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Mechanism of Action
Acetylcysteine may decrease the viscosity of secretions by splitting of disulphide bonds in mucoproteins. It also promotes the detoxification of an intermediate paracetamol metabolite which is used in the management of paracetamol overdosage.



Indication & Dosage
 
 
Intravenous
PARACETAMOL POISONING
Child: Child ≥20 kg: Initially, 150 mg/kg in 100 ml of infusion fluid given over 15 min, followed by 50 mg/kg in 250 ml of infusion given over the next 4 hr, then 100 mg/kg in 500 mL of infusion fluid over the next 16 hr. Child <20 kg: Doses as per adult dose but adjust volume of based on child age and wt to avoid fluid overload.
 
Intravenous
PARACETAMOL POISONING
Adult: Initially, 150 mg/kg in 200 ml of infusion fluid given over 15 minutes, followed by 50 mg/kg in 500 ml of infusion given over the next 4 hr, then 100 mg/kg in 1 L of infusion fluid over the next 16 hr.
 
Ophthalmic
DRY EYE ASSOCIATED WITH ABNORMAL MUCUS PRODUCTION
Adult: Instill 1-2 drops of a 5% solution into the affected eye 3-4 times daily
 
Inhalation
ACUTE COUGH ASSOCIATED WITH EXCESSIVE OR VISCOUS MUCUS
Adult: 3-5 ml of a 20% solution or 6-10 ml of a 10% solution 3-4 times daily by nebulising through a face mask, mouth piece or tracheostomy. May increase to 1-10 ml of a 20% solution or 2-20 ml of a 10% solution every 2-6 hr if needed.
 
Inhalation
ACUTE COUGH ASSOCIATED WITH EXCESSIVE OR VISCOUS MUCUS
Child: 3-5 ml of a 20% solution or 6-10 ml of a 10% solution 3-4 times daily by nebulising through a face mask, mouth piece or tracheostomy. May increase to 1-10 ml of a 20% solution or 2-20 ml of a 10% solution every 2-6 hr if needed.
 
Endotracheal
ACUTE COUGH ASSOCIATED WITH EXCESSIVE OR VISCOUS MUCUS
Adult: Instill 1-2 ml of a 10-20% solution as often as every hrly.
 
Endotracheal
ACUTE COUGH ASSOCIATED WITH EXCESSIVE OR VISCOUS MUCUS
Child: Instill 1-2 ml of a 10-20% solution as often as every hrly.
 
Oral
PARACETAMOL POISONING
Adult: After gastric lavage or induction of emesis with ipecac syrup, admin loading dose of 140 mg/kg, followed by maintenance doses of 70 mg/kg every 4 hr for a total of 17 doses. 1st maintenance dose to be given 4 hr after the loading dose. Repeat dose if the patient vomits within 1 hr of admin. Continue therapy until paracetamol levels are not detectable and there is no evidence of hepatotoxicity.
 
Oral
PARACETAMOL POISONING
Child: After gastric lavage or induction of emesis with ipecac syrup, admin loading dose of 140 mg/kg, followed by maintenance doses of 70 mg/kg every 4 hr for a total of 17 doses. 1st maintenance dose to be given 4 hr after the loading dose. Repeat dose if the patient vomits within 1 hr of admin. Continue therapy until paracetamol levels are not detectable and there is no evidence of hepatotoxicity.
 
Oral
ACUTE COUGH ASSOCIATED WITH EXCESSIVE OR VISCOUS MUCUS
Adult: As lozenges/ effervescent granules or tablets: 200 mg ti
 
Oral
ACUTE COUGH ASSOCIATED WITH EXCESSIVE OR VISCOUS MUCUS
Child: As lozenges/ effervescent granules or tablets: 2-7 yr: 200 mg bid; <2 yr: 200 mg daily.
  
PrecautionsAsthmatic patients, history of bronchospasm, peptic ulceration. Pregnancy, lactation.
  
Potentially Life-threatening 
Adverse Drug Reactions
Flushing, fever, stomatitis, nausea, vomiting, rhinorrhoea, bronchospasm, anaphylactoid reactions, rashes. Rarely, blurred vision, bradycardia, syncope, thrombocytopenia, convulsions.
  
Adverse Drug Reactions Rarely, respiratory or cardiac arrest.
  
   
 

 

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