Acetylcysteine (N-acetylcysteine)

Andrew Street
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Andrew Street
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Indications for acetylcysteine (N-acetylcysteine). Indications: • Antidote for paracetamol poisoning • To prevent renal damage from contrast material - contrast nephropathy • To reduce the viscosity of respiratory secretions (mucolytic)
MOA of acetylcysteine (N-acetylcysteine). MOA: In therapeutic doses, paracetamol is metabolised mainly by conjugation with glucuronic acid and sulfate. A small amount is converted to N-acetyl-p-benzoquinone imine (NAPQI), which is hepatotoxic. Normally, this is quickly detoxified by conjugation with glutathione. However, in paracetamol poisoning, the body’s supply of glutathione is overwhelmed and NAPQI is left free to cause liver damage. Acetylcysteine works mainly by replenishing the body’s supply of glutathione. Acetylcysteine also has antioxidant effects, which may contribute to its effect in preventing contrast nephropathy, although this is not completely understood. If acetylcysteine is brought into contact with mucus, it causes it to liquefy. For patients who have tenacious respiratory secretions (e.g. in bronchiectasis), this may aid sputum clearance.
SE's of acetylcysteine (N-acetylcysteine). SE's: • Anaphylactoid reaction - similar to an anaphylactic reaction but involves histamine release independent of IgE antibodies. Therefore, once the reaction has settled (by stopping the acetylcysteine and giving an antihistamine ± a bronchodilator), it is usually safe to restart acetylcysteine, but at a lower rate of infusion. • When used as a mucolytic and given as a nebuliser it can cause bronchospasm. A bronchodilator (eg salbutamol) is usually given beforehand.
CI's, cautions, & important interactions for acetylcysteine (N-acetylcysteine). CI's: • None Cautions: • Hx of anaphylactoid reactions Important interactions: • None
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