Pharmacopeia

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Field	N-ACETYL CYSTEINE (NAC) Antidotes · Antidotes · Level 3	Intralipid 20% Antidotes · Antidotes · Level 3
Mechanism of action	- Metabolized to cysteine → Regeneration of sulphydril groups and glutathione - acting as an alternate substrate for conjugation - reduces disulfide bonds in mucoproteins	- unclear - may involve establishment of concentration gradient away from primary site of action of LA
Physiological effects	- Reduces hepatotoxicity - mucolytic	- energy substrate (essential fatty acids) - managing lipophilic drug overdose by binding and facilitating clearance
Absorption	PO: BA low	IV only
Protein binding	66-97% Albumin	None
Volume of distribution	0.5 L/kg	Wide - distributed to fat and tissues
Metabolism	Liver Deacetylated to cysteine -> normal metabolism (Rapid)	Liver Broken down to Fatty acids and glycerol
Excretion	Unchanged: 40% urine, 3% feces	Liver and kidneys
Half-life	5.5 hrs	not well defined
Adverse Effects Toxicity	usually in 1st hr: - rash around infusion site - angiooedema - bronchospasm - hypo/hyper tension Mx: stop, give antihistamine, then restart at slowest infusion rate	- Fat embolism - Hyperlipidemia, pancreatitis - Hepatic dysfunction - Allergic reactions
Chemical Pharmaceutics	Synthetic derivative of cysteine	fat emulsion
Class Group	Antidote	Antidote Antidotes · Antidotes Antidotes
Indications Uses	- paracetamol overdose - non-paracetamol induced fulminant hepatic failure - prevention of contrast nephropathy - mucolytic therapy	- TPN mixtures - Local anaesthetic toxicity with or without circulatory arrest - Prevention of essential fatty acid deficiency syndrome
Legacy Cicm Level	Level 3	Level 3
Main Action	antioxidant and glutathione inducer	- Energy substrate - Reverse local anaesthetic cardiotoxicity
Onset Peak Duration	Duration: short	(For LA tox) onset: minutes peak: 15-30mins
Presentation	IV or oral formulation 200mg/mL compatible with 5% dextrose	white, oil-water emulsion with 20% soybean oil, egg yolk phospholipids, glycerin, sodium hydroxide and water
Route And Dose	IV, PO, Neb (inhaled) IV: 1st : 150mg/kg in 200ml dextrose over 15mins 2nd : 50mg/kg in 500ml over 4hrs 3rd : 100mg/kg in 1l over 16hrs	IV For LA tox: 1.5ml/kg bolus over 1 minute → Infusion 15 ml/kg/hr If not stabilized, two subsequent boluses may be given 5 mins apark. Then rate doubled to 30ml/kg/hr Max cumulative dose 12ml/kg
Special Points	—	serum amylase or lipase should be monitored for 2 days