Acetylcysteine
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Mode of action
It is a Precursor for glutathione synthesis.
Glutathione binds to reactive metabolite of Paracetamol (N-acetyl para benzoquinone imines) (and other drugs) and conjugate them and prevent hepatotoxicity.
Repletion of glutathione also directly reduces oxidative cell injury.
Acetylcysteine may also improve hepatic perfusion in established liver injury due to paracetamol or other insults.
Dosage and method of administration
Acetylcysteine is either given by the oral or parenteral route. Several protocols are suggested according to patient’s criteria
Oral
- Loading dose 140mg/kg of the 10% or 20% solution diluted to 5% in juice or soda.
- Maintenance dose: 70mg/kg every 4 hours for 17 doses [i.e., 72 hours], another option is to give 8 maintenance doses [i.e., 36 hours] if liver function tests are normal.
Parentral Dose
The initial dose is 150 mg/kg given in 200 ml of dextrose over 15 minutes, followed by 50 mg/kg in 500 ml of dextrose (5%) over 4 hours and finally 100 mg/kg in 1000 ml dextrose is given over the next 16 hours.