Alternate Name(s):
MUCOMYST®, PARVOLEX®, N-Acetylcysteine
Classification:
Antidote for acetaminophen poisoning
Original Date:
August 2005
Revised Date:
June 2019
Indications:
- Antidote to prevent or minimize hepatic injury following a potentially toxic acetaminophen ingestion
- Mucolytic agent
- Prevention of contrast media-induced nephropathy
Reconstitution and Stability:
- Store at room temperature
- Available as a 20% solution = 200 mg/mL
- Vial is stable 96 hours refrigerated once punctured
- Solutions diluted for bladder irrigation stable 28 days refrigerated (0.001% - 6 % or 0.01 mg/mL - 60 mg/mL) or 14 days at room temperature
Compatibility:
- Solutions Compatible: D5W, 0.9% NaCl
- Additives/Above Cassette Compatible: no information
- Y-site Compatible: no information
- Incompatible: amphotericin B, tetracyclines, erythromycin, ampicillin
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct | NO |
| IV Intermittent Infusion | YES |
| IV Continuous Infusion | YES Large volume pump: usual dilution 30 mg/mL |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Adults and Pediatric:
- Acetaminophen Poisoning
STANDARD RISK PROTOCOL
- Loading Dose: 60 mg/kg/hr (MAX 6 g/hr) IV x 4 hours followed by
- Maintenance Infusion: 6 mg/kg/hr (MAX 600 mg/hr) IV continuously until advised to stop by Ontario Poison Centre
HIGH RISK PROTOCOL
- Loading Dose: 60 mg/kg/hr (MAX 6 g/hr) IV x 4 hour followed by
- Maintenance Infusion: 12 mg/kg/hr (MAX 1200 mg/hr) IV continuously until advised to stop by Ontario Poison Centre
- Prevention of contrast media-induced nephropathy
- 25 - 50 mg/kg IV 30 min prior to contrast and Q8H x 3 doses
Potential hazards of parenteral administration:
Hypersensitivity reactions have been reported: rash, urticaria, facial edema, hypotension/hypertension, tachycardia, bronchospasm, anaphylaxis
- Nausea, vomiting, flushing
Notes:
- Therapy is most effective when administered within the first 8-10 hours post acetaminophen ingestion
- IV dose is NOT the same as the oral dose; IV therapy preferable if patient vomiting, or if activated charcoal or syrup of Ipecac have been used
- Monitor acetaminophen level and liver function tests
- Consultation with the Ontario Poison Control Center may be required to individualize the treatment. (416-813-5900)