Acetylcysteine

Acetylcysteine may be used to help clear mucus in chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, and tracheostomy care.

Acetylcysteine is a naturally occurring amino acid solution that is used to help clear mucus (acts as a mucolytic agent) and material entrapped in mucus in people with mucus that may interfere with breathing or other functions. For example, acetylcysteine solution may be used to help clear mucus in chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, and tracheostomy care. Acetylcysteine solution may also be used as an antidote for acetaminophen toxicity.

Acetylcysteine is available under the following different brand names: N-acetylcysteine, and Mucomyst.

Dosages of Acetylcysteine:

Adult and Pediatric Dosage Forms and Strengths

Nebulizer solution

• 10%
• 20%

Dosage Considerations – Should be Given as Follows:

Pulmonary Disease

• Facilitation of expectoration via mucolytic
• Adult: 5-10 mL of 10% or 20% solution by nebulization every 6-8 hours as needed
• Pediatric:
• Children 1-11 months: 1-2 mL of 20% solution or 2-4 mL of 10% solution by nebulization every 6-8 hours as needed
• Children 1-11 years: 3-5 mL of 20% solution or 6-10 mL of 10% solution by nebulization every 6-8 hours as needed
• Children over 12 years: 5-10 mL of 10% or 20% solution by nebulization every 6-8 hours as needed

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 the procedure

Acetaminophen Overdose

• See separate drug monograph, acetylcysteine (antidote)

Contrast Agent-Associated Nephrotoxicity (Off-label)

• Prevention
• 600 mg orally every 12 hours for 2 days on the day before and day of contrast agent administration

Keratoconjunctivitis Sicca (Off-label)

• Adult and pediatric: 1 drop of 10% solution in the eye(s) every 6-8 hours

Dosing Considerations

• 3-4 g intravenous/intramuscular (IV/IM) every 4-6 hours; not to exceed 24 g/24 hours

Uncomplicated Gonorrhea

• Direct instillation: 1-2 mL of 10% or 20% solution every hour as needed
• Routine nursing care of patients with tracheotomy: 1-2 mL of 10% or 20% solution every 1-4 hours by direct instillation into tracheotomy
• Instillation into a segment of the bronchopulmonary tree via small plastic catheter into the trachea (under local anesthesia and direct vision): 2-5 mL of 20% solution via a syringe connected to a catheter
• Instillation via percutaneous intratracheal catheter: 1-2 mL of 20% solution or 2-4 mL of 10% solution every 1-4 hours via a syringe connected to a catheter

Administration

• Administer aerosolized bronchodilator 10-15 minutes before administering acetylcysteine via nebulization
• Nebulizer solution may also be administered orally

Common side effects of acetylcysteine include:

• Bronchospasm
• Disagreeable odor
• Drowsiness
• Fever
• Coughing up blood
• Increased volume of bronchial secretions
• Irritation of tracheal or bronchial tract
• Nausea
• Runny or stuffy nose
• Swelling and sores inside the mouth
• Vomiting
• Clamminess
• Wheezing
• Shortness of breath

Serious side effects of acetylcysteine include:

• Chest tightness
• Bronchoconstriction
• Bleeding

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Acetylcysteine has no known severe interactions with other drugs.

Acetylcysteine has no known serious interactions with other drugs.

Moderate interactions of acetylcysteine include:

• activated charcoal

Mild interactions of acetylcysteine include:

• azithromycin
• bazedoxifene/conjugated estrogens
• chloramphenicol
• clarithromycin
• demeclocycline
• dichlorphenamide
• doxycycline
• erythromycin base
• erythromycin ethylsuccinate
• erythromycin lactobionate
• erythromycin stearate
• minocycline
• probenecid
• sodium picosulfate/magnesium oxide/anhydrous citric acid
• tetracycline
• vancomycin

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

Warnings

Not for injection.

This medication contains acetylcysteine. Do not take N-acetylcysteine or Mucomyst if you are allergic to acetylcysteine or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Acute asthma

Effects of Drug Abuse

• No information available

Short-Term Effects

• Slightly disagreeable odor after administration (temporary).
• A face mask may produce a sticky film on the face after nebulization; remove with water
• See "What Are Side Effects Associated with Using Acetylcysteine?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Acetylcysteine?"

Cautions

• The 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 a 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.
• Slightly disagreeable odor after administration (temporary).
• A face mask may produce a sticky film on the face after nebulization; remove with water
• Under certain conditions, the opened bottle may cause a slight purple color change as a consequence of chemical reaction; this does not affect drug safety or efficacy.
• Keratoconjunctivitis: Remove contact lenses; do not coadminister with topical antibiotics.

Pregnancy and Lactation

• Acetylcysteine may be acceptable for use during pregnancy. Either animal studies show no risk but human studies are not available or animal studies showed minor risks and human studies were done and showed no risk.
• It is unknown whether acetylcysteine is excreted in milk. Use caution if breastfeeding.