Acetylcysteine Injection Dosing Guidelines

Acetylcysteine Injection

  • Acetadote
  • Antidote
  • pH 6 to 7.5*


This drug is on the Black Box Warning list; however, a BBW is not provided in the parenteral prescribing information.


Assess the potential risk of hepatotoxicity by determining plasma or serum acetaminophen concentrations as early as possible but no sooner than 4 hours following an acute overdose; see Precautions and Monitor. Total dose equals 300 mg/kg administered over 21 hours. Distribute dose as indicated in the following guidelines.Loading dose (first): 150 mg/kg as an infusion over 60 minutes.Maintenance dose (second): 50 mg/kg as an infusion over 4 hours. Follow with another maintenance dose (third) of 100 mg/kg as an infusion over 16 hours.

Acetylcysteine Dose

Adjust total volume administered for patients less than 40 kg and for those requiring fluid restriction according to the following chart.

Acetylcysteine Dose 1






Protects the liver by maintaining or restoring the glutathione levels (metabolites formed after an overdose of acetaminophen may deplete the hepatic stores of glutathione and cause binding of the metabolite to protein molecules within the hepatocyte, resulting in cellular necrosis). It may also act by forming an alternate compound and detoxifying the reactive metabolite. Half-life is approximately 5.6 hours. Metabolizes to various compounds. Crosses the placental barrier. Some excretion in urine.



Adult and pediatric patients: Pruritus, rash, and urticaria have been reported most frequently and most commonly occur during the initial loading dose. Other reported side effects include anaphylactoid reactions, angioedema, dyspepsia, dysphoria (abnormal thinking or confusion), dyspnea, edema, erythema of the skin, eye pain, facial flushing, gait disturbances, hypotension, nausea and vomiting, palmar erythema, respiratory symptoms (e.g., bronchospasm, chest tightness, cough, respiratory distress, shortness of breath, stridor, wheezing), sweating, syncope, tachycardia, vasodilation.




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