ACETYLCYSTEINE – Drug Information

Generic Name: Acetylcysteine

Therapeutic Classification: Expectorant and Cough Products

Description:

Acetylcysteine (also known as N-acetylcysteine or N-acetyl-L-cysteine or NAC) is primarily used as a mucolytic agent and in the management of acetaminophen poisoning. It is a derivative of cysteine with an acetyl group attached to the amino group of cysteine. It is a mucolytic agent, prescribed for chronic bronchopulmonary disease, cystic fibrosis and others. It works by thinning of mucus and ease its removal. It is also used in the management of paracetamol overdose. It works by thinning of mucus and ease its removal.

Mechanism of Action:

It protects against acetaminophen/paracetamol overdose-induced hepatotoxicity by maintaining or restoring hepatic concentrations of glutathione. In acetaminophen overdose cases, excessive quantities of this metabolite are formed because the primary metabolic (glucuronide and sulfate conjugation) pathways become saturated. Acetylcysteine may act by reducing the metabolite to the parent compound and/or by providing sulfhydryl for conjugation of the metabolite. Experimental evidence also suggests that a sulfhydryl-containing compound such as acetylcysteine may also directly inactivate the metabolite.

Acetylcysteine exerts mucolytic activity through sulfhydryl group, which opens up disulfide bonds in mucoproteins and lowers mucous viscosity of pulmonary secretions.

Pharmacodynamics:

It is most effective when given orally, with benefit seen principally in patients treated within 8-10 hours of the overdose. Acetylcysteine likely protects the liver by maintaining or restoring the glutathione levels, or by acting as an alternate substrate for conjugation with, and thus detoxification of, the reactive metabolite.

Indication for Prescribe Acetylcysteine:

This Medication is indicated as adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions in such conditions as:

  • Chronic bronchopulmonary disease (chronic emphysema, emphysema with bronchitis, chronic asthmatic bronchitis, tuberculosis, bronchiectasis and primary amyloidosis of the lung)
  • Acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis)
  • Pulmonary complications associated with surgery
  • Pulmonary complications of cystic fibrosis
  • Use during anesthesia
  • Post-traumatic chest conditions
  • Atelectasis due to mucous obstruction
  • Diagnostic bronchial studies (bronchograms, bronchospirometry, and bronchial wedge catheterization)

Contraindications:

Hypersensitivity to Acetylcysteine, Acute asthma.

Pregnancy Category:

Category B

Animal studies have failed to demonstrate a risk to the fetus and appropriate studies on pregnant women are lacking.

Adverse Reactions / Side Effects of Acetylcysteine:

Mouth ulcer, Runny nose, Bronchoconstriction, Bronchospasm, Calmness, Chest tightness, Disagreeable odor, Drowsiness, Fever, Hemoptysis, Increased volume of bronchial secretions, Irritation of tracheal or bronchial, tract, Nausea, Rhinorrhea, Stomatitis & Vomiting.

Warnings and Precaution for Acetylcysteine:

  • Caution needed for pregnant and breastfeeding women.
  • Do not mix acetylcysteine with other inhaled medications unless directed by the Doctor or Pharmacist.
  • Avoid excess dosage of Acetylcysteine.

Dosage:

  • Pulmonary Disease
    • Facilitation of expectoration via mucolysis
    • 5-10 mL of 10% or 20% solution by nebulization q6-8hr PRN
  • Diagnostic Bronchography
    • 1-2 mL of 20% solution or 2-4 mL of 10% solution administered 2-3 times by nebulization or by intratracheal instillation before procedure
  • Acetaminophen Overdose
    • See separate drug monograph, acetylcysteine (antidote)

Storage Condition:

Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light. After opening the vial, store in the refrigerator and use within 96 hours (4 days).

Trade Names/Brand Names of Acetylcysteine:

India:

Gluton (600mg) | Flumucil (200mg) | Mucare (400mg) |  Mucyst (1000mg) | Nutradyn Capsules | Mucomix (400mg) | Mucotyle (1000mg) | Mucyst/Cilol (600mg) | Mucomelt (600mg) | Mucotyle (600mg) | Mucinac (600mg) | Nacel (600mg) | Mucyst/Cilol (200mg) | Mucosys (400mg) | Flumucil (100mg) | Mucomix (600mg) | Mucomelt (200mg) | Flumucil DT (200mg) | Cilol (1000mg) | Gluton (600mg) | Mucomelt (400mg) | Mucyst Inj (800mg) | Cilol (2000mg) | Nacel (200mg) | Rebagen Otic (100mg/100mg/100mg) | Mucare (200mg) | Mucotab (600mg) | Acedril Forte (100mg/600mg) | Mucinac (20% W/V)

International:

Acemuc, Acemuk, Acetyst, Acetadote, Asist, Bronkyl, Brunac eyedrops, Fluimucil, Fluimukan, Flumil, Flutafin, Lysox, Mucinac, Mucohelp, Mucomelt-A, MUCOMIX, Mucomyst, NAC AL, Nytex, Parvolex, PharmaNAC, Rheunac, Siran, Solmucaïne, Trebon N, Vlenolys

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