- 600mg effervescent tablets and oral capsules (PO)

- 6gr/60ml (100mg/ml) solution vial (PO)

- 6gr/30ml (200mg/ml) injection vial (IV)

Executive Summary

(April 2023)


N-Acetylcisteine (NAC) is a mucolytic, antioxidant and a glutathione-inducer. It is positioned as the cornerstone antidote for the prevention and treatment of liver toxicity secondary to acetaminophen (APAP) overdose (6, 10, 11, 12, 15, 16), with US-FDA approval for IV, PO and effervescent tablets (9, 13, 14). 

Adult and Pediatric dose for acetaminophen overdose: oral administration, 18 doses total. 

Adult and Pediatric dose (PO and IV)

Adult and Pediatric dose for acetaminophen overdose, prevention and treatment of hepatic toxicity:
Calculate dose with actual body weight.

*If the  patient vomits within the 1st hour of any dose, repeat that dose.

*Diluent solutions for IV NAC: 0.45% NaCl, or 5% dextrose.

When to start NAC therapy: Rumack - Matthew nomogram

In all patients with hepatotoxicity risk secondary to APAP overdose, including the following scenarios:

Why use NAC

It has several roles in preventing injury and diminishing ongoing hepatic damage due acetaminophen overdose  (1, 3, 5, 6, 11, 15):

PO versus IV administration

Election of PO versus IV formulation depends mostly on availability, as they are equally efficacious if successfully administered within 8 hours (the most significant efficacy predictor; with the greatest outcomes achieved when administered within 6-8 hours of APAP ingestion when glutathione stores are depleted around 30% of normal levels)(5, 7, 8, 15). 


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