Ver el código de «N-Acetylcysteine»

==General==
N-acetylcysteine (NAC) prevents toxicity by limiting the formation of NAPQI which increases the ability to detoxify the NAPQI that is formed via hepatotoxic substances such as tylenol.

*Type: Antioxidant
*Dosage Forms:, IV, PO
*Common Trade Names: NAC;

==Adult Dosing==
===[[Acetaminophen (tylenol) toxicity]]===
====PO====
*140mg/kg PO load
*70mg/kg PO q4hr x17 doses additional; dilute to 5% soln

====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

====Comments====
*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>

==Pediatric Dosing==

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
{{NAC use in pregnancy}}

*Lactation:
*Renal Dosing
**Adult
**Pediatric
*Hepatic Dosing
**Adult
**Pediatric

==Contraindications==
*Allergy to class/drug

==Adverse Reactions==
===Serious===
*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>
**No treatment is necessary for isolated flushing
**If urticaria, then [[Diphenhydramine]]
**If angioedema, bronchospasm, or hypotension, then [[Diphenhydramine]], corticosteroids, and bronchodilators along with cessation of the NAC
***Restart NAC infusion at a slower rate 1 hour after administration of medical therapy
**[[Epinephrine]] is not recommended although it can be used in patients with severe progressive symptoms<ref>Heard KJ. Acetylcysteine for acetaminophen poisoning. N Engl J Med. 2008; 359(3): 285-92.  </ref>

===Common===
*sulfur-smell causes nausea and vomiting. Consider mixing with juice or soda, in a cup with a lid and straw

==Pharmacology==
*Half-life: 
*Metabolism: 
*Excretion: 
*Mechanism of Action:
**Intravenous acetylcysteine is indicated for the treatment of acetaminophen overdose by preventing depletion of glutathione reserves.

==See Also==
*[[Acetaminophen (tylenol) toxicity]]

==References==
<references/>
[[Category:Drugs]]