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acetylcysteine (Rx)Brand and Other Names:N-acetylcysteine, Mucomyst

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

nebulizer solution

  • 10%
  • 20%
more...

Pulmonary Disease

Facilitation of expectoration via mucolysis

5-10 mL of 10% or 20% solution by nebulization q6-8hr PRN

Diagnostic Bronchography

1-2 mL of 20% solution or 2-4 mL of 10% solution administered 2-3 times by nebulization or by intratracheal instillation before procedure

Acetaminophen Overdose

See separate drug monograph, acetylcysteine (antidote)

Acute Hepatic Failure (Orphan)

Not FDA-approved for orphan designation

Orphan sponsor

  • Cumberland Pharmaceuticals, Inc, 2525 West End Ave, Suite 950, Nashville, TN 37203

Contrast Agent-Associated Nephrotoxicity (Off-label)

Prevention

600 mg PO q12hr for 2 days on day before and day of contrast agent administration

Keratoconjunctivitis Sicca (Off-label)

1 drop of 10% solution in eye(s) q6-8hr

Dosing Considerations

Direct instillation: 1-2 mL of 10% or 20% solution q1hr PRN

Routine nursing care of patients with tracheotomy: 1-2 mL of 10% or 20% solution q1-4hr by direct instillation into tracheotomy

Instillation into segment of bronchopulmonary tree via small plastic catheter into trachea (under local anesthesia and direct vision): 2-5 mL of 20% solution via syringe connected to catheter

Instillation via percutaneous intratracheal catheter: 1-2 mL of 20% solution or 2-4 mL of 10% solution q1-4hr via syringe connected to catheter

Administration

Administer aerosolized bronchodilator 10-15 minutes before administering acetylcysteine via nebulization

Nebulizer solution may also be administered PO

Dosage Forms & Strengths

nebulizer solution

  • 10%
  • 20%
more...

Pulmonary Disease

Facilitation of expectoration via mucolysis

1-11 months: 1-2 mL of 20% solution or 2-4 mL of 10% solution by nebulization q6-8hr PRN

1-11 years: 3-5 mL of 20% solution or 6-10 mL of 10% solution by nebulization q6-8hr PRN

>12 years: 5-10 mL of 10% or 20% solution by nebulization q6-8hr PRN

Acetaminophen Overdose

See separate drug monograph, acetylcysteine (antidote)

Ototoxicity Caused by Platinum-Based Chemotherapy (Orphan)

Prevention of ototoxicity caused by platinum-based chemotherapeutic agents used to treat pediatric cancers

Not FDA-approved for orphan indication

Orphan sponsor

  • Galephar Pharmaceutical Research, Inc, Road 198, No. 100 km. 14.7, Juncos Industrial Park, Juncos 00777-3873, Puerto Rico

Keratoconjunctivitis Sicca (Off-label)

1 drop of 10% solution in eye(s) q6-8hr

Dosing Considerations

Direct instillation: 1-2 mL of 10% or 20% solution q1hr PRN

Routine nursing care of patients with tracheotomy: 1-2 mL of 10% or 20% solution q1-4hr by direct instillation into tracheotomy

Instillation via percutaneous intratracheal catheter: 1-2 mL of 20% solution or 2-4 mL of 10% solution q1-4hr via syringe connected to catheter

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Interactions

Interaction Checker

acetylcysteine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Bronchoconstriction

            Bronchospasm

            Calmness

            Chest tightness

            Disagreeable odor

            Drowsiness

            Fever

            Hemoptysis

            Increased volume of bronchial secretions

            Irritation of tracheal or bronchial tract

            Nausea

            Rhinorrhea

            Stomatitis

            Vomiting

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            Warnings

            Black Box Warnings

            Not for injection

            Contraindications

            Acute asthma

            Cautions

            Volume of bronchial secretions may increase after administration; if cough response is inadequate, consider maintaining airway by mechanical suction if necessary; if airway block arises because of foreign body or local accumulation, clear by endotracheal aspiration, with or without bronchoscopy

            Monitor asthmatic patients closely

            In most instances, bronchospasm may be treated by prompt administration of bronchodilator via nebulization; if bronchospasm worsens, discontinue therapy immediately

            Slight disagreeable odor after administration (temporary)

            Face mask may produce sticky film on face after nebulization; remove with water

            Under certain conditions, opened bottle may cause slight purple color change as consequence of chemical reaction; this has no effect on drug safety or efficacy

            Keratoconjunctivitis: Remove contact lenses; do not coadminister with topical antibiotics

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            Pregnancy & Lactation

            Pregnancy category: B

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

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Exerts mucolytic activity through sulfhydryl group, which opens up disulfide bonds in mucoproteins and lowers mucous viscosity of pulmonary secretions

            Absorption

            Onset: 5-10 min

            Peak plasma time: 1-2 hr

            Distribution

            Duration: Variable (~1 hr)

            Protein bound: 80%

            Metabolism

            Metabolized in liver

            Elimination

            Excretion: Urine (primarily)

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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