Neonatal Drug Therapy Manual

Acetylcysteine

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Updated March 5, 2024 - 2:28pm

Alternate Name(s): 
Mucomyst
Original Date: 
June 2010
Indications: 
  • Distal intestinal obstruction syndrome (previously known as meconium ileus)
Administration: 
  • PO
  • PR
  • Intra operatively via local instillation
Dosage: 

Acetylcysteine 5 % Oral or Enema Solution

  • PO: 5 - 10 mL Q6H
  • PR: 10 mL/kg Q6H (up to 45 mL q6H)

Intra operative wash of distal ileum:

Procedure done using normal saline and 2 - 4 % acetylcysteine solution (by diluting available 20% N-acetylcysteine with sterile water)

 

Side Effects: 
  • Endocrine and metabolic: hypernatremia
  • GI: dyspepsia, nausea, vomiting
  • Hepatic: increase in transaminases and bilirubin
Parameters to Monitor: 
  • Serum sodium
  • Liver function tests
Reconstitution and Stability: 
  • Acetylcysteine 200 mg/mL (20%)
    • Withdraw 5 mL
    • Add to 15 mL of 0.9% NaCl
    • Final Concentration: Acetylcysteine 5%
  • Acetylcysteine 200 mg/mL (20%)
    • Withdraw 10 mL
    • Add to 40 mL of sterile water
    • Final Concentration: Acetylcysteine 4%
Compatibility: 

N/A

Notes: 

Rectal enemas of Acetylcysteine appear to have less favorable results than oral administration

References: 

-Bhattacharyaya S, BasuKS, Samanta N.  Proximal bowel T-tube drainage and local instillation of N-acetyl cysteine: A modified approach to management of meconium ileus.  J Indian Assoc Pediatr Surg 2005; 10: 37-40

-Emil S, Nguyen T, Sills J, et al:  Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management.  J Pediatr Surg 2004; 39 (5): 731-737

-Cooke A, Deshpande AV, Wong CKF and al: Hepatic derangement following N-Acetylcysteine enemas in an infant with cystic fibrosis.  Journal of Paediatrics and Child Health 2008; 44: 673 - 675

 

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