acetylcysteine (Rx)

Brand and Other Names:N-acetylcysteine, Mucomyst
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

nebulizer solution

  • 10%
  • 20%

Pulmonary Disease

Facilitation of expectoration via mucolysis

Solution (10 and 20%) may be used undiluted; 3-5 mL of 20% solution or 6-10 mL of 10% solution; administer 1 to 10 mL of 20% solution every 6-8 hours or 2 to 20 mL of 10% every 2 to 6 hours

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)

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%

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

>11 years: Solution (10 and 20%) may be used undiluted; 3-5 mL of 20% solution or 6-10 mL of 10% solution; administer 1 to 10 mL of 20% solution every 3 to 4 times/day or 2 to 20 mL of 10% every 2 to 6 hours

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

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

and acetylcysteine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (1)

                • activated charcoal

                  activated charcoal decreases effects of acetylcysteine by Other (see comment). Use Caution/Monitor. Comment: Conflicting reports exist; however, charcoal administration does not preclude acetylcysteine administration for acetaminophen overdose .

                Minor (7)

                • nitroglycerin IV

                  acetylcysteine increases effects of nitroglycerin IV by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

                • nitroglycerin PO

                  acetylcysteine increases effects of nitroglycerin PO by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

                • nitroglycerin rectal

                  acetylcysteine increases effects of nitroglycerin rectal by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

                • nitroglycerin sublingual

                  acetylcysteine increases effects of nitroglycerin sublingual by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

                • nitroglycerin topical

                  acetylcysteine increases effects of nitroglycerin topical by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

                • nitroglycerin transdermal

                  acetylcysteine increases effects of nitroglycerin transdermal by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

                • nitroglycerin translingual

                  acetylcysteine increases effects of nitroglycerin translingual by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

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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

                Contraindications

                Acute asthma

                Documented hypersensitivity

                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

                Not for injection

                Use with caution in patients with asthma or history of bronchospasm; these patients are at increased risk of hypersensitivity reactions

                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

                Since increased bronchial secretions may occur after inhalation, postural drainage, inhalation percussion, and suctioning should follow; if bronchospasm occurs, administer a bronchodilator; discontinue therapy if bronchospasm progresses

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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.

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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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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                NAC oral
                -
                600 mg capsule
                acetylcysteine
                -
                100 mg/mL (10 %) vial
                acetylcysteine
                -
                200 mg/mL (20 %) vial
                acetylcysteine
                -
                100 mg/mL (10 %) vial
                acetylcysteine
                -
                200 mg/mL (20 %) vial
                acetylcysteine
                -
                200 mg/mL (20 %) vial
                acetylcysteine
                -
                200 mg/mL (20 %) vial
                acetylcysteine
                -
                100 mg/mL (10 %) vial
                acetylcysteine
                -
                100 mg/mL (10 %) vial
                acetylcysteine
                -
                200 mg/mL (20 %) vial
                acetylcysteine
                -
                200 mg/mL (20 %) vial
                acetylcysteine
                -
                100 mg/mL (10 %) vial
                acetylcysteine
                -
                200 mg/mL (20 %) vial
                acetylcysteine
                -
                100 mg/mL (10 %) vial
                N-A-C Sustain oral
                -
                600 mg tablet
                acetylcysteine oral
                -
                600 mg capsule
                acetylcysteine intravenous
                -
                200 mg/mL (20 %) vial
                acetylcysteine intravenous
                -
                200 mg/mL (20 %) vial
                acetylcysteine intravenous
                -
                200 mg/mL (20 %) vial
                acetylcysteine intravenous
                -
                200 mg/mL (20 %) vial
                acetylcysteine intravenous
                -
                200 mg/mL (20 %) vial
                Acetadote intravenous
                -
                200 mg/mL (20 %) vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Select a drug:
                Patient Education
                acetylcysteine oral

                NO MONOGRAPH AVAILABLE AT THIS TIME

                USES: Consult your pharmacist.

                HOW TO USE: Consult your pharmacist.

                SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Consult your pharmacist.

                DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                NOTES: No monograph available at this time.

                MISSED DOSE: Consult your pharmacist.

                STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

                Information last revised July 2016. Copyright(c) 2022 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

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                • Compare formulary status to other drugs in the same class.
                • Access your plan list on any device – mobile or desktop.

                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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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.