ACETYLCYSTEINE 200mg/ml (MARTINDALE) Injection/Solution for

What is ACETYLCYSTEINE 200mg/ml (MARTINDALE)

ACETYLCYSTEINE 200mg/ml (MARTINDALE) is a sterile injectable solution of acetylcysteine, available in 10ml glass ampoules. It is primarily used as an antidote for paracetamol (acetaminophen) poisoning and also serves as a mucolytic agent in conditions involving thick or viscous mucus secretions, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, and bronchitis.

• Generic Name: Acetylcysteine
• Form: Solution for Injection
• Concentration: 200 mg/mL
• Pack Size: 10ml Glass Ampoules × 10

Its clinical value lies in its ability to replenish glutathione levels, break down mucus, and counteract hepatotoxic effects in acetaminophen overdose.

How to use ACETYLCYSTEINE 200mg/ml (MARTINDALE)

The administration of ACETYLCYSTEINE injection should always be carried out under medical supervision.

• Paracetamol Overdose: Administered intravenously over a specific time schedule using a three-step infusion protocol (e.g., 150 mg/kg over 1 hour, 50 mg/kg over 4 hours, and 100 mg/kg over 16 hours).
• Mucolytic Indication: May be given intravenously or via inhalation when available in nebulized form, though this injectable solution is predominantly for IV use.

Always dilute the ampoule content before administration and use appropriate aseptic techniques. Dosing must be calculated based on body weight and clinical condition.

Mode of Action ACETYLCYSTEINE 200mg/ml (MARTINDALE)

Acetylcysteine acts via two primary mechanisms:

• As an antidote: It restores hepatic glutathione levels, allowing detoxification of NAPQI (a toxic metabolite of paracetamol), thereby preventing liver damage.
• As a mucolytic: The free sulfhydryl group in acetylcysteine breaks disulfide bonds in mucoproteins, reducing mucus viscosity and aiding clearance from the respiratory tract.

These actions make it effective in both life-threatening paracetamol overdose and chronic respiratory conditions involving retained secretions.

ACETYLCYSTEINE 200mg/ml (MARTINDALE) Interactions ACETYLCYSTEINE 200mg/ml (MARTINDALE)

Acetylcysteine has relatively few drug interactions, but caution is advised with the following:

• Activated charcoal: May adsorb acetylcysteine when administered orally, reducing its effectiveness (not relevant for IV form but worth noting).
• Nitroglycerin: Co-administration may enhance vasodilatory and hypotensive effects.
• Antibiotics: Mixing with some antibiotics (e.g., tetracyclines) in the same nebulizer can reduce effectiveness; less relevant for injection but important in alternate forms.

Always assess the patient's medication profile when administering acetylcysteine, especially in polypharmacy cases.

Dosage of ACETYLCYSTEINE 200mg/ml (MARTINDALE)

Dosage varies depending on the indication and patient's clinical condition:

• Paracetamol Overdose (Adult):
  • Initial dose: 150 mg/kg IV over 1 hour
  • Second dose: 50 mg/kg IV over 4 hours
  • Third dose: 100 mg/kg IV over 16 hours
• Paracetamol Overdose (Pediatric): Similar to adult dosing, adjusted for body weight.
• Mucolytic use: Dosing is typically lower and depends on severity and response.

Dosages must be strictly calculated and infused over recommended time intervals to minimize adverse reactions.

Possible side effects of ACETYLCYSTEINE 200mg/ml (MARTINDALE)

While generally well tolerated, acetylcysteine may cause the following side effects:

• Common:
  • Nausea and vomiting (especially with high doses)
  • Flushing
  • Urticaria (hives)
• Serious but Rare:
  • Anaphylactoid reactions (rash, bronchospasm, hypotension)
  • Chest tightness
  • Severe hypotension

Adverse reactions can often be managed by slowing the infusion rate or temporarily discontinuing the drug. Emergency support should be available in the event of hypersensitivity reactions.

ACETYLCYSTEINE 200mg/ml (MARTINDALE) Contraindications ACETYLCYSTEINE 200mg/ml (MARTINDALE)

ACETYLCYSTEINE should not be used in the following cases:

• Known hypersensitivity: Allergy to acetylcysteine or any component of the formulation.
• Severe respiratory distress: For mucolytic purposes, acetylcysteine may worsen bronchospasm in susceptible individuals (more relevant in inhalation use).
• Advanced hepatic failure: Though used to protect the liver, caution is needed in severe hepatic impairment.

Relative caution is also required in patients with asthma or history of peptic ulcer disease.

Storage of ACETYLCYSTEINE 200mg/ml (MARTINDALE)

To maintain the stability and efficacy of this injectable solution, adhere to the following storage recommendations:

• Temperature: Store below 25°C (77°F). Do not freeze.
• Light protection: Keep ampoules in the original packaging to protect from light.
• Post-opening: Once an ampoule is opened, use immediately. Do not store opened ampoules for later use.
• Visual inspection: Do not use the solution if it is cloudy, discolored, or contains particulates.

Always keep medications out of the reach of children and follow local regulations for disposal of unused ampoules.