GENERIC NAME

Acetylcysteine

ACTION
Mucolytic that reduces the viscosity of pulmonary secretions by splitting disulfide linkages
between mucoprotein molecular complexes. Also, restores liver stores of glutathione to treat
acetaminophen toxicity.

BRAND NAME
Acetadote, Mucomyst

CLASSIFICATION
Miscellaneous respiratory tract drugs

INDICATION
 Adjunct therapy for abnormal viscid or thickened mucous secretions in patients with
pneumonia, bronchitis, bronchiectasis, primary amyloidosis of the lung, tuberculosis, cystic
fibrosis, emphysema, atelectasis, pulmonary complications of thoracic surgery, or CV
surgery
Adults and children: 1 to 2 ml 10% or 20% solution by direct instillation into trachea as often as
q hour. Or, 1 to 10 ml of 20% solution or 2 to 20 ml of 10% solution by nebulization q 2 to 6
hours, prn

 Acetaminophen toxicity
Adults and children: Initially, 140 mg/kg P.O. then 70 mg/kg P.O. q 4 hours for 17 doses. Or, a
loading dose of 150mg/kg IV over 15 minutes; then IV maintenance dose of 50 mg/kg infused
over 4 hours, followed by 100 mg/kg infused over 16 hours.

CONTRAINDICATION
 Contraindicated in patients hypersensitive to drug.
 Use cautiously in elderly or debilitated patients with severe respiratory insufficiency. Use I.V.
formulation cautiously in patients with asthma or a history of bronchospasm.

SIDE EFFECTS/ ADVERSE REACTIONS

CNS: fever, drowsiness, abnormal thinking, gait disturbances
CV: tachycardia, hypotension, hypertension, flushing, chest tightness
EENT: rhinorrhea, ear pain, eye pain, pharyngitis, throat tightness
GI: stomatitis, nausea, vomiting
Respiratory: rhonchi, bronchospasm, cough, dyspnea
Skin: rash, clamminess, diaphoresis, pruritus, urticaria
Other: angioedema, chills, anaphylactoid reaction

NURSING RESPONSIBILITY
 Observe 10 rights in drug administration.
 Use plastic, glass, stainless steel, or another nonreactive metal when giving by nebulization.
Hand-bulb nebulizers aren’t recommended because output is too small and particle size too
large.
 Drug is physically or chemically incompatible with tetracyclines, erythromycin lactobionate,
amphotericin B, and ampicillin sodium. If given by aerosol inhalation, nebulize these drugs
 separately. Iodized oil, trypsin, and hydrogen peroxide are physically incompatible with
acetylcysteine; don’t add to nebulizer.
 Drug smells strongly of sulfur. Mixing oral form with juice or cola improves its taste.
 Drug delivered through nasogastric tube may be diluted with water.
 Monitor cough type and frequency.
 Be aware that facial erythema may occur within 30 to 60 minutes after the start of an I.V.
infusion and usually resolves without infusion interruption.