Tuesday, January 24, 2012

Intravenous Mucomyst (Acetylcysteine) for Acetaminophen Overdose

Remember the days in the Intensive Care Unit (ICU) when giving patient Mucomyst to help break up that thick , yucky, stuff?  Or working in the emergency room (ER) and maybe the night shift receives an aecatminophen overdose.  They would pull out the Mucomyst and give the patient some orally to help protect the liver.

Mucomyst

USES: can be give by inhalation, acetylcysteine is used to help thin and loosen mucus in the airways due to certain lung diseases (such as emphysema, bronchitis, cystic fibrosis, pneumonia). This effect helps you to clear the mucus from your lungs so that you can breath easier.
May also be given by mouth (orally), used to prevent liver damage from acetaminophen overdose.
Working in the Emergency room (ER), nurses must be familiar with intravenous medications. One medication that stands out is intravenous (IV) Acetadote.  This medication is also given orally for acetaminophen overdose as well; however, oral medications can take longer to take effect and often these patients may not have the time.

What is Acetylcysteine(Acetadote)?

Acetylcysteine(Acetadote) is currently the only FDA-approved IV acetylcysteine for acetaminophen overdose.
Acetadote, was introduced into the United States in 2004 and is used in more than 3,000 emergency rooms across the U.S.  It has been proven to be a safe and effective treatment for acetaminophen overdose when administered within 8-10 hours post-ingestion

Acetaminophen Overdose

According to the data provided by the American Association of Poison Control Centers (AAPCC), acetaminophen was involved in more than 187,000 poisoning exposures in the United States in 2009, including more than 100,000 cases of acetaminophen in combination with other medications.2

CONTRAINDICATIONS

Patients who may have had a previous anaphylactic reaction to acetylcysteine should avoid this medication.

WARNINGS AND PRECAUTIONS

  • Acute flushing and erythema of the skin and serious anaphylactoid reactions may occur
  • Use with caution in patients with asthma or history of bronchospasm
  • Adjust total volume for patients less than 40 kg and for those requiring fluid restriction
Acetadote should be used with caution in patients with asthma or where there is a history of bronchospasm.

Indications for Use

View Webcast on IV Acetadote

Intravenous Acetadote, should be administered intravenously within 8 to 10 hours after the known ingestion of a potentially hepatotoxic quantity of acetaminophen.  This treatment is indicated to prevent or lessen the injury to the patients liver.
For best results it is important to administer the first intravenous dose within 8 hours.  The longer the time frame from ingestion the less likely the treatment will work effectively.

Safety Information

Acetadote should be used with extreme caution in patients who may suffer from asthma, COPD, or where there is a history of bronchospasm. "In the literature, the most frequently reported adverse reactions attributed to IV acetylcysteine administration were rash, urticaria and pruritus. The frequency of adverse reactions has been reported to be between 0.2% and 20.8%, and they most commonly occur during the initial loading dose of acetylcysteine."2




 References

  1. Bronstein AC, Spyker DA, Cantilena JR, et al. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Tox 2010; 48:979-1178.
  2. Acetadote (Acetylcysteine). http://www.acetadote.net/home.php
  3. Cumberland Pharmaceuticals.http://www.cumberlandpharma.com/