Names and pronunciation
(a-se-teel-sis′tay-een) Acetadote, Mucomyst
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Drug reference
(a-se-teel-sis′tay-een) Acetadote, Mucomyst
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Func. class.: Mucolytic; antidote— acetaminophen
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Chem. class.: Amino acid l-cysteine
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ACTION: Decreases viscosity of secretions by breaking disulfide links of mucoproteins; serves as a substrate in place of glutathione, which is necessary to inactivate toxic metabolites with acet- aminophen overdose
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USES: Acetaminophen toxicity; bron- chitis; cystic fibrosis; COPD; atelectasis
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Unlabeled uses: Prevention of con- trast medium nephrotoxicity
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, hypothyroidism, Addison’s disease, CNS depression, brain tumor, asthma, renal/ hepatic disease, COPD, psychosis, alco- holism, seizure disorders, broncho- spasms, anaphylactoid reactions, fluid restriction, weight <40 kg, increased intracranial pressure, status asthmaticus
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SIDE EFFECTS CNS: Dizziness, drowsiness, fever, chills CV: Edema, flushing tachycardia EENT: Rhinorrhea, pharyngitis GI: Nausea, stomatitis, vomiting, anorexia INTEG: Urticaria, rash, clamminess, pru ritus RESP: Bronchospasm, chest tightness, cough, dyspnea MISC: Anaphylaxis, angioedema, unpleas- ant odor
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DOSAGE AND ROUTES Acetaminophen toxicity • Adult and child: PO 140 mg/kg, then 70 mg/kg q4hr × 17 doses to total of 1330 mg/kg; ≥41-100 kg IV loading dose 150 mg/kg over 60 min (dilution 150 mg/kg in 200 mL of D5W); then 50 mg/kg over 4 hr (dilution 50 mg/kg in 500 mL D5W); then 100 mg/kg over 16 hr (dilution 100 mg/kg in 1000 D5W) • Adult/child 21-40 kg: IV 150 mg/kg in 100 mL diluent over 1 hr, then 50 mg/kg in 250 mL over 4 hr, then 100 mg/kg in 500 mg over 16 hr • Infant/child 5-20 kg: IV 150 mg/kg in 3 mL/kg diluent over 1 hr, then 50 mg/kg in 7 mL/kg diluent over 4 hr, then 100 mg/kg in 14 mL/kg diluent over 16 hr Mucolytic • Adult and child 1-12 yr: INSTILL 1-2 mL (10%-20% solution) q6-8hr prn or 3-5 mL (20% solution) or 6-10 mL (10% sol) tid or qid; NEBULIZER (face mask, mouthpiece, tracheostomy) 1-10 mL of a 20% sol, or 2-20 mL of a 10% sol, q2-8hr; NEBULIZER (tent, croupette) may re- quire large dose, up to 300 mL/treatment Tracheostomy care • Adult/child: INSTILL 1-2 mL (10%- 20% sol) q1-4hr directly into tracheostomy Diagnostic bronchial lab studies • Adult/child: NEBULIZER 2-3 uses of 1-2 mL of 20% sol or 2-4 mL of 10% sol Prevention of radiocontrast- induced renal reactions (unlabeled) • Adult: PO 600 mg bid × 2 days before radiocontrast
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Available forms: Oral solution 10%, 20%; inj 20% (200 mg/mL); effervescent tablet for oral solution 500, 2500 mg
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Administer: PO route • Antidotal use: give within 8 hr for best results; dilute 10% or 20% solution to a 5% solution with diet soda, may use water if giving via gastric tube; dilu- tion of 10% solution 1:1, 20% sol 1:3, store open undiluted solution refrig- erated ≤96 hr, repeat dose if vomited within 1 hr PO route (effervescent tablets for oral solution) • Dissolve in 100 mL water (50 mg/ mL) 1-19 kg; in 150 mL water 20-59 kg; 300 mg/mL ⬧60 kg Direct intratracheal instill route • By syringe: 1-2 mL of 10%-20% solu- tion up to q1hr • Decreased dose to geriatric patients; metabolism may be slowed • Only if suction machine is available • Only after patient clears airway by deep breathing, coughing • Assistance with inhaled dose: bron- chodilator if bronchospasm occurs; me- chanical suction if cough insufficient to remove excess bronchial secretions IV route • 21-hr regimen: loading dose: dilute 150 mg/kg in 200 mL D5W; maintenance dose 1: dilute 50 mg/kg in 500 mL D5W; maintenance dose 2: dilute 100 mg/kg in 1000 mL D5W; give loading dose over 15 min; give maintenance dose 1 over 4 hr; give maintenance dose 2 over 16 hr, administer sequentially without time between doses • Store in refrigerator; use within 96 hr of opening
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Assess: • Mucolytic use: cough—type, fre- quency, character, including sputum; bronchospasm • Rate, rhythm of respirations, in- creased dyspnea; sputum; discontinue if bronchospasm occurs • VS, cardiac status including checking for dysrhythmias, increased rate, palpita- tions • ABGs for increased CO2 retention in asthma patients • Antidotal use: use within 24 hr of acet aminophen toxicity, give within 10 hr of acetaminophen to minimize hepatotoxic- ity; monitor LFTs, PT, BUN, creatinine, glucose, electrolytes, acetaminophen lev- els; inform prescriber if dose is vomited or if vomiting is persistent; 150 mg/kg may be toxic, check acetaminophen level q4hr • Hypersensitivity: anaphylaxis may occur with IV dose; if present, stop in- fusion, treat, restart; assess for dys- pnea, swelling of face, lips, tongue; rash, itching • Nausea, vomiting, rash; notify pre- scriber if these occur • Pregnancy/breastfeeding: use only if clearly needed; cautious use in breast- feeding, excretion unknown
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Evaluate: • Therapeutic response: absence of pu- rulent secretions when coughing, clear lung sounds (mucolytic use); absence of hepatic damage with acetaminophen toxicity
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: A • That foul odor and smell may be un- pleasant • To clear airway for inhalation • To report vomiting because dose may need to be repeated • Acetaminophen toxicity: Explain reason for product, expected result
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PHARMACOKINETICS IV: Excreted in urine, half-life 5.6 hr (adult), 11 hr (newborn), protein binding 83%, peak up to 60 min (PO), 5-10 min (INH) Interactions • Do not use with activated charcoal
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• Adult and child: PO 140 mg/kg, then 70 mg/kg q4hr × 17 doses to total of 1330 mg/kg; ≥41-100 kg IV loading dose 150 mg/kg over 60 min (dilution 150 mg/kg in 200 mL of D5W); then 50 mg/kg over 4 hr (dilution 50 mg/kg in 500 mL D5W); then 100 mg/kg over 16 hr (dilution 100 mg/kg in 1000 D5W)
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• Adult/child 21-40 kg: IV 150 mg/kg in 100 mL diluent over 1 hr, then 50 mg/kg in 250 mL over 4 hr, then 100 mg/kg in 500 mg over 16 hr
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• Infant/child 5-20 kg: IV 150 mg/kg in 3 mL/kg diluent over 1 hr, then 50 mg/kg in 7 mL/kg diluent over 4 hr, then 100 mg/kg in 14 mL/kg diluent over 16 hr Mucolytic
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• Adult and child 1-12 yr: INSTILL 1-2 mL (10%-20% solution) q6-8hr prn or 3-5 mL (20% solution) or 6-10 mL (10% sol) tid or qid; NEBULIZER (face mask, mouthpiece, tracheostomy) 1-10 mL of a 20% sol, or 2-20 mL of a 10% sol, q2-8hr; NEBULIZER (tent, croupette) may re- quire large dose, up to 300 mL/treatment Tracheostomy care
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• Adult/child: INSTILL 1-2 mL (10%- 20% sol) q1-4hr directly into tracheostomy Diagnostic bronchial lab studies
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• Adult/child: NEBULIZER 2-3 uses of 1-2 mL of 20% sol or 2-4 mL of 10% sol Prevention of radiocontrast- induced renal reactions (unlabeled)
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• Adult: PO 600 mg bid × 2 days before radiocontrast
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