How do I mix acetylcysteine for oral use?

Mixing Acetylcysteine for Oral Use

For oral administration of acetylcysteine, dilute the 20% solution with diet cola or other diet soft drinks to achieve a final concentration of 5%, using the appropriate dose based on body weight.

Preparation Instructions

The FDA-approved method for preparing oral acetylcysteine involves specific dilution steps 1:

1. Calculate the appropriate dose based on patient weight:

   • Loading dose: 140 mg/kg body weight
   • Maintenance dose: 70 mg/kg body weight

2. Dilution process:

   • Dilute the 20% acetylcysteine solution with diet cola or other diet soft drinks to a final concentration of 5%
   • If administering via gastric tube or Miller-Abbott tube, water may be used as the diluent instead

3. Preparation ratios (based on FDA guidelines):

   For a 70-79 kg adult:

   • Loading dose: 55 mL of 20% acetylcysteine + 165 mL diluent = 220 mL of 5% solution
   • Maintenance dose: 28 mL of 20% acetylcysteine + 82 mL diluent = 110 mL of 5% solution

Important Considerations

• Freshly prepare dilutions and use within one hour 1
• Undiluted solutions in opened vials can be stored in the refrigerator for up to 96 hours 1
• If the patient vomits any oral dose within 1 hour of administration, repeat that dose 1
• Activated charcoal adsorbs acetylcysteine and may reduce its effectiveness, so avoid administering them together 1, 2

Administration Schedule for Acetaminophen Overdose

For acetaminophen overdose treatment:

1. Administer loading dose (140 mg/kg)
2. Follow with maintenance dose (70 mg/kg) 4 hours after loading dose
3. Continue maintenance doses every 4 hours for a total of 17 doses 1

Alternative Administration Routes

If the patient cannot tolerate oral administration due to persistent vomiting:

• The solution may be administered by duodenal intubation 1
• In cases where oral administration is contraindicated (coma, persistent vomiting), intravenous administration may be considered, though this is an off-label use of the oral preparation 3, 4

Cautions

• The diluted solution has an unpleasant odor and taste, which may contribute to nausea and vomiting 2
• Common side effects include nausea, vomiting, and diarrhea 5, 2
• Acetylcysteine solution is NOT approved for parenteral injection in its standard form 1

Following these preparation guidelines will ensure proper administration of acetylcysteine for oral use, maximizing its effectiveness while minimizing potential side effects.