acetylcysteine

Adult Dosing .

Dosage forms:  SOL (10%): 100 mg per mL; SOL (20%): 200 mg per mL; INJ: various

acetaminophen overdose

[PO/NG route, acute ingestion period <24h]

Dose: 140 mg/kg/dose PO/NG x1, then 70 mg/kg/dose PO/NG q4h x17 doses; 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; use 100 kg dosing wt for pts >100 kg; repeat dose if vomited w/in 1h; may cont. tx w/ IV form 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

[PO/NG route, acute ingestion period unknown or >24h]

Dose: 140 mg/kg/dose PO/NG x1, then 70 mg/kg/dose PO/NG q4h x17 doses; Start: if acetaminophen level >10 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; use 100 kg dosing wt for pts >100 kg; repeat dose if vomited w/in 1h; may cont. tx w/ IV form 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

[PO/NG route, repeated supratherapeutic ingestion period >24h]

Dose: 140 mg/kg/dose PO/NG x1, then 70 mg/kg/dose PO/NG q4h x17 doses; Start: if acetaminophen level at least 20 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; use 100 kg dosing wt for pts >100 kg; repeat dose if vomited w/in 1h; may cont. tx w/ IV form 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

[IV route, 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

[IV route, 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

[IV route, 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

for mucolytic uses

[nebulization via face mask, mouthpiece, or tracheostomy]

Dose: 3-5 mL 20% solution or 6-10 mL 10% solution NEB tid-qid; Max: 10 mL 20% solution or 20 mL 10% solution q2h; Info: give w/ bronchodilator

[nebulization via tent or croupette]

Dose: individualize dose to maintain very heavy mist for desired period; Info: admin. method requires large volumes up to 300 mL/treatment

[intratracheal route]

Dose: instill 1-2 mL 10% or 20% solution via tracheostomy q1-4h; Alt: instill 1-2 mL 20% solution or 2-4 mL 10% solution via percutaneous intratracheal catheter; Info: under local anesthesia and direct supervision may instill 2-5 mL 20% solution into specific bronchial segment(s)

[PO route (off-label)]

Dose: 200 mg PO bid-tid; Alt: 300 mg PO bid or 600 mg PO qd-bid; Info: may decr. frequency to 3x/wk for maint.

diagnostic bronchial studies

[1-2 mL 20% solution or 2-4 mL 10% solution NEB x2-3 doses]

Start: prior to procedure; Alt: instill 1-2 mL 20% solution or 2-4 mL 10% solution intratracheally x2-3 doses

nephropathy prophylaxis, radiocontrast-induced (off-label)

[600 mg PO bid x2 days]

Start: 1 day before procedure; Info: adjunct to hydration, low-osmolality contrast

renal dosing

[acetaminophen overdose, PO/NG route]

renal impairment: no adjustment

HD: no adjustment, on dialysis days admin. after dialysis; supplement not defined; PD: not defined

[acetaminophen overdose, IV route]

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

[all other indications]

renal impairment: no adjustment

HD: no adjustment, on dialysis days admin. after dialysis; supplement not defined; PD: not defined

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms:  SOL (10%): 100 mg per mL; SOL (20%): 200 mg per mL; INJ: various

acetaminophen overdose

[PO/NG route, acute ingestion period <24h]

Dose: 140 mg/kg/dose PO/NG x1, then 70 mg/kg/dose PO/NG q4h x17 doses; 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; use 100 kg dosing wt for pts >100 kg; repeat dose if vomited w/in 1h; may cont. tx w/ IV form 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

[PO/NG route, acute ingestion period unknown or >24h]

Dose: 140 mg/kg/dose PO/NG x1, then 70 mg/kg/dose PO/NG q4h x17 doses; Start: if acetaminophen level >10 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; use 100 kg dosing wt for pts >100 kg; repeat dose if vomited w/in 1h; may cont. tx w/ IV form 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

[PO/NG route, repeated supratherapeutic ingestion period >24h]

Dose: 140 mg/kg/dose PO/NG x1, then 70 mg/kg/dose PO/NG q4h x17 doses; Start: if acetaminophen level at least 20 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; use 100 kg dosing wt for pts >100 kg; repeat dose if vomited w/in 1h; may cont. tx w/ IV form 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

[IV route, 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

[IV route, 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

[IV route, 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

for mucolytic uses

[nebulization via face mask, mouthpiece, or tracheostomy]

Dose: 3-5 mL 20% solution or 6-10 mL 10% solution NEB tid-qid; Max: 10 mL 20% solution or 20 mL 10% solution q2h; Info: give w/ bronchodilator

[nebulization via tent or croupette]

Dose: individualize dose to maintain very heavy mist for desired period; Info: admin. method requires large volumes up to 300 mL/treatment

[intratracheal route]

Dose: instill 1-2 mL 10% or 20% solution via tracheostomy q1-4h; Alt: instill 1-2 mL 20% solution or 2-4 mL 10% solution via percutaneous intratracheal catheter; Info: under local anesthesia and direct supervision may instill 2-5 mL 20% solution into specific bronchial segment(s)

diagnostic bronchial studies

[1-2 mL 20% solution or 2-4 mL 10% solution NEB x2-3 doses]

Start: prior to procedure; Alt: instill 1-2 mL 20% solution or 2-4 mL 10% solution intratracheally x2-3 doses

renal dosing

[acetaminophen overdose, PO/NG route]

renal impairment: no adjustment

HD: no adjustment, on dialysis days admin. after dialysis; supplement not defined; PD: not defined

[acetaminophen overdose, IV route]

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

[all other indications]

renal impairment: no adjustment

HD: no adjustment, on dialysis days admin. after dialysis; supplement not defined; PD: not defined

hepatic dosing

[not defined]