Acetylcysteine, Acetadote, Mucomyst, Mucosil
Nursing Considerations
• Acetylcysteine should be used cautiously
in patients with asthma or a history of
bronchospasm because drug may adversely
affect respiratory function.
WARNING To avoid fluid overload and possibly
fatal hyponatremia or seizures, adjust
total administered volume, as ordered, for
patients weighing less than 40 kg (88 lb)
and for those who need fluid restriction.
• If needed, dilute 20% instillation or
inhalation solution with normal saline
solution or sterile water. The 10% solution
may be used undiluted.
•When treating acetaminophen overdose,
dilute 20% oral solution with cola or other
soft drink to a concentration of 5%, and
use within 1 hour. Dilute parenteral solution
with D5W or half-normal saline
(0.45% sodium chloride) solution for
injection following manufacturer guidelines
because dilution is based on dosage.
Acetadote may turn from colorless to
slight pink or purple once the stopper is
punctured, but color change has no effect
on product quality.
• Acetylcysteine is most effective if given
within 24 hours of acetaminophen ingestion.
For specific instructions, contact a
regional poison center at 1-800-222-1222
or a special health professional assistance
hotline at 1-800-525-6115.
• If patient vomits loading dose or any
maintenance dose within 1 hour of
administration, repeat dose as prescribed.
• Keep in mind that suicidal patient may
not provide reliable information about
vomiting.Watch such a patient to ensure
that he ingests all of prescribed dosage.
• During treatment for acetaminophen
overdose, watch for signs of hepatotoxicity,
such as prolonged bleeding time,
altered coagulation, and easy bruising.
• Be aware that acetylcysteine may have a
disagreeable odor, which disappears as
treatment progresses.
• Because nebulization causes sticky residue
on face and in mouth, have patient wash
his face and rinse his mouth at the end of
each treatment.
• Be aware that an open vial of solution may
turn light purple but that this doesn’t alter
its effectiveness.
• Refrigerate opened vials and discard after
96 hours.
• Assess type, frequency, and characteristics
of patient’s cough. Particularly note sputum.
If cough doesn’t clear secretions, prepare
to perform mechanical suctioning.
•Monitor patient for tachycardia.
PATIENT TEACHING
• Instruct patient to notify prescriber immediately
about nausea, rash, or vomiting.
•Warn patient about acetylcysteine’s
unpleasant smell; reassure him that it subsides
as treatment progresses.
• To decrease mucus viscosity, urge patient
to consume 2 to 3 L of fluid daily unless
contraindicated by another condition.
