What is the recommended dose of fluimucil (acetylcysteine) for a 15-year-old patient?

Fluimucil (Acetylcysteine) Dosing for a 15-Year-Old

For a 15-year-old patient, administer acetylcysteine (Fluimucil) 3-5 mL of the 20% solution or 6-10 mL of the 10% solution via nebulization 3-4 times daily. 1

Standard Nebulization Dosing

When using face mask, mouthpiece, or tracheostomy delivery:

• Recommended dose: 3-5 mL of 20% solution OR 6-10 mL of 10% solution, administered 3-4 times daily 1
• Dosing range: 1-10 mL of 20% solution OR 2-20 mL of 10% solution may be given every 2-6 hours depending on clinical severity 1
• The 20% solution can be diluted with sodium chloride for injection, sterile water for injection, or sterile water for inhalation if needed 1

Alternative Administration Routes

Direct Instillation (if tracheostomy present)

• Dose: 1-2 mL of 10-20% solution every 1-4 hours by instillation into the tracheostomy 1
• This route is appropriate for routine nursing care of patients with tracheostomy 1

Intratracheal Catheter

• Dose: 1-2 mL of 20% solution OR 2-4 mL of 10% solution every 1-4 hours via syringe attached to catheter 1

Critical Administration Considerations

Equipment compatibility: Use only glass, plastic, aluminum, anodized aluminum, chromed metal, tantalum, sterling silver, or stainless steel equipment 1

• Avoid iron, copper, and rubber materials as they react with acetylcysteine solution 1

Storage after opening: If only a portion of the vial is used, refrigerate the remainder and use within 96 hours for inhalation only 1

Nebulizing gas: Use compressed tank air or air compressor; oxygen may be used with caution in patients with severe respiratory disease and CO₂ retention 1

Clinical Context

The 15-year-old patient falls into the adolescent/adult dosing category, as pediatric-specific weight-based dosing for acetylcysteine is not provided in the FDA labeling 1. The standard adult dosing regimen applies, which has been established for mucolytic therapy in chronic bronchitis and other conditions with viscous mucus production 2.

Pharmacokinetic note: After oral administration of 200-400 mg, peak plasma concentrations of 0.35-4 mg/L are achieved within 1-2 hours, with a terminal half-life of 6.25 hours 2. However, for nebulized administration (the primary route for mucolytic effect), systemic absorption is minimal and local airway effects predominate 1.

Common Pitfalls to Avoid

• Do not use antimicrobial-free solution beyond 96 hours after opening to minimize contamination risk 1
• Monitor for nausea, vomiting, and diarrhea, which are frequently reported side effects, though typically not clinically significant 2
• Ensure proper equipment materials to prevent drug degradation from reactive metals 1