Acetylcysteine
Acetylcysteine (Mucomyst)
Acetylcysteine
(ah-see-till- SIS-tay-een)
Pregnancy Category: B Mucomyst Mucosil Parvolex (Rx)

Classification: Mucolytic

Action/Kinetics: Reduces the viscosity of purulent and nonpurulent pulmonary secretions and facilitates their removal by splitting disulfide bonds. Action increases with increasing pH (peak: pH 7-9). Onset, inhalation: Within 1 min; by direct instillation: immediate. Time to peak effect: 5-10 min. Also reduces liver injury due to acetaminophen overdosage by maintaining or restoring glutathione levels or by acting as an alternate substrate for the reactive metabolite of acetaminophen.

Uses: Adjunct in the treatment of chronic emphysema, emphysema with bronchitis, chronic asthmastic bronchitis, tuberculosis, bronchiectasis, primary amyloidosis of lung, acute bronchopulmonary disease (bronchitis, pneumonia, tracheobronchitis). Routine care of clients with tracheostomy, pulmonary complications after thoracic or CV surgery, use during anesthesia, atelectasis due to mucus obstruction, and in posttraumatic chest conditions. Pulmonary complications of cystic fibrosis. Diagnostic bronchial studies. Antidote in acetaminophen poisoning to reduce or prevent hepatotoxicity. Investigational: As an ophthalmic solution for dry eye. As an enema to treat bowel obstruction due to meconium ileus or equivalent.

Contraindications: Sensitivity to drug.

Special Concerns: Use with caution during lactation, in the elderly, and in clients with asthma.

Side Effects: Respiratory: Increased incidence of bronchospasm in clients with asthma. Increased amount of liquefied bronchial secretions, which must be removed by suction if cough is inadequate. Bronchial and tracheal irritation, tightness in chest, bronchoconstriction. GI: N&V;, stomatitis. Other: Rashes, fever, drowsiness, rhinorrhea.

Drug Interactions: Acetylcysteine is incompatible with antibiotics and should be administered separately.

How Supplied: Solution: 10%, 20%

Dosage
?10% or 20% Solution: Nebulization, Direct Application, or Direct Intratracheal Instillation Nebulization into face mask, tracheostomy, mouth piece.
1-10 mL of 20% solution or 2-10 mL of 10% solution 3-4 times/day.
Closed tent or croupette.
Up to 300 mL of 10% or 20% solution/treatment.
Direct instillation into tracheostomy.
1-2 mL of 10%-20% solution q 1-4 hr.
Percutaneous intratracheal catheter.
1-2 mL of 20% solution or 2-4 mL of 10% solution q 1-4 hr by syringe attached to catheter.
Instillation to particular portion of bronchopulmonary tree using small plastic catheter into the trachea.
2-5 mL of 20% solution instilled into the trachea by means of a syringe connected to a catheter.
Diagnostic procedures.
2-3 doses of 1-2 mL of 20% or 2-4 mL of 10% solution by nebulization or intratracheal instillation before the procedure.
Acetaminophen overdose.
Given PO, initial: 140 mg/kg; then, 70 mg/kg q 4 hr for a total of 17 doses.