Acetylcysteine PO, NG, IV
PO / NG:
Give IV solution orally (unlicensed section 29 use - see below)
Acetadote and Parvolex are supplied as sterile solutions in 10ml vials containing 20% (200 mg/ml) acetylcysteine.
Compatible with 5% dextrose. Prepare immediately before use and discard any solution not used within 24 hours.
Note: Section 29 drug when administered orally (requires specific notification to Director-General of Health as unapproved route of administration)
150mg/kg over 15 minutes; 50mg/kg over the next 4 hours,100mg per kg over the next 16 hours. Total dose 300mg/kg in 20 hours
Initial dose: 150mg/kg in 200ml of D5W over 15 minutes
Second dose: 50mg/kg in 500ml of D5W over 4 hours
Third dose: 100mg/kg in 1000ml of D5W over 16 hours
150mg/kg over 15 minutes; 50mg/kg over the next 4 hours, 100mg per kg over the next 16 hours. Total dose 300mg/kg in 20 hours
Note: - In children, N-acetylcysteine should be given intravenously as a 40 mg/mL solution in 5% dextrose in water. This is to prevent possible hyponatraemia.
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
No dose adjustment is required.
Acetylcysteine likely protects the liver by maintaining or restoring the glutathione levels, or by acting as an alternate substrate for conjugation with, and thus detoxification of, the reactive metabolite.
Hypersensitivity or previous anaphylactoid reactions to acetylcysteine
Serious anaphylactoid reactions, including death in a patient with asthma, have been reported in patients administered acetylcysteine intravenously.
The total volume administered should be adjusted for patients less than 40 kg and for those requiring fluid restriction (use paediatric dosage regimen).
No tests are required in addition to routine ICU blood tests
Drug/Laboratory Test Interactions
Body as a Whole:
Urticaria, vasodilatation, rash and itch
Dyspepsia, nausea, vomiting
Abnormal thinking (dysphoria), Gait disturbances
Bronchospasm, coughing, dyspnoea
Skin & Appendages
Angioedema, facial erythema, palmar erythema, pruritus, pruritus, rash, sweating