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Also known as: N-acetyl-l-cysteine, 616-91-1, N-acetylcysteine, Mercapturic acid, Acetadote, Broncholysin
Molecular Formula
C5H9NO3S
Molecular Weight
163.20  g/mol
InChI Key
PWKSKIMOESPYIA-BYPYZUCNSA-N
FDA UNII
WYQ7N0BPYC

Acetylcysteine
The N-acetyl derivative of CYSTEINE. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates.
Acetylcysteine is an Antidote, and Antidote for Acetaminophen Overdose, and Mucolytic. The mechanism of action of acetylcysteine is as a Reduction Activity. The physiologic effect of acetylcysteine is by means of Decreased Respiratory Secretion Viscosity, and Increased Glutathione Concentration.
1 2D Structure

Acetylcysteine

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
(2R)-2-acetamido-3-sulfanylpropanoic acid
2.1.2 InChI
InChI=1S/C5H9NO3S/c1-3(7)6-4(2-10)5(8)9/h4,10H,2H2,1H3,(H,6,7)(H,8,9)/t4-/m0/s1
2.1.3 InChI Key
PWKSKIMOESPYIA-BYPYZUCNSA-N
2.1.4 Canonical SMILES
CC(=O)NC(CS)C(=O)O
2.1.5 Isomeric SMILES
CC(=O)N[C@@H](CS)C(=O)O
2.2 Other Identifiers
2.2.1 UNII
WYQ7N0BPYC
2.3 Synonyms
2.3.1 MeSH Synonyms

1. Actylcystine Gnr

2. Acebraus

3. Acemuc

4. Acetabs

5. Acetylcystein Al

6. Acetylcystein Atid

7. Acetylcystein Heumann

8. Acetylcystein Trom

9. Acetylcystein, Mentopin

10. Acetylcysteine Hydrochloride

11. Acetylcysteine Sodium

12. Acetylcysteine Zinc

13. Acetylcysteine, (d)-isomer

14. Acetylcysteine, (dl)-isomer

15. Acetylcysteine, Monoammonium Salt

16. Acetylcysteine, Monosodium Salt

17. Acetylin

18. Acetyst

19. Acid, Mercapturic

20. Airbron

21. Alveolex

22. Azubronchin

23. Bisolvon Nac

24. Bromuc

25. Broncho Fips

26. Broncho-fips

27. Bronchofips

28. Broncholysin

29. Broncoclar

30. Codotussyl

31. Cystamucil

32. Dampo Mucopect

33. Durabronchal

34. Eurespiran

35. Exomuc

36. Fabrol

37. Fluimucil

38. Fluprowit

39. Frekatuss

40. Genac

41. Hoestil

42. Hustengetrnk, Optipect

43. Hydrochloride, Acetylcysteine

44. Ilube

45. Jenacystein

46. Jenapharm

47. Lantamed

48. Larylin Nac

49. Lindocetyl

50. M Pectil

51. M-pectil

52. Mentopin Acetylcystein

53. Mercapturic Acid

54. Monoammonium Salt Acetylcysteine

55. Monosodium Salt Acetylcysteine

56. Mpectil

57. Muciteran

58. Muco Sanigen

59. Mucomyst

60. Mucopect, Dampo

61. Mucosil

62. Mucosol

63. Mucosolvin

64. N Acetyl L Cysteine

65. N Acetylcysteine

66. N-acetyl-l-cysteine

67. N-acetylcysteine

68. Nac Al

69. Nac Zambon

70. Nac, Bisolvon

71. Optipect Hustengetrnk

72. Sanigen, Muco

73. Siccoral

74. Siran

75. Sodium, Acetylcysteine

76. Solmucol

77. Zambon, Nac

78. Zinc, Acetylcysteine

2.3.2 Depositor-Supplied Synonyms

1. N-acetyl-l-cysteine

2. 616-91-1

3. N-acetylcysteine

4. Mercapturic Acid

5. Acetadote

6. Broncholysin

7. Mucomyst

8. L-acetylcysteine

9. Fluimucetin

10. Fluimucil

11. Parvolex

12. N-acetyl-cysteine

13. Fluprowit

14. Respaire

15. Acetein

16. Airbron

17. Fabrol

18. Mucosil

19. Flumucetin

20. Mucosolvin

21. Brunac

22. Fluimicil Infantil

23. N-acetyl Cysteine

24. Acetilcisteina

25. Acetylcysteinum

26. Lysomucil

27. Mucofilin

28. Syntemucol

29. Acetyl Cysteine

30. Exomuc

31. Inspir

32. Tixair

33. Ac-cys-oh

34. N-acetyl-3-mercaptoalanine

35. Mucolyticum Lappe

36. Mucolytikum Lappe

37. (r)-2-acetamido-3-mercaptopropanoic Acid

38. Acetyl-l-cysteine

39. Mucolyticum

40. Cetylev

41. Cysteine, N-acetyl-, L-

42. N-acetyl-l-(+)-cysteine

43. Neo-fluimucil

44. Nac-tb

45. L-cysteine, N-acetyl-

46. (2r)-2-acetamido-3-sulfanylpropanoic Acid

47. Component Of Naxid

48. Mercapturic Acid, (r)-

49. Cysteine, N-acetyl-

50. (r)-mercapturic Acid

51. Fluatox

52. Fluimicil

53. Mucolator

54. Mucret

55. Oristar Nalc

56. (2r)-2-acetamido-3-sulfanyl-propanoic Acid

57. L-alpha-acetamido-beta-mercaptopropionic Acid

58. N-acetyi-l-cysteine

59. Nsc 111180

60. Mucolyticum-lappe

61. N-acetyl-l-cysteine Hydrochloride

62. N-acetyl-(r)-cysteine

63. Wyq7n0bpyc

64. Nsc-111180

65. Rk-0202

66. Mls000028419

67. Chebi:28939

68. Ncgc00022304-05

69. Lnac

70. Smr000058377

71. Dsstox_cid_21

72. (r)-2-acetylamino-3-mercaptopropanoic Acid

73. (2r)-2-acetylamino-3-sulfanylpropanoic Acid

74. Mfcd00004880

75. Dsstox_rid_75324

76. Dsstox_gsid_20021

77. Flumil

78. Ilube

79. N-acetylcystein

80. Muco Sanigen

81. Mucosil-10

82. Mucosil-20

83. Acetylcysteinum [inn-latin]

84. Cas-616-91-1

85. Acetilcisteina [inn-spanish]

86. Ccris 3764

87. Hsdb 3003

88. Sr-01000075439

89. Unii-wyq7n0bpyc

90. Einecs 210-498-3

91. Mucocedyl

92. Accys

93. Nsc111180

94. N-acetyl-l-cys

95. Sodium 2-acetamido-3-mercaptopropionate

96. Sc2

97. Ilube (eye Drops)

98. N-a-c Sustain

99. N-acetyl-l-cystein

100. Naxid (salt/mix)

101. N-acety-l-cysteine

102. (r)-n-acetylcysteine

103. Acetyl Cysteine,(s)

104. Acetylcysteine [usan:usp:inn:ban:jan]

105. Opera_id_452

106. Mucomyst (tn)

107. Acetylcysteine Ph. Eur.

108. Spectrum2_000086

109. Spectrum3_000287

110. Spectrum4_000137

111. Spectrum5_000764

112. Chembl600

113. Nac & Tnf

114. Acetylcysteine [ii]

115. Acetylcysteine [mi]

116. Schembl5292

117. Acetylcysteine [inn]

118. Acetylcysteine [jan]

119. Lopac0_000081

120. Acetylcysteine [hsdb]

121. Acetylcysteine [usan]

122. Bspbio_001794

123. Kbiogr_000554

124. Mls001076125

125. Mls006011563

126. Acetylcysteine [vandf]

127. Spectrum1500105

128. Spbio_000012

129. Acetyl Cysteine [inci]

130. Acetylcysteine [mart.]

131. Acetylcysteine [usp-rs]

132. Acetylcysteine [who-dd]

133. Acetylcysteine(n-acetylcysteine)

134. Dtxsid5020021

135. Gtpl10945

136. Kbio3_001294

137. N-acetyl-l-cysteine, Usp Grade

138. Acetylcysteine (jp17/usp/inn)

139. Hms1920a11

140. Hms2091g11

141. Hms2234j22

142. Hms3260a04

143. Hms3655g11

144. Hms3715d03

145. Hms3884e04

146. Hy-b0215

147. Zinc3589203

148. 2-acetylamino-3-mercapto-propionate

149. Acetylcysteine [orange Book]

150. Tox21_110877

151. Tox21_201078

152. Tox21_500081

153. Acetylcysteine (n-acetyl-l-cysteine)

154. Acetylcysteine [ep Monograph]

155. Bdbm50420190

156. Ccg-38902

157. S1623

158. Acetylcysteine [usp Monograph]

159. Akos015841009

160. Tox21_110877_1

161. Ccg-204176

162. Db06151

163. Gs-3121

164. Lp00081

165. Sdccgsbi-0050069.p002

166. (r)-2-acetamido-3-mercaptopropanoicacid

167. Ncgc00015086-04

168. Ncgc00022304-03

169. Ncgc00022304-04

170. Ncgc00022304-06

171. Ncgc00022304-07

172. Ncgc00022304-08

173. Ncgc00022304-17

174. Ncgc00022304-23

175. Ncgc00258631-01

176. Ncgc00260766-01

177. Ac-16071

178. Ac-24117

179. Bp-12854

180. Sbi-0051272.p003

181. Db-038288

182. A0905

183. Am20100502

184. Eu-0100081

185. Sw199597-2

186. (2r)-2-acetylamino-3-mercapto-propionic Acid

187. En300-72028

188. 16a911

189. A 7250

190. A-1100

191. C06809

192. D00221

193. L-cysteine, N-acetyl- & Tumor Necrosis Factor

194. N-acetyl-l-cysteine, Bioxtra, >=99% (tlc)

195. Ab00051908_02

196. Ab00382974-12

197. Ab00382974_13

198. L-.alpha.-acetamido-.beta.-mercaptopropionic Acid

199. Q375613

200. J-507685

201. N-acetyl-l-cysteine & Tumor Necrosis Factor (tnf)

202. N-acetyl-l-cysteine 100 Microg/ml In Acetonitrile

203. Sr-01000075439-1

204. Sr-01000075439-3

205. Sr-01000075439-5

206. Brd-k59058747-001-20-9

207. N-acetyl-l-cysteine, Cell Culture Tested, Bioreagent

208. N-acetyl-l-cysteine, Vetec(tm) Reagent Grade, 98%

209. F1905-7178

210. Cabc898a-e48b-4e13-9f72-98d0609a1854

211. N-acetyl-l-cysteine, Saj Special Grade, 98.0-102.0%

212. N-acetyl-l-cysteine, Sigma Grade, >=99% (tlc), Powder

213. Acetylcysteine, British Pharmacopoeia (bp) Reference Standard

214. Acetylcysteine, European Pharmacopoeia (ep) Reference Standard

215. Acetylcysteine, United States Pharmacopeia (usp) Reference Standard

216. N-acetyl-l-cysteine, Pharmaceutical Secondary Standard; Certified Reference Material

217. N-acetyl-l-cysteine, Pharmagrade, Ajinomoto, Manufactured Under Appropriate Gmp Controls For Pharma Or Biopharmaceutical Production, Suitable For Cell Culture

2.4 Create Date
2004-09-16
3 Chemical and Physical Properties
Molecular Weight 163.20 g/mol
Molecular Formula C5H9NO3S
XLogP30.4
Hydrogen Bond Donor Count3
Hydrogen Bond Acceptor Count4
Rotatable Bond Count3
Exact Mass163.03031432 g/mol
Monoisotopic Mass163.03031432 g/mol
Topological Polar Surface Area67.4 Ų
Heavy Atom Count10
Formal Charge0
Complexity148
Isotope Atom Count0
Defined Atom Stereocenter Count1
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 4  
Drug NameAcetadote
PubMed HealthAcetylcysteine (Injection)
Drug ClassesAcetaminophen Antidote
Drug LabelAcetylcysteine injection is an intravenous antidote for the treatment of acetaminophen overdose. Acetylcysteine is the nonproprietary name for the N-acetyl derivative of the naturally occurring amino acid, L-cysteine (N-acetyl-L-cysteine). The compou...
Active IngredientAcetylcysteine
Dosage FormInjectable
RouteIntravenous
Strength6gm/30ml (200mg/ml)
Market StatusPrescription
CompanyCumberland Pharms

2 of 4  
Drug NameAcetylcysteine
PubMed HealthAcetylcysteine
Drug ClassesAcetaminophen Antidote, Amino Acid Supplement, Diagnostic Agent, Bronchial, Mucolytic
Drug LabelAcetylcysteine injection is an intravenous antidote for the treatment of acetaminophen overdose. Acetylcysteine is the nonproprietary name for the N-acetyl derivative of the naturally occurring amino acid, L-cysteine (N-acetyl-L-cysteine). The compou...
Active IngredientAcetylcysteine
Dosage FormInjectable; Solution
RouteIntravenous; Inhalation, oral
Strength6gm/30ml (200mg/ml); 10%; 20%
Market StatusPrescription
CompanyHospira; Luitpold; Innopharma Licensing

3 of 4  
Drug NameAcetadote
PubMed HealthAcetylcysteine (Injection)
Drug ClassesAcetaminophen Antidote
Drug LabelAcetylcysteine injection is an intravenous antidote for the treatment of acetaminophen overdose. Acetylcysteine is the nonproprietary name for the N-acetyl derivative of the naturally occurring amino acid, L-cysteine (N-acetyl-L-cysteine). The compou...
Active IngredientAcetylcysteine
Dosage FormInjectable
RouteIntravenous
Strength6gm/30ml (200mg/ml)
Market StatusPrescription
CompanyCumberland Pharms

4 of 4  
Drug NameAcetylcysteine
PubMed HealthAcetylcysteine
Drug ClassesAcetaminophen Antidote, Amino Acid Supplement, Diagnostic Agent, Bronchial, Mucolytic
Drug LabelAcetylcysteine injection is an intravenous antidote for the treatment of acetaminophen overdose. Acetylcysteine is the nonproprietary name for the N-acetyl derivative of the naturally occurring amino acid, L-cysteine (N-acetyl-L-cysteine). The compou...
Active IngredientAcetylcysteine
Dosage FormInjectable; Solution
RouteIntravenous; Inhalation, oral
Strength6gm/30ml (200mg/ml); 10%; 20%
Market StatusPrescription
CompanyHospira; Luitpold; Innopharma Licensing

4.2 Therapeutic Uses

Antiviral Agents; Expectorants; Free Radical Scavengers

National Library of Medicine's Medical Subject Headings online file (MeSH, 1999)


... 113 patients entered into the study were reported to be pregnant at the time of /acetaminophen/ overdose. Follow up including appropriate laboratory and pregnancy data outcome data, was available in 60 cases. Of these, 19 overdosed during the first trimester, 22 during the second trimester and 19 during the third trimester of pregnancy. Of the 24 patients with acetaminophen levels above the acetaminophen overdose nomogram line, 10 were treated with N-acetylcysteine within 10 hr postingestion; eight delivered normal infants, two had elective abortions. Of ten patients treated with N-acetylcysteine 10-16 hr postingestion, five delivered viable infants, two had elective abortions, and three had spontaneous abortions. Of four women treated with N-acetylcysteine 16-24 hr postingestion, one mother died, and there was one spontaneous abortion, one stillbirth, one elective abortion, and one delivery. ...

PMID:2748061 Riggs BS et al; Obstet Gynecol 74 (2): 247-53 (1989)


Acetylcysteine is indicated in the treatment of acetaminophen overdose to protect against hepatotoxicity . /Included in US product labeling/

Thomson.Micromedex. Drug Information for the Health Care Professional. 24th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2004.


Acetylcysteine is used in current medical practice in conjunction with chest physiotherapy as mucolytic in patients who have viscid or thickened airway mucus. When administered via direct instillation, it is used to loosen impacted mucus plugs during bronchoscopy. Acetylcysteine can irritate the airways and induce bronchospasm when given by inhalation; therefore, it should be administered simultaneously with or following administration of an inhaled beta-adrenergic bronchodilator. /NOT included in US product labeling/

Thomson.Micromedex. Drug Information for the Health Care Professional. 24th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2004., p. 19


To evaluate the effectiveness and safety of N-acetylcysteine (NAC) in treating chronic hepatitis B patients, 144 patients with chronic hepatitis B (total bilirubin, TBil>170 mmol/L) from several centers were chosen for a randomized and double blind clinical trial. The patients were divided into a NAC group and a placebo group and all of them were treated with an injection containing the same standardized therapeutic drugs. A daily dose of 8 microgram NAC was added to the injection of the NAC group. The trial lasted 45 days. Hepatic function and other biochemistry parameters were checked at the experimental day 0 and days 15, 30, 45. Each group consisted of 72 patients of similar demology and disease characteristics. During the trial, 28 cases of the 144 patients dropped out. In the NAC group, at day 0 and day 30, the TBil were401.7 vs. 149.2 and 160.1+/-160.6. In the placebo group, the TBil on the corresponding days were 384.1+/-134.0 and 216.3+/-199.9. Its decrease in the NAC group was 62% and 42% in the placebo group. At day 0 and day 45 of treatment, the effective PTa increase rate was 72% in the NAC group and 54% in the placebo group. The total effective rate (TBil + PTa) was 90% in the NAC group and 69% in the placebo group. The parameters of the two groups showed a remarkable difference. The rate of side effects was 14% in the NAC and 5% in the placebo groups. NAC can decrease the level of serum TBil, increase the PTa and reduce the time of hospitalization. NAC showed no serious adverse effects during the period of our treatment. We find that NCA is effective and secure in treating chronic hepatitis B patients.

PMID:15670485 Shi XF et al; Zhonghua Gan Zang Bing Za Zhi 13 (1): 20-3 (2005)


4.3 Drug Warning

... /Acetylcysteine/ should be used during pregnancy only when clearly needed. ... Since it is not known if acetylcysteine is distributed into human milk, the drug should be used with caution in nursing women.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 3565


Anaphylactoid reactions (i.e., acute hypersensitivity reactions such as rash, hypotension, wheezing, and/or dyspnea) have been reported in patients receiving IV acetylcysteine for the treatment of acetaminophen overdosage; in some cases, the anaphylactoid reactions were serious, including death in a patient with asthma. Rash, urticaria, and pruritus are the most frequently reported adverse reactions in patients receiving IV acetylcysteine. Acute flushing and erythema also have occurred; these reactions generally occur 30-60 minutes after initiating the infusion and resolve despite infusion of the drug. Reactions to acetylcysteine that involve manifestations other than flushing and erythema should be considered anaphylactoid reactions and treated as such.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 3564


Chest tightness and bronchoconstriction have been reported with acetylcysteine. Clinically overt acetylcysteine-induced bronchospasm occurs rarely and unpredictably, even in patients with asthmatic bronchitis or bronchitis complicating bronchial asthma. Occasionally, patients receiving oral inhalation of acetylcysteine develop increased airway obstruction of varying and unpredictable severity. Patients who have had such reactions to previous therapy with acetylcysteine may not react during subsequent therapy with the drug, and patients who have had inhalation treatments with acetylcysteine without incident may react to subsequent therapy.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 3564


Nausea, vomiting, and other GI symptoms may occur following oral administration of acetylcysteine in the treatment of acetaminophen overdosage. The drug may also aggravate vomiting associated with acetaminophen overdosage. Administration of dilute acetylcysteine solutions may minimize the tendency of the drug to aggravate vomiting.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 3564


For more Drug Warnings (Complete) data for N-ACETYLCYSTEINE (15 total), please visit the HSDB record page.


4.4 Minimum/Potential Fatal Human Dose

2. 2= Slightly toxic. Probable oral lethal dose (human) 5-15 g/kg; for 70 kg person (150 lb) between 1 pint and 1 quart.

Gosselin, R.E., R.P. Smith, H.C. Hodge. Clinical Toxicology of Commercial Products. 5th ed. Baltimore: Williams and Wilkins, 1984., p. II-380


4.5 Drug Indication

Acetylcysteine is indicated for mucolytic therapy and in the management of [acetaminophen] overdose.


FDA Label


5 Pharmacology and Biochemistry
5.1 Pharmacology

Acetylcysteine is indicated for mucolytic therapy and in the management of acetaminophen overdose. It has a short duration of action as it is given every 1-8 hours depending on route of administration, and has a wide therapeutic window. Patients should be counselled regarding diluting oral solutions in cola for taste masking, the risk of hypersensitivity, and the risk of upper gastrointestinal hemorrhage.


5.2 MeSH Pharmacological Classification

Antiviral Agents

Agents used in the prophylaxis or therapy of VIRUS DISEASES. Some of the ways they may act include preventing viral replication by inhibiting viral DNA polymerase; binding to specific cell-surface receptors and inhibiting viral penetration or uncoating; inhibiting viral protein synthesis; or blocking late stages of virus assembly. (See all compounds classified as Antiviral Agents.)


Expectorants

Agents that increase mucous excretion. Mucolytic agents, that is drugs that liquefy mucous secretions, are also included here. (See all compounds classified as Expectorants.)


Free Radical Scavengers

Substances that eliminate free radicals. Among other effects, they protect PANCREATIC ISLETS against damage by CYTOKINES and prevent myocardial and pulmonary REPERFUSION INJURY. (See all compounds classified as Free Radical Scavengers.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
ACETYLCYSTEINE
5.3.2 FDA UNII
WYQ7N0BPYC
5.3.3 Pharmacological Classes
Antidote for Acetaminophen Overdose [EPC]; Decreased Respiratory Secretion Viscosity [PE]; Increased Glutathione Concentration [PE]; Mucolytic [EPC]; Reduction Activity [MoA]; Antidote [EPC]
5.4 ATC Code

R05CB01

S76 | LUXPHARMA | Pharmaceuticals Marketed in Luxembourg | Pharmaceuticals marketed in Luxembourg, as published by d'Gesondheetskeess (CNS, la caisse nationale de sante, www.cns.lu), mapped by name to structures using CompTox by R. Singh et al. (in prep.). List downloaded from https://cns.public.lu/en/legislations/textes-coordonnes/liste-med-comm.html. Dataset DOI:10.5281/zenodo.4587355


R - Respiratory system

R05 - Cough and cold preparations

R05C - Expectorants, excl. combinations with cough suppressants

R05CB - Mucolytics

R05CB01 - Acetylcysteine


S - Sensory organs

S01 - Ophthalmologicals

S01X - Other ophthalmologicals

S01XA - Other ophthalmologicals

S01XA08 - Acetylcysteine


V - Various

V03 - All other therapeutic products

V03A - All other therapeutic products

V03AB - Antidotes

V03AB23 - Acetylcysteine


5.5 Absorption, Distribution and Excretion

Absorption

An 11 g dose in the form of an effervescent tablet for solution reaches a mean Cmax of 26.5 g/mL, with a Tmax of 2 hours, and an AUC of 186 g\*h/mL.


Route of Elimination

An oral dose of radiolabelled acetylcysteine is 13-38% recovered in the urine in the first 24 hours, while 3% is recovered in the feces.


Volume of Distribution

The volume of distribution of acetylcysteine is 0.47 L/kg.


Clearance

Acetylcysteine has a mean clearance of 0.11 L/hr/kg.


Following oral administration (e.g., when used as an antidote for acetaminophen overdosage), acetylcysteine is absorbed from the GI tract.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 3565


Oral acetylcysteine is rapidly absorbed, but the bioavailability is low (10-30%) due to significant first-pass metabolism. Intact acetylcysteine has a relatively small volume of distribution (0.5 L/kg). Serum concentrations after intravenous administration of an initial loading dose of 150 mg/kg over 15 minutes are about 500 mg/L. A steady state plasma concentration of 35 mg/L (10-90 mg/L) was reached in about 12 hours following the loading dose with a continuous infusion of 50 mg/kg over 4 hours and 100 mg/kg over the next 16 hours.

Goldfrank, L.R., Flomenbaum, N.E., Lewin, N.A., Weisman, R.S., Howland, M.A., Hoffman, R.S., Goldfrank's Toxicologic Emergencies 6th Ed. (1998)., McGraw-Hill, New York, N.Y., p. 566


5.6 Metabolism/Metabolites

Acetylcysteine can be deacetylated by aminoacylase 1 or other undefined deacetylases before undergoing the normal metabolism of cysteine.


Following oral inhalation or intratracheal instillation, most of the administered drug appears to participate in the sulfhydryl-disulfide reaction; the remainder is absorbed from the pulmonary epithelium, deacetylated by the liver to cysteine, and subsequently metabolized.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 3565


Acetylcysteine undergoes rapid deacetylation in vivo to yield cysteine or oxidation to yield diacetylcystine.

Thomson.Micromedex. Drug Information for the Health Care Professional. 24th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2004., p. 19


5.7 Biological Half-Life

The mean terminal half life of acetylcysteine in adults is 5.6 hours and in pre-term neonates is 11 hours.


Following IV administration of acetylcysteine, mean elimination half lives of 5.6 and 11 hours have been reported in adults and in neonates, respectively. The mean elimination half life was increased by 80% in patients with severe liver damage (i.e., alcoholic cirrhosis (Child-Pugh score of 7-13) or primary and/or secondary biliary cirrhosis (Child-Pugh score of 5-11)).

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 3565


5.8 Mechanism of Action

A number of possible mechanisms for the mucolytic activity of acetylcysteine have been proposed. Acetylcysteine's sulfhydryl groups may hydrolize disulfide bonds within mucin, breaking down the oligomers, and making the mucin less viscous. Acetylcysteine has also been shown to reduce mucin secretion in rat models. It is an antioxidant in its own right but is also deacetylated to cysteine, which participates in the synthesis of the antioxidant glutathione. The antioxidant activity may also alter intracellular redox reactions, decreasing phosphorylation of EGFR and MAPK, which decrease transcription of the gene MUC5AC which produces mucin. In the case of acetaminophen overdoses, a portion of the drug is metabolized by CYP2E1 to form the potentially toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI). The amount of NAPQI produced in an overdose saturates and depletes glutathione stores. The free NAPQI promiscuously binds to proteins in hepatocytes, leading to cellular necrosis. Acetylcysteine can directly conjugate NAPQI or provide cysteine for glutathione production and NAPQI conjugation.


Acetylcysteine exerts its mucolytic action through its free sulfhydryl group, which opens the disulfide bonds and lower the viscosity of the mucus. This action increases with increasing pH and is most significant at pH 7 to 9. The mucolytic action of acetylcysteine is not affected by the presence of DNA.

Thomson.Micromedex. Drug Information for the Health Care Professional. 24th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2004., p. 19


Acetylcysteine may protect against acetaminophen overdose-induced hepatotoxicity by maintaining or restoring hepatic concentrations of glutathione. Glutathione is required to inactivate an intermediate metabolite of acetaminophen that is thought to be hepatotoxic. In acetaminophen overdose, excessive quantities of this metabolite are formed because the primary metabolic (glucuronide and sulfate conjugation) pathways become saturated. Acetylcysteine may act by reducing the metabolite to the parent compound and/or by providing sulfhydryl for conjugation of the metabolite. Experimental evidence also suggests that a sulfhydryl-containing compound such as acetylcysteine may directly inactivate the metabolite.

Thomson.Micromedex. Drug Information for the Health Care Professional. 24th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2004.


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