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Acetadote
acetylcysteine
Adult Dosing .
Dosage forms: INJ
acetaminophen overdose
- [acute ingestion period <24h]
- Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Info: refer to Rumack-Matthew nomogram to determine need for tx based on post-ingestion time; see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well; consider incr. dose if high-risk ingestion
- [acute ingestion period unknown or >24h]
- Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Start: if acetaminophen level >10 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well; consider incr. dose if high-risk ingestion
- [repeated supratherapeutic ingestion period >24h]
- Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Start: if acetaminophen level at least 20 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well
renal dosing
- [see below]
- renal impairment: no adjustment
- HD: incr. continuous infusion rate to at least 12.5 mg/kg/h during dialysis; supplement not defined; PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ
acetaminophen overdose
- [acute ingestion period <24h, >5 kg]
- Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Info: refer to Rumack-Matthew nomogram to determine need for tx based on post-ingestion time; see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well; consider incr. dose if high-risk ingestion
- [acute ingestion period unknown or >24h, >5 kg]
- Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Start: if acetaminophen level >10 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well; consider incr. dose if high-risk ingestion
- [repeated supratherapeutic ingestion period >24h, >5 kg]
- Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Start: if acetaminophen level at least 20 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well
renal dosing
- [see below]
- renal impairment: no adjustment
- HD: incr. continuous infusion rate to at least 12.5 mg/kg/h during dialysis; supplement not defined; PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- caution: hemodialysis (IV use)
- caution: asthma
- caution: bronchospasm hx
- caution: upper GI bleeding risk (PO use)
Drug Interactions .
Overview
acetylcysteine
mucolytic; glutathione inducer
-
None
Caution Advised
- charcoal, activated
Adverse Reactions .
Serious Reactions
- hypersensitivity rxn
- bronchospasm
- anaphylaxis (IV use)
- fluid overload (IV use)
Common Reactions
- anaphylaxis (IV use)
- nausea
- vomiting
- urticaria
- tachycardia
- rash
- pruritus
- flushing
- URI sx
- stomatitis
- fever
- drowsiness
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Look/Sound-Alike Drug Names
acetylcysteine confused with: acetaZOLAMIDE
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; risk of fetal harm not expected based on limited human data
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: liver extensively; CYP450: minimal
Excretion: urine 13-38%; Half-life: 5.6h (adults), 11h (neonates)
Subclass: Toxicity: Drugs
Mechanism of Action
breaks disulfide bonds, decreasing mucus viscosity; replenishes glutathione, facilitating non-toxic metabolism of acetaminophen
Formulary .
No Formulary Selected
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