N-Acetylcysteine: Difference between revisions
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Intravenous acetylcysteine is indicated for the treatment of acetaminophen overdose by preventing depletion of glutathione reserves. | Intravenous acetylcysteine is indicated for the treatment of acetaminophen overdose by preventing depletion of glutathione reserves. | ||
==N-acetylcysteine (NAC)== | |||
===Background=== | |||
#Almost 100% effective if given <8 hr post-ingestion; less effective if 16-24 hr post-ingestion | |||
#May still be useful >24 hr post-ingestion, even with fulminant hepatic failure. Give NAC until LFTs improve (not until APAP level is 0) <ref>Keays R, Harrison PM, Wendon JA, et al. Intravenous acetylcysteine in paracetamol-induced fulminant hepatic failure: a prospective controlled trial. BMJ. 1991;303(6809):1026-1029. (Prospective randomized controlled trial; 50 patients)</ref> <ref>Harrison PM, Keays R, Bray GP, et al. Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of N-acetylcysteine. Lancet. 1990;335(8705):1572- 1573. (Retrospective analysis; 100 patients)</ref> | |||
#Be aware NAC treatment may affect PT. May see a dose-dependent increase in PT following NAC in patients without hepatotoxicity. <ref>Wasserman GS, Garg U. Intravenous administration of Nacetylcysteine: interference with coagulopathy testing. Ann Emerg Med. 2004;44(5):546-547. (Letter)</ref> | |||
===Dosing:=== | |||
====PO==== | |||
#140mg/kg PO load | |||
#70mg/kg PO q4hr x17 doses additional; dilute to 5% soln | |||
;Side Effects: sulfur-smell causes nausea and vomiting. Consider mixing with juice or soda, in a cup with a lid and straw | |||
====IV==== | |||
#Loading dose: 150mg/kg in 100 mL D5W over 60min | |||
#Second (maintenance) dose: 50mg/kg in 250 mL D5W over 4hr | |||
#Third dose: 100mg/kg in 500 mL D5W over 16hr | |||
;Side Effects: | |||
#Anaphylactoid reaction but also associated with seizures, cerebral edema, & herniation. <ref>http://journals.lww.com/em-news/Fulltext/2012/02000/Toxicology_Rounds__Lessons_from_the_Courtroom_.9.aspx</ref> | |||
#Anaphylaxis responds to standard therapies and can usually restart NAC without safely without complications. <ref>Sandilands EA, Bateman DN. Adverse reactions associated with acetylcysteine. Clin Toxicol (Phila). 2009;47(2):81-88. (Systematic literature review)</ref> | |||
[[Category:Drugs]] | [[Category:Drugs]] | ||
Revision as of 19:59, 28 January 2015
Intravenous acetylcysteine is indicated for the treatment of acetaminophen overdose by preventing depletion of glutathione reserves.
N-acetylcysteine (NAC)
Background
- Almost 100% effective if given <8 hr post-ingestion; less effective if 16-24 hr post-ingestion
- May still be useful >24 hr post-ingestion, even with fulminant hepatic failure. Give NAC until LFTs improve (not until APAP level is 0) [1] [2]
- Be aware NAC treatment may affect PT. May see a dose-dependent increase in PT following NAC in patients without hepatotoxicity. [3]
Dosing:
PO
- 140mg/kg PO load
- 70mg/kg PO q4hr x17 doses additional; dilute to 5% soln
- Side Effects
- sulfur-smell causes nausea and vomiting. Consider mixing with juice or soda, in a cup with a lid and straw
IV
- Loading dose: 150mg/kg in 100 mL D5W over 60min
- Second (maintenance) dose: 50mg/kg in 250 mL D5W over 4hr
- Third dose: 100mg/kg in 500 mL D5W over 16hr
- Side Effects
- Anaphylactoid reaction but also associated with seizures, cerebral edema, & herniation. [4]
- Anaphylaxis responds to standard therapies and can usually restart NAC without safely without complications. [5]
- ↑ Keays R, Harrison PM, Wendon JA, et al. Intravenous acetylcysteine in paracetamol-induced fulminant hepatic failure: a prospective controlled trial. BMJ. 1991;303(6809):1026-1029. (Prospective randomized controlled trial; 50 patients)
- ↑ Harrison PM, Keays R, Bray GP, et al. Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of N-acetylcysteine. Lancet. 1990;335(8705):1572- 1573. (Retrospective analysis; 100 patients)
- ↑ Wasserman GS, Garg U. Intravenous administration of Nacetylcysteine: interference with coagulopathy testing. Ann Emerg Med. 2004;44(5):546-547. (Letter)
- ↑ http://journals.lww.com/em-news/Fulltext/2012/02000/Toxicology_Rounds__Lessons_from_the_Courtroom_.9.aspx
- ↑ Sandilands EA, Bateman DN. Adverse reactions associated with acetylcysteine. Clin Toxicol (Phila). 2009;47(2):81-88. (Systematic literature review)