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acetylcysteine (Mucomyst, Mucosol, Acetadote)

Tradenames: Mucomyst, Mucosol, Acetadote. Indications: 1) adjunctive therapy in patients with abnormal or viscid mucus secretions (bronchial secretions) a) acute & chronic bronchopulmonary diseases 1] bronchitis, bronchiectasis, atelectasis 2] of little or no benefit in COPD (see BRONCUS study) b) postoperative complications - adjunct to general anesthesia c) cystic fibrosis 2) diagnostic bronchial studies 3) antidote for acute acetaminophen toxicity 4) prevention of renal damage from IV contrast (contrast nephropathy) [6] - useful for patients with serum creatinine below 2.0 mg/dL 5) trichotillomania [7] 6) may decrease compulsive gambling and cocaine addiction 7) meconium ileus [8] 8) amyloidosis Contraindications: Caution: 1) if bronchospasm occurs a) administer a bronchodilator b) discontinue acetylcysteine if bronchospasm progresses 2) percussion, postural drainage & suction should follow administration of inhaled acetylcysteine since increased bronchial secretions may develop Dosage: 1) mucolytic: - 6-10 mL of 10% or 3-5 mL of 20% solution nebulized every 6-8 hours - aerosolized bronchodilator 10-15 minutes prior to acetylcholine 2) oral 20% solution, 3 mL BID one day prior to & on day of procedure to prevent contrast nephropathy 3) acetaminophen toxicity: a) load 140 mg/kg PO or NG, then 70 mg/kg every 4 hours X 17 may be mixed in water or soda b) intravenous: (Acetadote) [5] - 140 mg/kg infused into a peripheral IV over 1 hour using an in-line 0.2-m millipore filter - maintenance 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 acetylcysteine to 3% with D5W - millipore filter may be unneccesary with c) average length of treatment is 48 hours 4) trichotillomania - start 1200 mg PO QD; may increase to 2400 mg PO QD Adverse effects: 1) common (> 10%): nausea/vomiting (foul odor) 2) less common (1-10%) - drowsiness, chills, stomatitis, nausea, irritation, bronchospasm, rhinorrhea, hemoptysis, clamminess 3) uncommon (< 1%) - rash, unpleasant odor during administration 4) few adverse effects with IV use - erythema, itching & redness at IV site - anaphylaxis Test interactions: - may falsely lower serum creatinine [4] Mechanism of action: 1) mucolytic activity results from splitting of disulfide linkages between mucoproteins resulting in depolymerization & a decrease in mucus viscosity 2) 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 3) modulates the glutamatergic pathway by increasing extracellular glutamate in the nucleus accumbens

Related

acetaminophen poisoning Bronchitis Randomized on NAC Cost-Utility Study (BRONCUS) contrast nephropathy (contrast-induced nephropathy, CIN)

General

antidote mucolytic agent

Properties

MISC-INFO: elimination route LIVER pregnancy-category B safety in lactation ?

Database Correlations

PUBCHEM correlations

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#: 200511 (subscription needed) http://www.prescribersletter.com
  6. Kelly AM et al, Meta-analysis: Effectiveness of drugs for treating contrast- induced nephropathy. Ann Intern Med 2008, 148:284 PMID: 18283206
  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: 19581567
  8. Deprecated Reference

Component-of

acetylcysteine/folic acid/methylcobalamin acetylcysteine/methylcobalamin