Acetylcysteine

Name: Acetylcysteine

Duration of Action

Inhalation: >1 hour

Half-Life Elimination

Reduced acetylcysteine: 2 hours; Total acetylcysteine: Adults: 5.6 hours, Newborns: 11 hours

Effervescent tablets: Terminal half-life: 18.1 hours

Protein Binding

66% to 87%

Off Label Uses

Prevention of contrast-induced nephropathy

Acetylcysteine has been studied in numerous controlled trials and meta-analyses demonstrating conflicting results in the prevention of contrast-induced nephropathy. Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines for acute kidney injury (AKI) suggest the use of oral acetylcysteine with intravenous (IV) isotonic crystalloids for the prevention of contrast-induced AKI in patients at increased risk (eg, advanced age, baseline renal impairment, diabetes, hypotension), based on a very low level of evidence (ie, the estimate of effect is very uncertain, and often will be far from the truth). The American Heart Association/American College of Cardiology (AHA/ACC) guideline for the management of patients with non–ST-elevation acute coronary syndromes and American College of Cardiology Foundation/American Heart Association/Society for Cardiovascular Angiography and Intervention (ACCF/AHA/SCAI) practice guidelines for percutaneous coronary intervention (PCI) recommend adequate hydration as the only prevention strategy for contrast-induced nephropathy in patients undergoing coronary and left ventricular angiography or PCI. The amounts of contrast media should be limited. In patients with chronic kidney disease (CKD), omission of left ventricular angiography and assessment via echocardiography is prudent. .

Additional Off-Label Uses

Distal intestinal obstruction syndrome (DIOS, previously referred to as meconium ileus equivalent)

Dosing Obesity

Refer to indication-specific dosing for obesity-related information (may not be available for all indications).

Monitoring Parameters

Acetaminophen overdose: Monitor patient for the development of anaphylaxis or anaphylactoid reactions; monitor serum acetaminophen concentrations, AST, ALT, bilirubin, PT, INR, serum creatinine, BUN, serum glucose, hemoglobin, hematocrit, and electrolytes. Assess patient for nausea, vomiting, and skin rash following oral administration. Reassess LFTs for possible hepatotoxicity every 4 to 6 hours. An early elevation in the INR may be related to acetylcysteine therapy (Schmidt 2002).

Acute ingestion: Obtain the first acetaminophen concentration 4 hours postingestion (or as soon as possible thereafter); plot on the Rumack-Matthew nomogram. In patients who have ingested an extended release formulation of acetaminophen or have coingested an agent known to delay gastric emptying, obtain a repeat serum acetaminophen measurement 4 to 6 hours following the first measurement if the original concentration (taken at 4 to 8 hours postingestion) when plotted on the Rumack-Matthew nomogram indicated that treatment was not necessary.

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies. Based on limited reports using acetylcysteine to treat acetaminophen overdose in pregnant women, acetylcysteine has been shown to cross the placenta and may provide protective concentrations in the fetus.

Acetylcysteine may be used to treat acetaminophen overdose in during pregnancy (Wilkes 2005). In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant women if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey 2003).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience mouth sores, rhinorrhea, fatigue, clammy skin, or flushing. Have patient report immediately to prescriber shortness of breath; severe nausea; black, tarry, or bloody stools; severe vomiting; vomiting blood; severe dizziness; or passing out (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Uses

When inhaled by mouth, acetylcysteine is used to help thin and loosen mucus in the airways due to certain lung diseases (such as emphysema, bronchitis, cystic fibrosis, pneumonia). This effect helps you to clear the mucus from your lungs so that you can breathe easier.

When taken by mouth, acetylcysteine is used to prevent liver damage from acetaminophen overdose.

How to use Acetylcysteine 100 Mg/Ml (10 %) Solution

If you are using this medication to treat lung disease, inhale this medication by mouth as directed by your doctor. A health care professional will show you the proper way to use this medication. Learn all preparation and usage instructions.

You may notice a slight odor when you first breathe in the medication. This odor will quickly go away. If you are using a face mask to breathe in the medication, there may be some stickiness on your face after use. Wash your face with water to remove the stickiness.

Do not mix acetylcysteine with other inhaled medications unless directed by the doctor or pharmacist.

If you are taking this medication by mouth, take it as directed by your doctor. The solution is usually mixed with another liquid (such as cola) to decrease nausea and vomiting. Drink the medication within 1 hour of mixing.

Tell your doctor if you vomit within 1 hour after taking your medication. You may need to take another dose.

The dosage is based on your medical condition and response to treatment. For acetaminophen overdose, the dosage is also be based on your weight.

Tell your doctor if your condition does not improve or if it worsens.

Side Effects

Nausea and vomiting may occur. Mouth sores and runny nose may also occur if you are inhaling this medication by mouth. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

If you are taking this medication by mouth, tell your doctor right away if any of these unlikely but serious side effects occur: severe stomach/abdominal pain, black stools, vomit that looks like coffee grounds.

If you are inhaling this medication by mouth, seek immediate medical attention if any of these rare but very serious side effects occur: chest pain/tightness, trouble breathing.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or 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.

List Acetylcysteine 100 Mg/Ml (10 %) Solution side effects by likelihood and severity.

Precautions

Before using acetylcysteine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: asthma, stomach/intestinal ulcer.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

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

Do not share this medication with others.

For acetaminophen overdose, laboratory and/or medical tests (such as liver/kidney function test, acetaminophen drug levels, blood mineral levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Missed Dose

If you are using this medication to treat lung disease and miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

If you are using this medication to treat acetaminophen overdose, it is important to take each scheduled dose as directed. If you miss a dose, contact your doctor right away to establish a new dosing schedule.

Storage

Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light. After opening the vial, store in the refrigerator between 35-46 degrees F (2-8 degrees C) and use within 96 hours (4 days). The solution may change to a light purple color. This is normal and will not affect how the drug works. Do not store in the bathroom. Keep all medicines away from children and pets.

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) 2016 First Databank, Inc.

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