Acetylcysteine

Pre-Treatment Assessment Following Acute Ingestion : Obtain a plasma or serum sample to assay for acetaminophen concentration at least 4 hours after ingestion. If the time of acetaminophen ingestion is unknown: Administer a loading dose of acetylcysteine injection immediately. Obtain an acetaminophen concentration to determine need for continued treatment. If the acetaminophen concentration cannot be obtained (or is unavailable or uninterpretable) within the 8-hour time interval after acetaminophen ingestion or there is clinical evidence of acetaminophen toxicity: Administer a loading dose of acetylcysteine injection immediately and continue treatment for a total of three doses over 21 hours. If the patient presents more than 8 hours after ingestion and the time of acute acetaminophen ingestion is known: Administer a loading dose of acetylcysteine injection immediately. Obtain acetaminophen concentration to determine need for continued treatment.

Recommended Dosage in Adults and Pediatrics for Acute Acetaminophen Ingestion Acetylcysteine injection is for intravenous administration only. Dosage Regimen The total recommended dosage of acetylcysteine injection is 300 mg/kg given intravenously as 3 separate, sequential doses (i.e., 3-bag method to administer the loading, second, and third doses). The total recommended infusion time for 3 doses is 21 hours. For the recommended weight-based dosage and weight-based dilution in patients who weigh: 5 to 20 kg (see Table 2 ) 21 to 40 kg (see Table 3 ) 41 kg or greater (see Table 4 ) Table 2. Recommended Acetylcysteine Injection Dosage and Dilution for Patients 5 kg to 20 kg * Dilute acetylcysteine injection in one of the following three solutions: sterile water for injection, 0.45% sodium chloride injection, or 5% dextrose in water. ** Recommended dosing for those less than 5 kg has not been studied.