Acetylcysteine inhalation

Name: Acetylcysteine inhalation

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Adverse Reactions

Adverse effects have included stomatitis, nausea, vomiting, fever, rhinorrhea, drowsiness, clamminess, chest tightness, and bronchoconstriction. Clinically overt acetylcysteine induced bronchospasm occurs infrequently and unpredictably even in patients with asthmatic bronchitis or bronchitis complicating bronchial asthma.

Acquired sensitization to acetylcysteine has been reported rarely. Reports of sensitization in patients have not been confirmed by patch testing. Sensitization has been confirmed in several inhalation therapists who reported a history of dermal eruptions after frequent and extended exposure to acetylcysteine.

Reports of irritation to the tracheal and bronchial tracts have been received and although hemoptysis has occurred in patients receiving acetylcysteine such findings are not uncommon in patients with bronchopulmonary disease and a causal relationship has not been established.

References

  1. Bonanomi L, Gazzaniga A. Toxicological, pharmacokinetic and metabolic studies on acetylcysteine. Eur J Respir Dis, 1981; 61 (Suppl III): 45-51.
  2. Am Rev Respir Dis, 1960; 82:627-639.

Rx Only

IN7504
Rev. 5/14
MG #11105

AMERICAN
REGENT, INC.
SHIRLEY, NY 11967

Usual Pediatric Dose for Diagnostic Bronchograms

Nebulized into a face mask, mouth piece, or tracheostomy:
Recommended dosage: 3 to 5 mL of 20% solution, or 6 to 10 mL of 10% solution, 3 to 4 times a day
Dosage range: 1 to 10 mL of 20% solution, or 2 to 20 mL of 10% solution, every 2 to 6 hours

Nebulization tent, Croupette:
Recommended dose: The volume of 10% or 20% solution that will maintain a very heavy mist in the tent or Croupette for the desired period.
-This requires very large solution volumes, as much as 300 mL in a single treatment period.
-Intermittent or continuous prolonged administration periods, including overnight, may be desirable.
-Nebulization into a tent or Croupette must be individualized.
-Take into account the available equipment.

Direct Instillation:
Dose range: 1 to 2 mL of 10% to 20% solution, as often as every hour.
-Routine tracheostomy care: 1 to 2 mL of 10% to 20% solution, every 1 to 4 hours, instilled into the tracheostomy
-Percutaneous intratracheal catheter: 1 to 2 mL of 20% solution, or 2 to 4 mL of 10% solution, every 1 to 4 hours, via a syringe attached to the catheter
-Direct pulmonary installation: 2 to 5 mL of 20% solution
--Introduce directly into a particular segment of the bronchopulmonary tree by inserting (under local anesthesia and direct vision) a small plastic catheter into the trachea; instill using a syringe connected to the catheter.

Diagnostic Bronchograms:
Recommended dosing: 1 to 2 mL of the 20% solution, or 2 to 4 mL of the 10% solution, by nebulization or by instillation intratracheally, two or three times prior to the procedure.

Comments:
-The 20% solution may be diluted to a lesser concentration with either Sodium Chloride Injection, Sodium Chloride Inhalation Solution, Sterile Water for Injection, or Sterile Water for Inhalation.
-The 10% solution may be used undiluted.
-Use compressed tank gas (air) or an air compressor to provide pressure for nebulizing the solution.
-Oxygen may also be used but should be used with the usual precautions in patients with severe respiratory disease and CO2 retention.

Use: Adjuvant therapy for abnormal, viscid, or inspissated mucous secretions, such as in:
Chronic bronchopulmonary disease (chronic emphysema or asthmatic bronchitis, emphysema with bronchitis, tuberculosis, bronchiectasis, or primary pulmonary amyloidosis)
Acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis)
Pulmonary complications of cystic fibrosis
Tracheostomy care
Pulmonary complications associated with surgery
Use during anesthesia
Post-traumatic chest conditions
Atelectasis due to mucous obstruction
Diagnostic bronchial studies (bronchograms, bronchospirometry, and bronchial wedge catheterization)

Usual Pediatric Dose for Mucolytic

Nebulized into a face mask, mouth piece, or tracheostomy:
Recommended dosage: 3 to 5 mL of 20% solution, or 6 to 10 mL of 10% solution, 3 to 4 times a day
Dosage range: 1 to 10 mL of 20% solution, or 2 to 20 mL of 10% solution, every 2 to 6 hours

Nebulization tent, Croupette:
Recommended dose: The volume of 10% or 20% solution that will maintain a very heavy mist in the tent or Croupette for the desired period.
-This requires very large solution volumes, as much as 300 mL in a single treatment period.
-Intermittent or continuous prolonged administration periods, including overnight, may be desirable.
-Nebulization into a tent or Croupette must be individualized.
-Take into account the available equipment.

Direct Instillation:
Dose range: 1 to 2 mL of 10% to 20% solution, as often as every hour.
-Routine tracheostomy care: 1 to 2 mL of 10% to 20% solution, every 1 to 4 hours, instilled into the tracheostomy
-Percutaneous intratracheal catheter: 1 to 2 mL of 20% solution, or 2 to 4 mL of 10% solution, every 1 to 4 hours, via a syringe attached to the catheter
-Direct pulmonary installation: 2 to 5 mL of 20% solution
--Introduce directly into a particular segment of the bronchopulmonary tree by inserting (under local anesthesia and direct vision) a small plastic catheter into the trachea; instill using a syringe connected to the catheter.

Diagnostic Bronchograms:
Recommended dosing: 1 to 2 mL of the 20% solution, or 2 to 4 mL of the 10% solution, by nebulization or by instillation intratracheally, two or three times prior to the procedure.

Comments:
-The 20% solution may be diluted to a lesser concentration with either Sodium Chloride Injection, Sodium Chloride Inhalation Solution, Sterile Water for Injection, or Sterile Water for Inhalation.
-The 10% solution may be used undiluted.
-Use compressed tank gas (air) or an air compressor to provide pressure for nebulizing the solution.
-Oxygen may also be used but should be used with the usual precautions in patients with severe respiratory disease and CO2 retention.

Use: Adjuvant therapy for abnormal, viscid, or inspissated mucous secretions, such as in:
Chronic bronchopulmonary disease (chronic emphysema or asthmatic bronchitis, emphysema with bronchitis, tuberculosis, bronchiectasis, or primary pulmonary amyloidosis)
Acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis)
Pulmonary complications of cystic fibrosis
Tracheostomy care
Pulmonary complications associated with surgery
Use during anesthesia
Post-traumatic chest conditions
Atelectasis due to mucous obstruction
Diagnostic bronchial studies (bronchograms, bronchospirometry, and bronchial wedge catheterization)

Other Comments

Administration advice:
Acetaminophen Overdose:
-For specific treatment information/clinical management, contact your regional poison center at 1-800-222-1222, or alternatively, a special health professional assistance line for acetaminophen overdose at 1-800-525-6115.
-The manufacturer product information should be consulted for interpretation of acetaminophen assays.
Administration of Aerosol:
-To prevent acetylcysteine concentrating in the solution after prolonged nebulization, dilute with an equal volume of sterile water for injection, when three-quarters of the initial volume has been nebulized.
-The manufacturer product information should be consulted.

Storage requirements:
-Injection: Single dose vial, preservative-free, discard unused portion.
-If vial was previously opened, do not use for intravenous administration.
-Diluted solution for injection is stable for 24 hours at controlled room temperature.
-Inhalation: If only a portion of the solution in a vial is used, refrigerate the remainder and use within 96 hours.

Reconstitution/preparation techniques:
-Preparation for Oral Administration: Dilute the 20% solution with diet cola or other diet soft drinks, to a final concentration of 5% (the manufacturer product information should be consulted). If administered via gastric tube or Miller-Abbott tube, may use water as the diluent.
-The oral dilutions should be freshly prepared and utilized within one hour; remaining undiluted solutions in opened vials can be stored in the refrigerator up to 96 hours.
-Acetylcysteine for inhalation does not contain an antimicrobial agent, and care must be taken to minimize contamination of the sterile solution.

General:
-The color of the Injection may turn from essentially colorless to a slight pink or purple once the stopper is punctured. The color change does not affect the quality of the product.
-Clean nebulizing equipment immediately after use; residues may clog smaller orifices or corrode metal parts.

Monitoring (acetaminophen overdose):
-Determine aspartate aminotransferase (AST, SGOT), alanine aminotransferase (ALT, SGPT), bilirubin, prothrombin time, creatinine, blood urea nitrogen (BUN), blood glucose, and electrolytes to monitor hepatic and renal function, and electrolyte and fluid balance.
-Repeat SGOT, SGPT, bilirubin, prothrombin time, creatinine, BUN, blood sugar and electrolytes daily if the acetaminophen plasma level is in the potentially toxic range.

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