Acetylcysteine

From Anvita Health Wiki

Contents 1 Introduction 2 Indications 3 Contraindications 4 Dosage 5 Adverse-effects 6 Test-interactions 7 Mechanism-of-action 8 More General Terms 9 Additional Terms 10 Internet Database 11 References

Introduction

• Tradenames: Mucomyst, Mucosol, Acetadote.

Indications

• adjunctive therapy in patients with abnormal or viscid mucous secretions:

• acute & chronic bronchopulmonary diseases

• of little or no benefit in COPD (see BRONCUS study)

• complications of surgery & cystic fibrosis

• diagnostic bronchial studies
• antidote for acute acetaminophen toxicity
• prevention of renal damage from IV contrast ( contrast nephropathy) [6]

• useful for patients with serum creatinine below 2.0 mg/dL

• trichotillomania [7]
• may decrease compulsive gambling and cocaine addiction

Contraindications

• Caution:
• if bronchospasm occurs

• administer a bronchodilator
• discontinue acetylcysteine if bronchospasm progresses

• percussion, postural drainage & suction should follow adminstration of inhaled acetylcysteine since increased bronchial secretions may develop
  

• pregnancy category = b
• safety in lactation = ?

Dosage

• mucolytic:

• 6-10 mL of 10% or 3-5 mL of 20% solution nebulized every 6-8 hours
• aerosilized bronchodilator 10-15 minutes prior to acetyl- choline

• oral 20% solution, 3 mL BID one day prior to & on day of procedure to prevent contrast nephropathy
• acetaminophen toxicity:

• load 140 mg/kg PO or NG, then 70 mg/kg every 4 hours X 17 may be mixed in water or soda
• intravenous: (Acetadote) [5]

• 140 mg/kg infused into a peripheral IV over 1 hour using an in-line 0.2-m millipore filter
• maintainance doses every 4 hours of 70 mg/kg infused into a peripheral IV over 1 hour using an in-line 0.2-m millipore filter
• IV solution made by diluting a 20% solution of acetyl- cysteine to 3% with D5W
• millipore filter may be unneccesary with

• average length of treatment is 48 hours

• trichotillomania

• start 1200 mg PO QD; may increase to 2400 mg PO QD

Adverse-effects

• common (> 10%): nausea/vomiting (foul odor)
• less common (1-10%)

• drowsiness, chills, stomatitis, nausea, irritation, bronchospasm, rhinorrhea, hemoptysis, clamminess

• uncommon (< 1%)

• rash, unpleasant odor during administration

• few adverse effects with IV use

• erythema, itching & redness at IV site
• anaphylaxis

Test-interactions

• may falsely lower serum creatinine [4]

Mechanism-of-action

• mucolytic activity results from splitting of disulfide linkages between mucoproteins resulting in depolymerization & a decrease in mucus viscosity
• acetylcysteine protects the liver in acetaminophen toxicity by maintaining glutathione levels & acting as a direct nucleophile reacting with the electrophilic aromatic metabolite of acetaminophen responsible for its toxicity
• modulates the glutamatergic pathway by increasing extracellular glutamate in the nucleus accumbens

More General Terms

• mucolytic agent
• antidote

Additional Terms

• acetaminophen (Tylenol, Paracematol, Panadol, Tempra, Datril, APAP)
• acetaminophen poisoning
• Bronchitis Randomized on NAC Cost-Utility Study (BRONCUS)
• contrast nephropathy (contrast-induced nephropathy, CIN)

Internet Database

PubChem: 581
PubChem: 12035
PubChem: 44591
PubChem: 500198
PubChem: 469105

References

1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
4. Prescriber's Letter 9(5):28 2002
5. Prescriber's Letter 11(5):28-29 2004 Detail-Document#: [1] (subscription needed) [2]
6. Kelly AM et al, Meta-analysis: Effectiveness of drugs for treating contrast- induced nephropathy. Ann Intern Med 2008, 148:284 PMID: [3]
7. Grant JE et al N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: A double-blind, placebo-controlled study. Arch Gen Psychiatry 2009 Jul; 66:756. PMID: [4]

acetylcysteine (Mucomyst, Mucosol, Acetadote)