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acetylcysteine (oral, effervescent)

Pronunciation

Generic Name: acetylcysteine (oral, effervescent) (a SEET il SIS teen)
Brand Name: Cetylev

What is acetylcysteine?

Acetylcysteine is an acetaminophen antidote that helps your body preserve a substance that can help detoxify the liver.

Acetylcysteine is used to treat acetaminophen overdose and help prevent damage to your liver caused by taking large quantities of acetaminophen (Tylenol).

There are other brands and forms of acetylcysteine available, and some can be purchased over the counter. Not all forms of this medicine are effective as an acetaminophen antidote. Treatment of acetaminophen overdose should be managed by a medical doctor.

Acetylcysteine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about acetylcysteine?

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

What should I discuss with my healthcare provider before taking acetylcysteine?

You should not use acetylcysteine if you are allergic to it.

To make sure this medicine is safe for you, tell your doctor if you have:

  • a stomach ulcer;

  • a history of stomach bleeding or bleeding in your esophagus (esophageal varices);

  • high blood pressure, or if you are on a low-salt diet;

  • congestive heart failure; or

  • kidney disease.

It is not known whether this medicine is harmful to use during pregnancy. However, an acetaminophen overdose may cause harm to both the mother and the baby. The benefit of treating the overdose may outweigh any risks of taking acetylcysteine. Tell your doctor if you are pregnant.

It is not known whether acetylcysteine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

In an emergency situation it may not be possible to tell your caregivers if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medicine.

How should I take acetylcysteine?

Before you take acetylcysteine, your caregivers may perform a blood test to measure the level of acetaminophen in your body. This test is most effective when performed within 4 to 8 hours after you have taken acetaminophen. If you cannot remember when you last took acetaminophen, you will most likely be given the first dose of acetylcysteine right away.

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Do not swallow or chew an effervescent tablet. This tablet must be dissolved in water before you take it. Keep the tablet in its foil blister pack until you are ready to use it. Drop the tablet into a glass of water. Stir and drink this mixture right away.

Do not take acetylcysteine at home if you do not fully understand all instructions specific to your use of this medicine.

While using acetylcysteine, you may need frequent blood tests.

Your doctor will determine how long to treat you with acetylcysteine. Do not stop taking this medicine until your doctor tells you to.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking acetylcysteine?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Acetylcysteine side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • severe or ongoing vomiting;

  • coughing up blood or vomit that looks like coffee grounds; or

  • signs that the medicine may not be working--upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • nausea, vomiting, upset stomach;

  • rash; or

  • fever.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Acetylcysteine dosing information

Usual Adult Dose for Acetaminophen Overdose:

Injectable:
The total dose is 300 mg/kg, given as 3 separate doses, administered over a total of 21 hrs.
Dose preparation is weight based:

5 to 20 kg:
Loading Dose: 150 mg/kg in 3 mL/kg diluent, infused over 1 hour
Second Dose: 50 mg/kg in 7 mL/kg diluent, infused over 4 hours
Third Dose: 100 mg/kg in 14 mL/kg diluent, infused over 16 hours

21 to 40 kg:
Loading Dose: 150 mg/kg in 100 mL diluent, infused over 1 hour
Second Dose: 50 mg/kg in 250 mL diluent, infused over 4 hours
Third Dose: 100 mg/kg in 500 mL diluent, infused over 16 hours

41 to 100 kg:
Loading Dose: 150 mg/kg in 200 mL diluent, infused over 1 hour
Second Dose: 50 mg/kg in 500 mL diluent, infused over 4 hours
Third Dose: 100 mg/kg in 1,000 mL diluent, infused over 16 hours

Over 100 kg:
Loading Dose: 15,000 mg in 200 mL diluent, infused over 1 hour
Second Dose: 5,000 mg in 500 mL diluent, infused over 4 hours
Third Dose: 10,000 mg in 1,000 mL diluent, infused over 16 hours

Compatible diluents: 5% Dextrose in Water, 0.45% Sodium Chloride Injection, and Sterile Water for Injection

Comments:
-Limited information is available regarding dosing patients weighing more than 100 kg; there are no specific studies.
-The critical ingestion to treatment interval is 0 to 8 hours for maximal protection against severe hepatic injury.
-Efficacy diminishes progressively after 8 hours.
-Initiating treatment 15 to 24 hours post-ingestion yields limited efficacy, but does not appear to worsen the patient's condition and it should not be withheld, as reported ingestion time may not be correct.
-Determine serum acetaminophen level at least 4 hours after ingestion of suspected overdose to determine the need for treatment with acetylcysteine.
-If patient presents after 4 hours post-ingestion, determine the serum acetaminophen level immediately.
-Administer within 8 hours from acetaminophen ingestion for maximal protection against hepatic injury for patients whose serum acetaminophen levels fall above the "possible" toxicity line on the Rumack-Matthew nomogram (line connecting 150 mcg/mL at 4 hours with 37.5 mcg/mL at 12 hours); the manufacturer product information should be consulted.
-Administer immediately if time of ingestion is unknown, or serum acetaminophen level is not available/cannot be interpreted/is not available within 8 hours of ingestion.
-Administer immediately if 24 hours or less have elapsed from the reported time of overdose, regardless of the ingested quantity reported.

Use: Antidote for Acute Ingestion or Repeated Supratherapeutic Ingestion (RSI) acetaminophen overdose, to prevent or lessen hepatic injury after ingestion of a potentially hepatotoxic quantity of acetaminophen.

----

Oral administration of 20% solution for inhalation:
Loading Dose: 140 mg/kg body weight, orally, once as a loading dose (see preparation instructions below)
Maintenance Dose: 70 mg/kg body weight, orally, 4 hours after the loading dose and every 4 hours for 17 total doses, unless repeated acetaminophen assays reveal nontoxic levels (see preparation instructions below)
Dose preparation is weight based:

100 to 109 kg/220 to 240 lb:
Loading dose: 15 g (75 mL) in 225 mL diluent; total volume: 300 mL
Maintenance Dose: 7.5 g (37 mL) in 113 mL diluent; total volume: 150 mL

90 to 99 kg/198 to 218 lb:
Loading dose: 14 g (70 mL) in 210 mL diluent; total volume: 280 mL
Maintenance Dose: 7 g (35 mL) in 105 mL diluent; total volume: 140 mL

80 to 89 kg/176 to 196 lb:
Loading dose: 13 g (65 mL) in 195 mL) in 210 mL diluent; total volume: 260 mL
Maintenance Dose: 6.5 g (33 mL) in 97 mL diluent; total volume: 130 mL

70 to 79 kg/154 to 174 lb:
Loading dose: 11 g (55 mL) in 165 mL) in 210 mL diluent; total volume: 220 mL
Maintenance Dose: 5.5 g (28 mL) in 82 mL diluent; total volume: 110 mL

60 to 69 kg/132 to 152 lb:
Loading dose: 10 g (50 mL) in 150 mL) in 210 mL diluent; total volume: 200 mL
Maintenance Dose: 5 g (25 mL) in 75 mL diluent; total volume: 100 mL

50 to 59 kg/110 to 130 lb:
Loading dose: 8 g (40 mL) in 120 mL) in 210 mL diluent; total volume: 160 mL
Maintenance Dose: 4 g (20 mL) in 60 mL diluent; total volume: 80 mL

40 to 49 kg/88 to 108 lb:
Loading dose: 7 g (35 mL) in 105 mL) in 210 mL diluent; total volume: 140 mL
Maintenance Dose: 3.5 g (18 mL) in 52 mL diluent; total volume: 70 mL

30 to 39 kg/66 to 86 lb:
Loading dose: 6 g (30 mL) in 90 mL) in 210 mL diluent; total volume: 120 mL
Maintenance Dose: 3 g (15 mL) in 45 mL diluent; total volume: 60 mL

20 to 29 kg/44 to 64 lb:
Loading dose: 4 g (20 mL) in 60 mL) in 210 mL diluent; total volume: 80 mL
Maintenance Dose: 2 g (10 mL) in 30 mL diluent; total volume: 40 mL

Less than 20 kg (usually patients younger than 6 years), must calculate diluent volume:
Loading dose: 140 g/kg
Maintenance Dose: 70 g/kg
-Add 3 mL of diluent to each 1 mL (200 mg) of 20% acetylcysteine solution
-Do not decrease the proportion of diluent.

Diluents: Dilute in diet cola or other diet soft drink; if giving via g-tube or Miller-Abbott tube, may dilute with water.

Comments:
-Administer immediately if 24 hours or less from ingestion of an overdose, regardless of the quantity of acetaminophen reported to have been ingested. Do not await acetaminophen assay results before initiating treatment.
The following procedures are recommended:
-Empty stomach promptly by lavage or inducing emesis with syrup of ipecac.
-Activated charcoal may be indicated for a mixed drug overdose, but if used, lavage before administering acetylcysteine. Activated charcoal adsorbs acetylcysteine in vitro and may reduce its effectiveness.
-Draw blood for predetoxification acetaminophen plasma assay and baseline SGOT, SGPT, bilirubin, prothrombin time, creatinine, BUN, blood sugar and electrolytes.
-Administer the loading dose of acetylcysteine.
-Determine subsequent action based on predetoxification plasma acetaminophen information. Choose ONE of the following courses of therapy:

A. Predetoxification plasma acetaminophen level is clearly in the toxic range or cannot be obtained:
Administer first maintenance dose (70 g/kg acetylcysteine) 4 hours after the loading dose; repeat at 4-hour intervals for a total of 17 doses. Monitor hepatic and renal function and electrolytes throughout the detoxification process.

B. Predetoxification acetaminophen level is clearly in the non-toxic range (beneath the dashed line on the nomogram) and you know that overdose occurred at least 4 hours before the level was taken:
Discontinue acetylcysteine.

C. Predetoxification acetaminophen level was in the non-toxic range, but time of ingestion was unknown or less than 4 hours:
Obtain a second plasma level to decide if the full 17 dose treatment is necessary (acetaminophen peak may not be achieved before 4 hours post-ingestion, so the assay level may not be a peak value).

-If the patient vomits an oral dose within 1 hour of administration, repeat that dose.
-If the patient is persistently unable to retain oral acetylcysteine, the antidote may be administered by duodenal intubation.

Use: As an antidote to prevent or lessen hepatic injury which may occur following the ingestion of a potentially hepatotoxic quantity of acetaminophen.

Usual Adult Dose for Diagnostic Bronchograms:

Nebulized into a face mask, mouth piece, or tracheostomy:
Recommended dosage: 3 to 5 mL of 20% solution, or 6 to 10 mL of 10% solution, 3 to 4 times a day
Dosage range: 1 to 10 mL of 20% solution, or 2 to 20 mL of 10% solution, every 2 to 6 hours

Nebulization tent, Croupette:
Recommended dose: The volume of 10% or 20% solution that will maintain a very heavy mist in the tent or Croupette for the desired period.
-This requires very large solution volumes, as much as 300 mL in a single treatment period.
-Intermittent or continuous prolonged administration periods, including overnight, may be desirable.
-Nebulization into a tent or Croupette must be individualized.
-Take into account the available equipment.

Direct Instillation:
Dose range: 1 to 2 mL of 10% to 20% solution, as often as every hour.
-Routine tracheostomy care: 1 to 2 mL of 10% to 20% solution, every 1 to 4 hours, instilled into the tracheostomy
-Percutaneous intratracheal catheter: 1 to 2 mL of 20% solution, or 2 to 4 mL of 10% solution, every 1 to 4 hours, via a syringe attached to the catheter
-Direct pulmonary installation: 2 to 5 mL of 20% solution
--Introduce directly into a particular segment of the bronchopulmonary tree by inserting (under local anesthesia and direct vision) a small plastic catheter into the trachea; instill using a syringe connected to the catheter.

Diagnostic Bronchograms:
Recommended dosing: 1 to 2 mL of the 20% solution, or 2 to 4 mL of the 10% solution, by nebulization or by instillation intratracheally, two or three times prior to the procedure.

Comments:
-The 20% solution may be diluted to a lesser concentration with either Sodium Chloride Injection, Sodium Chloride Inhalation Solution, Sterile Water for Injection, or Sterile Water for Inhalation.
-The 10% solution may be used undiluted.
-Use compressed tank gas (air) or an air compressor to provide pressure for nebulizing the solution.
-Oxygen may also be used but should be used with the usual precautions in patients with severe respiratory disease and CO2 retention.

Use: Adjuvant therapy for abnormal, viscid, or inspissated mucous secretions, such as in:
Chronic bronchopulmonary disease (chronic emphysema or asthmatic bronchitis, emphysema with bronchitis, tuberculosis, bronchiectasis, or primary pulmonary amyloidosis)
Acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis)
Pulmonary complications of cystic fibrosis
Tracheostomy care
Pulmonary complications associated with surgery
Use during anesthesia
Post-traumatic chest conditions
Atelectasis due to mucous obstruction
Diagnostic bronchial studies (bronchograms, bronchospirometry, and bronchial wedge catheterization)

Usual Adult Dose for Mucolytic:

Nebulized into a face mask, mouth piece, or tracheostomy:
Recommended dosage: 3 to 5 mL of 20% solution, or 6 to 10 mL of 10% solution, 3 to 4 times a day
Dosage range: 1 to 10 mL of 20% solution, or 2 to 20 mL of 10% solution, every 2 to 6 hours

Nebulization tent, Croupette:
Recommended dose: The volume of 10% or 20% solution that will maintain a very heavy mist in the tent or Croupette for the desired period.
-This requires very large solution volumes, as much as 300 mL in a single treatment period.
-Intermittent or continuous prolonged administration periods, including overnight, may be desirable.
-Nebulization into a tent or Croupette must be individualized.
-Take into account the available equipment.

Direct Instillation:
Dose range: 1 to 2 mL of 10% to 20% solution, as often as every hour.
-Routine tracheostomy care: 1 to 2 mL of 10% to 20% solution, every 1 to 4 hours, instilled into the tracheostomy
-Percutaneous intratracheal catheter: 1 to 2 mL of 20% solution, or 2 to 4 mL of 10% solution, every 1 to 4 hours, via a syringe attached to the catheter
-Direct pulmonary installation: 2 to 5 mL of 20% solution
--Introduce directly into a particular segment of the bronchopulmonary tree by inserting (under local anesthesia and direct vision) a small plastic catheter into the trachea; instill using a syringe connected to the catheter.

Diagnostic Bronchograms:
Recommended dosing: 1 to 2 mL of the 20% solution, or 2 to 4 mL of the 10% solution, by nebulization or by instillation intratracheally, two or three times prior to the procedure.

Comments:
-The 20% solution may be diluted to a lesser concentration with either Sodium Chloride Injection, Sodium Chloride Inhalation Solution, Sterile Water for Injection, or Sterile Water for Inhalation.
-The 10% solution may be used undiluted.
-Use compressed tank gas (air) or an air compressor to provide pressure for nebulizing the solution.
-Oxygen may also be used but should be used with the usual precautions in patients with severe respiratory disease and CO2 retention.

Use: Adjuvant therapy for abnormal, viscid, or inspissated mucous secretions, such as in:
Chronic bronchopulmonary disease (chronic emphysema or asthmatic bronchitis, emphysema with bronchitis, tuberculosis, bronchiectasis, or primary pulmonary amyloidosis)
Acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis)
Pulmonary complications of cystic fibrosis
Tracheostomy care
Pulmonary complications associated with surgery
Use during anesthesia
Post-traumatic chest conditions
Atelectasis due to mucous obstruction
Diagnostic bronchial studies (bronchograms, bronchospirometry, and bronchial wedge catheterization)

Usual Pediatric Dose for Acetaminophen Overdose:

Injectable:
The total dose is 300 mg/kg, given as 3 separate doses, administered over a total of 21 hrs.
Dose preparation is weight based:

5 to 20 kg:
Loading Dose: 150 mg/kg in 3 mL/kg diluent, infused over 1 hour
Second Dose: 50 mg/kg in 7 mL/kg diluent, infused over 4 hours
Third Dose: 100 mg/kg in 14 mL/kg diluent, infused over 16 hours

21 to 40 kg:
Loading Dose: 150 mg/kg in 100 mL diluent, infused over 1 hour
Second Dose: 50 mg/kg in 250 mL diluent, infused over 4 hours
Third Dose: 100 mg/kg in 500 mL diluent, infused over 16 hours

41 to 100 kg:
Loading Dose: 150 mg/kg in 200 mL diluent, infused over 1 hour
Second Dose: 50 mg/kg in 500 mL diluent, infused over 4 hours
Third Dose: 100 mg/kg in 1,000 mL diluent, infused over 16 hours

Over 100 kg:
Loading Dose: 15,000 mg in 200 mL diluent, infused over 1 hour
Second Dose: 5,000 mg in 500 mL diluent, infused over 4 hours
Third Dose: 10,000 mg in 1,000 mL diluent, infused over 16 hours

Compatible diluents: 5% Dextrose in Water, 0.45% Sodium Chloride Injection, and Sterile Water for Injection

Comments:
-Limited information is available regarding dosing patients weighing more than 100 kg; there are no specific studies.
-The critical ingestion to treatment interval is 0 to 8 hours for maximal protection against severe hepatic injury.
-Efficacy diminishes progressively after 8 hours.
-Initiating treatment 15 to 24 hours post-ingestion yields limited efficacy, but does not appear to worsen the patient's condition and it should not be withheld, as reported ingestion time may not be correct.
-Determine serum acetaminophen level at least 4 hours after ingestion of suspected overdose to determine the need for treatment with acetylcysteine.
-If patient presents after 4 hours post-ingestion, determine the serum acetaminophen level immediately.
-Administer within 8 hours from acetaminophen ingestion for maximal protection against hepatic injury for patients whose serum acetaminophen levels fall above the "possible" toxicity line on the Rumack-Matthew nomogram (line connecting 150 mcg/mL at 4 hours with 37.5 mcg/mL at 12 hours); the manufacturer product information should be consulted.
-Administer immediately if time of ingestion is unknown, or serum acetaminophen level is not available/cannot be interpreted/is not available within 8 hours of ingestion.
-Administer immediately if 24 hours or less have elapsed from the reported time of overdose, regardless of the ingested quantity reported.

Use: Antidote for Acute Ingestion or Repeated Supratherapeutic Ingestion (RSI) acetaminophen overdose, to prevent or lessen hepatic injury after ingestion of a potentially hepatotoxic quantity of acetaminophen.

----

Oral administration of 20% solution for inhalation:
Loading Dose: 140 mg/kg body weight, orally, once as a loading dose (see preparation instructions below)
Maintenance Dose: 70 mg/kg body weight, orally, 4 hours after the loading dose and every 4 hours for 17 total doses, unless repeated acetaminophen assays reveal nontoxic levels (see preparation instructions below)
Dose preparation is weight based:

100 to 109 kg/220 to 240 lb:
Loading dose: 15 g (75 mL) in 225 mL diluent; total volume: 300 mL
Maintenance Dose: 7.5 g (37 mL) in 113 mL diluent; total volume: 150 mL

90 to 99 kg/198 to 218 lb:
Loading dose: 14 g (70 mL) in 210 mL diluent; total volume: 280 mL
Maintenance Dose: 7 g (35 mL) in 105 mL diluent; total volume: 140 mL

80 to 89 kg/176 to 196 lb:
Loading dose: 13 g (65 mL) in 195 mL) in 210 mL diluent; total volume: 260 mL
Maintenance Dose: 6.5 g (33 mL) in 97 mL diluent; total volume: 130 mL

70 to 79 kg/154 to 174 lb:
Loading dose: 11 g (55 mL) in 165 mL) in 210 mL diluent; total volume: 220 mL
Maintenance Dose: 5.5 g (28 mL) in 82 mL diluent; total volume: 110 mL

60 to 69 kg/132 to 152 lb:
Loading dose: 10 g (50 mL) in 150 mL) in 210 mL diluent; total volume: 200 mL
Maintenance Dose: 5 g (25 mL) in 75 mL diluent; total volume: 100 mL

50 to 59 kg/110 to 130 lb:
Loading dose: 8 g (40 mL) in 120 mL) in 210 mL diluent; total volume: 160 mL
Maintenance Dose: 4 g (20 mL) in 60 mL diluent; total volume: 80 mL

40 to 49 kg/88 to 108 lb:
Loading dose: 7 g (35 mL) in 105 mL) in 210 mL diluent; total volume: 140 mL
Maintenance Dose: 3.5 g (18 mL) in 52 mL diluent; total volume: 70 mL

30 to 39 kg/66 to 86 lb:
Loading dose: 6 g (30 mL) in 90 mL) in 210 mL diluent; total volume: 120 mL
Maintenance Dose: 3 g (15 mL) in 45 mL diluent; total volume: 60 mL

20 to 29 kg/44 to 64 lb:
Loading dose: 4 g (20 mL) in 60 mL) in 210 mL diluent; total volume: 80 mL
Maintenance Dose: 2 g (10 mL) in 30 mL diluent; total volume: 40 mL

Less than 20 kg (usually patients younger than 6 years), must calculate diluent volume:
Loading dose: 140 g/kg
Maintenance Dose: 70 g/kg
-Add 3 mL of diluent to each 1 mL (200 mg) of 20% acetylcysteine solution
-Do not decrease the proportion of diluent.

Diluents: Dilute in diet cola or other diet soft drink; if giving via g-tube or Miller-Abbott tube, may dilute with water.

Comments:
-Administer immediately if 24 hours or less from ingestion of an overdose, regardless of the quantity of acetaminophen reported to have been ingested. Do not await acetaminophen assay results before initiating treatment.
The following procedures are recommended:
-Empty stomach promptly by lavage or inducing emesis with syrup of ipecac.
-Activated charcoal may be indicated for a mixed drug overdose, but if used, lavage before administering acetylcysteine. Activated charcoal adsorbs acetylcysteine in vitro and may reduce its effectiveness.
-Draw blood for predetoxification acetaminophen plasma assay and baseline SGOT, SGPT, bilirubin, prothrombin time, creatinine, BUN, blood sugar and electrolytes.
-Administer the loading dose of acetylcysteine.
-Determine subsequent action based on predetoxification plasma acetaminophen information. Choose ONE of the following courses of therapy:

A. Predetoxification plasma acetaminophen level is clearly in the toxic range or cannot be obtained:
Administer first maintenance dose (70 g/kg acetylcysteine) 4 hours after the loading dose; repeat at 4-hour intervals for a total of 17 doses. Monitor hepatic and renal function and electrolytes throughout the detoxification process.

B. Predetoxification acetaminophen level is clearly in the non-toxic range (beneath the dashed line on the nomogram) and you know that overdose occurred at least 4 hours before the level was taken:
Discontinue acetylcysteine.

C. Predetoxification acetaminophen level was in the non-toxic range, but time of ingestion was unknown or less than 4 hours:
Obtain a second plasma level to decide if the full 17 dose treatment is necessary (acetaminophen peak may not be achieved before 4 hours post-ingestion, so the assay level may not be a peak value).

-If the patient vomits an oral dose within 1 hour of administration, repeat that dose.
-If the patient is persistently unable to retain oral acetylcysteine, the antidote may be administered by duodenal intubation.

Use: As an antidote to prevent or lessen hepatic injury which may occur following the ingestion of a potentially hepatotoxic quantity of acetaminophen.

Usual Pediatric Dose for Diagnostic Bronchograms:

Nebulized into a face mask, mouth piece, or tracheostomy:
Recommended dosage: 3 to 5 mL of 20% solution, or 6 to 10 mL of 10% solution, 3 to 4 times a day
Dosage range: 1 to 10 mL of 20% solution, or 2 to 20 mL of 10% solution, every 2 to 6 hours

Nebulization tent, Croupette:
Recommended dose: The volume of 10% or 20% solution that will maintain a very heavy mist in the tent or Croupette for the desired period.
-This requires very large solution volumes, as much as 300 mL in a single treatment period.
-Intermittent or continuous prolonged administration periods, including overnight, may be desirable.
-Nebulization into a tent or Croupette must be individualized.
-Take into account the available equipment.

Direct Instillation:
Dose range: 1 to 2 mL of 10% to 20% solution, as often as every hour.
-Routine tracheostomy care: 1 to 2 mL of 10% to 20% solution, every 1 to 4 hours, instilled into the tracheostomy
-Percutaneous intratracheal catheter: 1 to 2 mL of 20% solution, or 2 to 4 mL of 10% solution, every 1 to 4 hours, via a syringe attached to the catheter
-Direct pulmonary installation: 2 to 5 mL of 20% solution
--Introduce directly into a particular segment of the bronchopulmonary tree by inserting (under local anesthesia and direct vision) a small plastic catheter into the trachea; instill using a syringe connected to the catheter.

Diagnostic Bronchograms:
Recommended dosing: 1 to 2 mL of the 20% solution, or 2 to 4 mL of the 10% solution, by nebulization or by instillation intratracheally, two or three times prior to the procedure.

Comments:
-The 20% solution may be diluted to a lesser concentration with either Sodium Chloride Injection, Sodium Chloride Inhalation Solution, Sterile Water for Injection, or Sterile Water for Inhalation.
-The 10% solution may be used undiluted.
-Use compressed tank gas (air) or an air compressor to provide pressure for nebulizing the solution.
-Oxygen may also be used but should be used with the usual precautions in patients with severe respiratory disease and CO2 retention.

Use: Adjuvant therapy for abnormal, viscid, or inspissated mucous secretions, such as in:
Chronic bronchopulmonary disease (chronic emphysema or asthmatic bronchitis, emphysema with bronchitis, tuberculosis, bronchiectasis, or primary pulmonary amyloidosis)
Acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis)
Pulmonary complications of cystic fibrosis
Tracheostomy care
Pulmonary complications associated with surgery
Use during anesthesia
Post-traumatic chest conditions
Atelectasis due to mucous obstruction
Diagnostic bronchial studies (bronchograms, bronchospirometry, and bronchial wedge catheterization)

Usual Pediatric Dose for Mucolytic:

Nebulized into a face mask, mouth piece, or tracheostomy:
Recommended dosage: 3 to 5 mL of 20% solution, or 6 to 10 mL of 10% solution, 3 to 4 times a day
Dosage range: 1 to 10 mL of 20% solution, or 2 to 20 mL of 10% solution, every 2 to 6 hours

Nebulization tent, Croupette:
Recommended dose: The volume of 10% or 20% solution that will maintain a very heavy mist in the tent or Croupette for the desired period.
-This requires very large solution volumes, as much as 300 mL in a single treatment period.
-Intermittent or continuous prolonged administration periods, including overnight, may be desirable.
-Nebulization into a tent or Croupette must be individualized.
-Take into account the available equipment.

Direct Instillation:
Dose range: 1 to 2 mL of 10% to 20% solution, as often as every hour.
-Routine tracheostomy care: 1 to 2 mL of 10% to 20% solution, every 1 to 4 hours, instilled into the tracheostomy
-Percutaneous intratracheal catheter: 1 to 2 mL of 20% solution, or 2 to 4 mL of 10% solution, every 1 to 4 hours, via a syringe attached to the catheter
-Direct pulmonary installation: 2 to 5 mL of 20% solution
--Introduce directly into a particular segment of the bronchopulmonary tree by inserting (under local anesthesia and direct vision) a small plastic catheter into the trachea; instill using a syringe connected to the catheter.

Diagnostic Bronchograms:
Recommended dosing: 1 to 2 mL of the 20% solution, or 2 to 4 mL of the 10% solution, by nebulization or by instillation intratracheally, two or three times prior to the procedure.

Comments:
-The 20% solution may be diluted to a lesser concentration with either Sodium Chloride Injection, Sodium Chloride Inhalation Solution, Sterile Water for Injection, or Sterile Water for Inhalation.
-The 10% solution may be used undiluted.
-Use compressed tank gas (air) or an air compressor to provide pressure for nebulizing the solution.
-Oxygen may also be used but should be used with the usual precautions in patients with severe respiratory disease and CO2 retention.

Use: Adjuvant therapy for abnormal, viscid, or inspissated mucous secretions, such as in:
Chronic bronchopulmonary disease (chronic emphysema or asthmatic bronchitis, emphysema with bronchitis, tuberculosis, bronchiectasis, or primary pulmonary amyloidosis)
Acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis)
Pulmonary complications of cystic fibrosis
Tracheostomy care
Pulmonary complications associated with surgery
Use during anesthesia
Post-traumatic chest conditions
Atelectasis due to mucous obstruction
Diagnostic bronchial studies (bronchograms, bronchospirometry, and bronchial wedge catheterization)

What other drugs will affect acetylcysteine?

Other drugs may interact with acetylcysteine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

See also: Side effects (in more detail)

Where can I get more information?

  • Your doctor or pharmacist can provide more information about acetylcysteine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.02.

Last reviewed: September 20, 2016
Date modified: September 05, 2017

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