function.

Dose in Patients undergoing Renal Replacement Therapies
CAPDLikely to be Dialysed. Dose as in normal renal function
HDDialysed. Dose as in normal renal function
HDF/High fluxDialysed. Dose as in normal renal function
CAV/VVHDLikely to be Dialysed. Dose as in normal renal function

Hepatic Dose :

Although there is a 3-fold increase in acetylcysteine plasma concentrations in patients with cirrhosis, no dosage adjustments are recommended.
12/21/2023 02:15:25 Acetyl Cysteine
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