acetylcysteine

Adult Dosing .

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

acetaminophen overdose

[PO/NG route]

Dose: 140 mg/kg/dose PO/NG x1, then 4h later, 70 mg/kg/dose PO/NG q4h x17 doses; Start: w/in 24h of ingestion; Info: repeat dose if vomited w/in 1h

[IV route]

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: w/in 24h of ingestion, w/in 8h for max benefit; Info: dilute before use based on wt/fluid status, see pkg insert for dilution instructions; for pts >100 kg, cap wt at 100 kg for dose calculations; may cont. tx at dose from poison control center for >21h if detectable acetaminophen levels, LFTs cont. to rise, or INR remains elev.

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

[see below]

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]

Dose: 140 mg/kg/dose PO/NG x1, then 4h later, 70 mg/kg/dose PO/NG q4h x17 doses; Start: w/in 24h of ingestion; Info: repeat dose if vomited w/in 1h

[IV route]

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: w/in 24h of ingestion, w/in 8h for max benefit; Info: dilute before use based on wt/fluid status, see pkg insert for dilution instructions; for pts >100 kg, cap wt at 100 kg for dose calculations; may cont. tx at dose from poison control center for >21h if detectable acetaminophen levels, LFTs cont. to rise, or INR remains elev.

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

[see below]

renal impairment: no adjustment

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

hepatic dosing

[not defined]