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Acetylcysteine Brand Names
Acetadote | CETYLEV | Mucomyst | Mucosil Acetylcysteine
What is Acetylcysteine
Acetylcysteine is the N-acetyl derivative of L-cysteine.
Although it was originally marketed as a mucolytic, there is little evidence that inhaled N-acetylcysteine (NAC) is more effective than adequate hydration for clearing bronchial secretions.
However, oral administration of acetylcysteine modestly reduces COPD exacerbation rates by roughly 30%, particularly during the winter months in those with severe disease.
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, in COPD patients not receiving inhaled corticosteroids, regular treatment with mucolytics such as N-acetylcysteine (NAC) may reduce COPD exacerbations and modestly improve health status.
Acetylcysteine is a first-line treatment for acetaminophen toxicity, and is administered orally or via IV infusion to prevent hepatotoxicity that may occur following an acute overdose or chronic supratherapeutic doses.
The drug continues to be investigated as an antioxidant to ameliorate the toxic effects of ischemic injury on various tissues, including the heart, kidney, liver, and lung.
Prophylactic administration of acetylcysteine, along with hydration, appears to prevent nephrotoxicity induced by radiographic-contrast agents in high-risk patients.
Because acetylcysteine contains sulfhydryl groups, it possesses a strong odor, often described as rotten eggs. The FDA originally approved acetylcysteine in 1963.
Indications
- acetaminophen overdose
- amyloidosis
- bronchiectasis
- chronic bronchitis
- chronic obstructive pulmonary disease (COPD)
- distal intestinal obstruction syndrome
- emphysema
- giant papillary conjunctivitis (GPC)
- mucolysis
- nephrotoxicity prophylaxis
For the prevention of hepatotoxicity after an acute acetaminophen overdose or repeated ingestion of supratherapeutic doses
Side Effects
- anaphylactoid reactions
- bronchospasm
- drowsiness
- dysgeusia
- dyspnea
- edema
- erythema
- fever
- flushing
- hemoptysis
- hypotension
- nausea
- pharyngitis
- pruritus
- rash
- rhinorrhea
- sinus tachycardia
- stomatitis
- urticaria
- vomiting
- wheezing
Monitoring Parameters
- blood glucose
- LFTs
- prothrombin time (PT)
- serum creatinine/BUN
- serum electrolytes
Contraindications
- acute bronchospasm
- asthma
- breast-feeding
- children
- esophageal varices
- gag reflex depression
- GI bleeding
- heart failure
- hypertension
- infants
- neonates
- peptic ulcer disease
- pregnancy
- renal disease
- respiratory insufficiency
- vomiting
Interactions
- Charcoal
Charcoal: (Moderate) Administration of activated charcoal and oral acetylcysteine at the same time may cause a reduction in acetylcysteine (NAC) absorption.
