How to Administer Nebulized Acetylcysteine (Mucomix)
For most patients, nebulize 3 to 5 mL of the 20% solution or 6 to 10 mL of the 10% solution, 3 to 4 times daily via face mask, mouthpiece, or tracheostomy. 1
Standard Nebulization Dosing
Face Mask, Mouthpiece, or Tracheostomy
- Dose range: 1 to 10 mL of 20% solution OR 2 to 20 mL of 10% solution 1
- Frequency: Every 2 to 6 hours 1
- Recommended dose for most patients: 3 to 5 mL of 20% solution OR 6 to 10 mL of 10% solution, administered 3 to 4 times daily 1
Solution Preparation
- The 20% solution may be diluted with Sodium Chloride Injection, Sodium Chloride Inhalation Solution, Sterile Water for Injection, or Sterile Water for Inhalation 1
- The 10% solution may be used undiluted 1
- Critical: Acetylcysteine contains no antimicrobial preservative—minimize contamination 1
- Store opened vials refrigerated and use within 96 hours 1
Equipment Requirements
Nebulizer Selection
- Use conventional plastic or glass nebulizers capable of producing particles <10 microns in diameter 1
- Acceptable materials: glass, plastic, aluminum, anodized aluminum, chromed metal, tantalum, sterling silver, or stainless steel 1
- Avoid: Iron, copper, and rubber components—these react with acetylcysteine 1
Gas Source
- Use compressed tank air or an air compressor for nebulization 1
- Oxygen may be used but exercise caution in patients with severe respiratory disease and CO₂ retention 1
Delivery Method
- Mouthpieces are preferred over face masks for antibiotics, rhDNase, and corticosteroids 2
- Face masks should be tight-fitting, and patients should breathe with an open mouth 2
- For bronchodilators, either masks or mouthpieces produce equivalent responses 2
Special Administration Techniques
Direct Instillation (Tracheostomy Care)
- Dose: 1 to 2 mL of 10% to 20% solution 1
- Frequency: Every 1 to 4 hours for routine tracheostomy care 1
- May be given as often as every hour for acute situations 1
Tent or Croupette (Rarely Used)
- Requires very large volumes, occasionally up to 300 mL per treatment 1
- Use volume sufficient to maintain a heavy mist for the desired period 1
- May be administered intermittently or continuously, including overnight 1
Treatment Duration and Technique
Nebulization Time
- Continue nebulization for approximately 1 minute after "spluttering" occurs 2
- Patients should know the expected treatment duration when equipment is functioning correctly 2
- Tap the nebulizer chamber when solution begins to splutter—this increases volume output 2
On-Demand vs. Routine Use
- On-demand nebulization (based on strict clinical indications) is noninferior to routine preventive nebulization every 6 hours in mechanically ventilated ICU patients 3
- On-demand use results in fewer adverse events (13.8% vs 29.3%) compared to routine administration 3
Equipment Maintenance
Daily Cleaning Protocol
- Disassemble nebulizer after each use 2
- Wash all parts in warm water with detergent 2
- Rinse thoroughly and dry completely 2
- Run nebulizer empty briefly before next use 2
For Antibiotic Nebulization (Higher Standard)
- Clean after every use, not just daily 2
- Disconnect tubing and run compressor briefly to clear moisture 2
- Replace standard jet nebulizers, tubing, and mouthpieces every 3 months 2
Important Precautions
Equipment Warnings
- Do not place acetylcysteine directly into heated (hot pot) nebulizers 1
- A heated nebulizer may be used separately to provide warm saturated atmosphere, with acetylcysteine introduced via a separate unheated nebulizer 1
- Hand bulbs are not recommended—their output is too small and particle size too large 1
Clinical Considerations
- Acetylcysteine reduces sputum viscosity, making expectoration easier and improving oxygenation 4
- The drug acts as both a mucolytic (breaking disulfide bonds) and a mucokinetic agent 5
- In life-threatening mucus plugging resistant to conventional therapy, acetylcysteine can be administered directly via bronchoscope 6