Acetylcysteine (Page 2 of 5)

2.3 Preparation and Storage of Acetylcysteine Injection Diluted Solution Prior to Administration

Because acetylcysteine injection is hyperosmolar (2600 mOsmol/L), acetylcysteine injection must be diluted in sterile water for injection, 0.45% sodium chloride injection (1/2 normal saline), or 5% dextrose in water prior to intravenous administration [see Warnings and Precautions (5.2)]. Dilution in these three solutions results in different osmolarity of the solution for intravenous administration (see Table 1 for examples of different osmolarity of the solution depending on the type of solution and the acetylcysteine injection concentration).

Visually inspect for particular matter and discoloration prior to administration. The color of the diluted solution ranges from colorless to a slight pink or purple once the stopper is punctured (the color change does not affect the quality of the product). The diluted solution can be stored for 24 hours at room temperature. Discard unused portion. If a vial was previously opened, do not use for intravenous administration.

Table 1. Examples of Acetylcysteine Injection Concentration and Osmolarity in Three Solutions

Acetylcysteine Injection Concentration

Osmolarity

Sterile Water for Injection

½ Normal Saline

D5W

7 mg/mL

91 mOsmol/L

245 mOsmol/L

343 mOsmol/L

24 mg/mL

312 mOsmol/L

466 mOsmol/L

564 mOsmol/L

2.4 Recommended Dosage in Adults and Pediatrics for Acute Acetaminophen Ingestion

Table 2. Recommended Acetylcysteine Injection Dosage and Dilution for Patients 5 kg to 20 kg

Body Weight

Bag 1 (Loading Dose)

150 mg/kg in 3 mL/kg of diluent* infused over 1 hour

Bag 2 (Second Dose)

50 mg/kg in 7 mL/kg of diluent* infused over 4 hours

Bag 3 (Third Dose)

100 mg/kg diluted in 14 mL/kg of diluent* infused over 16 hours

Loading Dose

Diluent Volume

Second Dose

Diluent Volume

Third Dose

Diluent Volume

5 kg**

750 mg

15 mL

250 mg

35 mL

500 mg

70 mL

10 kg

1,500 mg

30 mL

500 mg

70 mL

1,000 mg

140 mL

15 kg

2,250 mg

45 mL

750 mg

105 mL

1,500 mg

210 mL

20 kg

3,000 mg

60 mL

1,000 mg

140 mL

2,000 mg

280 mL

*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.

Table 3. Recommended Acetylcysteine Injection Dosage and Dilution for Patients 21 kg to 40 kg

Body Weight

Bag 1 (Loading Dose)

150 mg/kg in 100 mL of diluent* infused over 1 hour

Bag 2 (Second Dose)

50 mg/kg in 250 mL of diluent* infused over 4 hours

Bag 3 (Third Dose)

100 mg/kg in 500 mL of diluent* infused over 16 hours

21 kg

3,150 mg

1,050 mg

2,100 mg

30 kg

4,500 mg

1,500 mg

3,000 mg

40 kg

6,000 mg

2,000 mg

4,000 mg

* Dilute acetylcysteine injection in one of the following three solutions: sterile water for injection, 0.45% sodium chloride injection, or 5% dextrose in water.

Table 4. Recommended Acetylcysteine Injection Dosage and Dilution for Patients 41 kg or Greater

Body Weight

Bag 1 (Loading Dose)

150 mg/kg in 200 mL of diluent* infused over 1 hour

Bag 2 (Second Dose)

50 mg/kg in 500 mL diluent* infused over 4 hours

Bag 3 (Third Dose)

100 mg/kg in 1000 mL of diluent* infused over 16 hours

41 kg

6,150 mg

2,050 mg

4,100 mg

50 kg

7,500 mg

2,500 mg

5,000 mg

60 kg

9,000 mg

3,000 mg

6,000 mg

70 kg

10,500 mg

3,500 mg

7,000 mg

80 kg

12,000 mg

4,000 mg

8,000 mg

90 kg

13,500 mg

4,500 mg

9,000 mg

≥ 100 kg**

15,000 mg

5,000 mg

10,000 mg

*Dilute acetylcysteine injection in one of the following three solutions: sterile water for injection, 0.45% sodium chloride injection, or 5% dextrose in water.

**No specific studies have been conducted to evaluate the necessity of dose adjustments in patients weighing over 100 kg. Limited information is available regarding the dosing requirements of patients that weigh more than 100 kg.

All MedLibrary.org resources are included in as near-original form as possible, meaning that the information from the original provider has been rendered here with only typographical or stylistic modifications and not with any substantive alterations of content, meaning or intent.

This site is provided for educational and informational purposes only, in accordance with our Terms of Use, and is not intended as a substitute for the advice of a medical doctor, nurse, nurse practitioner or other qualified health professional.

Privacy Policy | Copyright © 2024. All Rights Reserved.