Dosing and uses of N-acetylcysteine, Mucomyst (acetylcysteine)
Adult dosage forms and strengths
nebulizer solution
- 10%
- 20%
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
Pediatric dosage forms and 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
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
N-acetylcysteine, Mucomyst (acetylcysteine) adverse (side) 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
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
Pregnancy and 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.
Pharmacology of N-acetylcysteine, Mucomyst (acetylcysteine)
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)
